The Context of NHS Safeguarding

Adverse childhood experiences and the lasting impact

There is no universally agreed definition of an adverse childhood experience, noting NHS Safeguarding does not recommend shortening to “ACE” since the lived experience have asked us not to do so.

Most studies addressing the issue have mostly converged on a similar set of experiences falling under this term:

Experiencing childhood adversity is correlated only to a higher risk of experiencing certain problems in later life. Experiencing these problems is not guaranteed. Indeed, one research found that the majority of individuals, including those who have suffered four or more adverse childhood experiences, do not engage in each of the correlated health-harming behaviours. Furthermore, all of these health-harming behaviours were also exhibited by some of those who had experienced no adverse childhood experiences. Nevertheless, the prevalence of some conditions, such as low mental wellbeing, rises significantly with the number of adverse childhood experiences that individuals have experienced.

Although the correlation between suffering adverse childhood experiences and negative consequences in later life seems widely accepted, this does not necessarily demonstrate causation. The British Psychological Society outlined one possible mechanism by which adverse childhood experiences could lead to negative later outcomes:

Research indicates that experience of traumatic events in childhood can have a profound adverse impact on brain development leading to both physical and behavioural changes as the child tries to adapt to environmental stressors. If trauma occurs over a prolonged period, it can rupture the child’s internal stress system which then contributes to physical and mental health problems over the life course, making children more vulnerable to difficulties with emotional regulation from birth and is often linked to difficulties with cognition such as problems with attention and focus in early and later childhood.

Survivors of adverse childhood experiences can often be reluctant to disclose voluntarily, due in part to feelings of shame, guilt and anxiety about their experiences and the act or consequences of disclosure. However, survivors have suggested that these issues can either be exacerbated or alleviated by the responses of the person listening to their disclosure. Furthermore, health and social care practitioners have described an unwillingness or discomfort with the idea of having to ask people about childhood adversity and trauma.

Routine Enquiry about Adverse Childhood Experiences May 2018
PDF, 1400kb, 65 pages