Seven-year-old Ralph finds school challenging. While his classmates work intently on the maths task at hand, he fidgets, screams, pokes the child next to him, and generally disregards the teacher's instructions. Break time is no easier, as he repeatedly ends up in time-out for running into the other children and playing too rough. On the walk home from school, an enormous mastiff dog is growling at a chain link fence. Other children cower behind their parents or jump into the street to avoid the dog; Ralph walks straight up to the chain link fence and starts growling back.
Undeniably, Ralph can be a handful. To understand Ralph, however, is to look beyond the behaviour to the root cause of his issues. Ralph, like many children in the UK, experienced significant neglect during his early childhood. This neglect led Ralph and his siblings to be taken into care and eventually adopted. He is now in a loving, nurturing family where he receives plenty of appropriate structure and input, but the adverse experiences of his early childhood have unquestionably impacted his neurodevelopment.
From conception, a person's brain is developing the circuitry it needs to make good decisions, respond appropriately to stress, and regulate emotions. During infancy and early childhood, children in healthy social environments receive a multitude of sensory and social inputs that begin to establish the neural pathways for normal cognitive, lingual, and psychosocial developmental; this process is known as synaptic formation. Starting around the age of three and lasting until early adulthood, children's brains undergo an important process called synaptic pruning, during which the most used pathways are strengthened and the least used are eliminated.
When children do not receive the appropriate love, care, structure and stimulation, their neurodevelopment is impacted. The Adverse Childhood Experiences (ACE) study has isolated several events that can seriously impact a child's neurological development, including physical/sexual abuse, parental drug/alcohol misuse, witnessing violence in the home and the loss of a parent. Two thirds of people in general are likely to have experienced at least one ACE, but experiencing multiple ACEs before the age of 18 contributes significantly to the long-term physical and mental health of a person. Having a high ACE score correlates with increased risk of cardiovascular disorders, mental health issues, low productivity, and a shortened life expectancy. People with six or more ACE scores have a life expectancy that is 20 years less than the average population.
The impact of adverse childhood experiences is undeniable, but it can be mitigated. Neurodevelopment experts have established (with the help of PET scans and other technology) a greater understanding of neuroplasticity, and evidence now shows that the brain is more capable of developing appropriate pathways, longer than previously expected; pathways can even be re-established in older patients after stroke or traumatic brain injury. Building resilience can help people to transform the effects of adversity in early life, and experts have shown that resilience can be built at any age if the appropriate interventions are available. It has been shown that the impact of ACEs can be reduced when people are cared for in supportive, stable community groups.
One charity working to address and mitigate the negative consequences of ACEs is Body & Soul, based in London. They currently work with three primary populations: people living with HIV, children and teens adopted from the care system, and young people who have attempted suicide. It might seem like there is substantial disconnect between these three groups, but Body & Soul have found that they all exhibit much higher than average ACE scores. All three groups also exhibit self-shaming behaviour, which erodes individuals' self-worth and coping skills.
HIV-affected children, whose parents or carers are living with HIV, are more vulnerable to being exposed to the experiences captured by the ACE score. For biological and social reasons, parents living with HIV often experience complex mental health comorbidities, are more likely to experience domestic violence (which the children, in turn, witness) and are more likely to self-medicate using alcohol or drugs. Globally, the poverty associated with HIV also makes these families more likely to experience sustained food insecurity or homelessness.
An all too common end result of a traumatic childhood is suicidality. Body & Soul's trauma-based approach identifies people who have attempted suicide as being more likely to have high ACE Scores. While a person's ACE score does not change after age 18 (the inventory measures only experiences from childhood), the impact of high ACE scores can be proactively addressed. Ralph is a member of the Body & Soul community. Ralph attends the Explorers' Club, Body & Soul's innovative programme that uses a group therapeutic model to build social skills, regulation, emotional literacy, and resilience in adopted children. He also receives support from occupational and speech and language therapists. At a time when many therapeutic statutory services are being cut, the charity provides a vital lifeline for children like Ralph, who has made significant strides since joining the group.
The impact of traumatic childhood is staggering, but expert trauma-centred programming can help people of all ages, including children like Ralph, to have a greater chance of achieving a productive, fulfilled life.