worry about little brains. Much of the time, the brains I worry about are the ones that belong to my two young children. My 3-year-old gets up five times during the night and I panic – his brain needs sleep to learn and develop, what will become of him?! I read an article about how arsenic in apples may affect infant brain development, and in the trash go the ten jars of apple baby food I just bought my 8-month-old. A television clicks on anywhere in my house and I think, “Screen time! Nooooo! Their poor little brains!” I have to reassure myself though; because, in the long run, they’re probably going to be just fine.

But, there are about 34 million other little brains I worry about on a regular basis that are not doing fine. Those brains belong to the children in the U.S. who have been exposed to Adverse Childhood Experiences, or ACEs.[1]Identified in a 1998 Kaiser Permanente study, ACEs include things like physical and sexual abuse; exposure to domestic violence and substance abuse in the home; and physical and emotional neglect.[2]ACEs have a devastating and lasting impact on little brains – shrinking  the hippocampus (responsible for managing emotion), reducing gray matter in the prefrontal cortex (responsible for decision-making), and impeding the lymphatic system (integral to the body’s immune system).[3]

In November 2019, the CDC released a report linking ACEs to at least five of the ten leading causes of death in the U.S.[4]ACEs create lasting negative health outcomes; the original 1998 study found that adults with four or more ACEs were twice as likely to have cancer and heart disease, six times more likely to commit suicide, and seven times more likely to be alcoholic. More recent research has established connections between ACEs and increased risks for poverty, homelessness, substance abuse, and HIV/AIDS.[5]^,[6],[7]At the heart of our most intractable social and health problems, you will find ACEs.

So, what do we do? The good news is that little brains are resilient. With early, supportive interventions, it is possible to heal some of the neurological impact of ACEs and reduce long-term adverse outcomes.[8]But resilience alone cannot be our ultimate answer. It is not enough to heal the impact of ACEs, we have to take steps to get out in front of the problem and prevent ACEs before they ever occur. It is imperative on us as prevention practitioners, community members, decision-makers, and kin to create a world inhospitable to ACEs.

We create that world by building protective factors for communities and families. Protective factors for ACEs include things like the presence of supportive adults, quality early-childhood education, coordination of community-based services, willingness to intervene on the behalf of others, family-friendly employment policies, social intolerance for violence, and economic supports.[9]^{,[10],[11],[12]}No matter who you are, no matter what roles you hold, there are things you can do right now to prevent ACEs.

Individuals can:

• Find ways to be a supportive adult for children and youth in your community.
• Intervene if you’re concerned about a child or family in trouble.
• Talk about the issue and help to set the norm that child maltreatment is not tolerated.
• Donate or volunteer your time for early childhood education programs.

Decision-makers can:

• Enact policies that promote financial self-sufficiency and provide concrete, material supports for families.
• Be deliberate and strategic about coordinating services and prevention initiatives. ACEs are a shared risk factor for so many community problems and we must work together to solve them.
• Facilitate and fund programs that foster community connectedness and teach bystander intervention skills.
• Enact employment practices that support families and children.
• Use your voice to communicate intolerance for child maltreatment and support for prevention.

While the impact of ACEs is devastating, this is a solvable problem. And there is urgency in solving it. Research tells us that there is a tremendous difference in long-term outcomes between having one ACE and having four or more.

Little brains are vulnerable. Let’s all find a way to do something to protect not just the little brains we love, but all the little brains to whom we are handing the future.

[1]Robert Wood Johnson Foundation. (2017). Traumatic experiences widespread among U.S. youth, new data show. Retrieved from  https://www.rwjf.org/en/library/articles-and-news/2017/10/traumatic-experiences-widespread-among-u-s–youth–new-data-show.html

[2]Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P., & Marks, J.S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14(4), 245-258.https://doi.org/10.1016/S0749-3797(98)00017-8

[3]Nakazawa, D.J. (2016). 7 ways childhood adversity changes a child’s brain. Retrieved from https://acestoohigh.com/2016/09/08/7-ways-childhood-adversity-changes-a-childs-brain/

[4]Merrick, M.T., Ford, D.C., Ports, K.A., Guinn, A.S., Chen, J., Klevens, J., Metzler, M., Jones, C.M., Simon, T.R., Daniel, V.M., Ottley, P., & Mercy, J.A. (2019). Vital signs: Estimated proportion of adult health problems attributable to adverse childhood experiences and implications for prevention – 25 states, 2015-2017. Morbidity and Mortality Weekly Report, 68(44), 999-105. http://dx.doi.org/10.15585/mmwr.mm6844e1

[5]Metzler, M., Merrick, M.T., Klevens, J., Ports, K.A., & Ford, D.C. (2017). Adverse childhood experiences and life opportunities: Shifting the narrative. Children and Youth Services Review, 72, 141-149. https://doi.org/10.1016/j.childyouth.2016.10.021

[6]Sekharan, V. (2016). Infographic: Adverse childhood experiences and adult homelessness. Retrieved from https://www.homelesshub.ca/blog/infographic-adverse-childhood-experiences-and-adult-homelessness

[7]Fang, L., Chuang, D., Lee, Y. (2016). Adverse child experiences, gender, and HIV risk behaviors: Results from a population-based sample. Preventive Medicine Reports, 4, 113-120. https://doi.org/10.1016/j.pmedr.2016.05.019

[8]Leitch, L. (2017). Action steps using ACEs and trauma-informed care: A resilience model. Health & Justice, 5(5). https://doi.org/10.1186/s40352-017-0050-5

[9]Centers for Disease Control and Prevention. (n.d.). Essentials for childhood: Creating safe, stable, nurturing relationships and environments for all children. Retrieved from https://www.cdc.gov/violenceprevention/pdf/essentials-for-childhood-framework508.pdf

[10]Centers for Disease Control and Prevention. (2019). Vital signs: Preventing adverse childhood experiences to improve U.S. health. Retrieved from https://www.cdc.gov/vitalsigns/aces/index.html

[11]Centers for Disease Control and Prevention. (n.d.). Intimate partner violence risk and protective factors. Retrieved from https://www.cdc.gov/violenceprevention/intimatepartnerviolence/riskprotectivefactors.html

[12]Centers for Disease Control and Prevention. (n.d.). Sexual violence risk and protective factors. Retrieved from https://www.cdc.gov/violenceprevention/sexualviolence/riskprotectivefactors.html