There is a plethora of evidence for the association between Adverse Childhood Experiences (ACES) and its harmful impact on adolescent and adult mental health across the life span.
Childhood adversity is a common societal problem that increases the risk for mental and physical health problems in one’s life. ACES are stressful or traumatic events such as being physically, emotionally, or sexually abused, neglected, the death of a parent or parental divorce. The impact of ACES on health is due to toxic stress resulting from exposure to these adverse experiences in childhood. There is a strong co-relation between the number of ACES experienced by an individual and the chance of poor health outcomes later in life including high risk of heart diseases, diabetes, obesity, depression, substance abuse, poor academic achievement and even early death. There is a dose dependent relationship between ACES score and adult mental health outcomes, i.e. the higher the number of ACES, the poorer the long term outcomes.
Even though it is unlikely that memories from under the age of three are remembered in the conscious mind as the child is preverbal, the adverse experiences can be sealed in the unconscious mind and emerge as emotional responses. This explains why adverse experiences that occur during that period of early childhood, especially in the first three years of life are likely predictors of an increased risk of developmental, emotional or behavioural problems, and consequently, health issues in adulthood.
A local study conducted in Singapore showed that almost two in three, or 64 per cent of our resident adult population have experienced at least one adverse childhood experience (ACE) in the first 18 years of their life. Therefore, it is important to identify families experiencing ACES so as to provide support to them and prevent further harm from happening.
The Intergenerational Cycle of Childhood Trauma
The insidious part of childhood trauma is that its impact is not just experienced by a single person. If unresolved, it can be intergenerational. Childhood trauma can cast a long shadow throughout one’s life, and be passed on to their children.
“Women who have suffered adverse childhood experiences are at higher risk of antepartum and postpartum health problems. They may have a pattern of relating that stems from a mistrust of the world because they have been hurt before — that can create a coping style characterised by social withdrawal, anger, rejection of help,” Associate Professor Helen Chen, Head and Senior Consultant, Department of Psychological Medicine, KK Women’s and Children’s Hospital (KKH), said in an interview.
Dr. Sita Padmini Yeleswarapu, Senior Consultant, Department of Child Development, KKH, agreed, “Some of the parents that we’ve worked with report to having a very traumatic upbringing. However, affected parents may not even be aware of the impact of their childhood adversities on their current parenting/life circumstances.” She continued, “Clinically, we can see [this] in terms of how they’re parenting their children, and their responses or non-responses. A lot of ongoing work needs to be done — it will take much longer for us to understand where those parenting strategies come from, and what it is the parents or primary caregiver has gone through, in order to support them better.”
A study of a Singaporean mother-child cohort found that there was a direct association between maternal sensitivity and connectivity with the hippocampus, which is important for memory, emotional regulation, and socio-emotional functioning.
Associate Professor Chen explained that women who have been traumatised badly as children and have been let down by parents who could not protect them or dismissed their cries for help, typically struggle with anxiety or anger. “When we are afraid, a possible reaction is anger, because it makes us feel stronger. So when baby cries, a mother who herself had a traumatic childhood and whose needs were not met, may experience the crying as something anxiety-provoking, and may feel overwhelmed and avoid attending to the baby. Or she may actually feel irritated and angry that the baby is ‘purposely’ annoying her, and smack the baby.”
“You can see how then there is a transmission of trauma through the generations — from mother to baby,” Associate Professor Chen pointed out.
According to Associate Professor Chen, in the first year of a child’s life, emotional development begins. The infant forms an understanding of his/her own feelings and how these feelings resonates with others, and learns to regulate it in a culturally appropriate way. These are the beginnings of self-worth, self-confidence, and self-regulation.
She explained that scientific studies have shown a clear link between a caregiver’s influence on a child’s neurodevelopment. A study of a Singaporean mother-child cohort found that there was a direct association between maternal sensitivity and connectivity with the hippocampus, which is important for memory, emotional regulation, and socio-emotional functioning. This suggests that early life experiences are locked in emotional memory. As such, even without language, a child at a pre-verbal stage is primed to respond to triggers through bodily reactions.
Associate Professor Chen added, “Mothers help their babies learn to self-regulate by empathic mirroring. Mothers do this intuitively by mirroring an appropriate emotional response to their baby’s emotional state — smiling when the baby is happy; soothing and comforting when the baby is upset or scared; concern when the baby is angry. In this way, babies learn how to make sense of the myriad of emotions that arise within them. However, should a mother be mentally unwell, her emotional and mental state might get in the way of her being present, sensitive and attuned to her baby’s needs — a mother struggling with depression is often locked into her internal struggles.”
“One of the worrying signs is when the baby does not gaze at the mother’s face. As social beings, babies are just born to seek out faces — it has been said that some of this is innate — and in many ways, nature has created us in a way that holds the attention of the baby — like the contrast of colours — in a mother’s eyes, between her hairline and forehead. Babies who find mothers not attending, will eventually lose interest, and not seek out her face because it seems too cold, too hostile,” Associate Professor Chen said.
In fact, the worldview that a parent has adopted from their childhood trauma can be projected onto their children. For example: “mothers who have experienced childhood trauma (ACEs) struggle to make sense of the world as being a safe place, and model for their child a response to the world as if it is frightening. This in turn leads to the child internalising fear, anxiety and sadness,” Associate Professor Chen explained.
Dr. Padmini echoes Associate Professor Chen’s views, “A nurturing relationship needs to be developed between a parent and child through engaging and meaningful interactions. I cannot over-emphasise enough about the importance of the interactions needed for the parent to have with the child, in order to build, develop a good and healthy brain architecture. If the responses are unreliable, inappropriate or simple absent either due to poor maternal mental health, economic hardships or caregiver being in an abuse relationship, this will cause a disruption to the developing brain architecture resulting in long term negative impact on later learning, behaviour and health of the child.”
Breaking the Cycle
Dr. Padmini noted that the children who are referred for suspected abuse and/or neglect is the “tip of an iceberg,” because, “we are identifying only after harm has been done to a child. Given the evidence we have for impact of ‘toxic stress’ on individuals, it is imperative that these families are identified early and supported appropriately, so as to prevent further harm from happening.
Associate Professor Chen offers a message of hope for parents who have gone through trauma. “Just as ACEs can affect a mother, positive experiences can be healing. Often, women tell us how an aunt or grandmother, or even a teacher provided love and care — and the memory gives the woman hope. And from that position of hope and positive energy, the mother can find in herself the capacity to tend to her child’s needs, to soothe and mend a rupture in their bond.”
“It takes a long time to change the parenting strategies. This is perhaps the only way of parenting that the caregivers have experienced. With some families, it takes ever so long in order to change their perspective. But doing so, and making these little gains is crucial,” Dr. Padmini said.
Any form of supportive relationship in a child’s life, whether it comes from a parent, from pre-school, or foster care, can help a child’s development. “Fostering strong and positive relationships between caregiver and child, and helping the child to build core life skills can buffer him/her from the effects of toxic stress, ” Dr. Padmini emphasised.
As the proverb goes: It takes a village to raise a child. Breaking the intergenerational cycle of childhood trauma and addressing maternal ACEs, requires a collective approach.
“In many ways, all of us can provide a caring touch point for every mother-to-be by being sensitive, non-judgmental, empathic and respectful. We must be open to the fact that a stroppy or “difficult” patient may actually be a trauma survivor who relates like so because of past hurts. In being kind and mindful, we provide a different experience for the at-risk mother-to-be, and in so doing help her shift towards a more hopeful and positive stance,” said Associate Professor Chen.
“This can be just a tiny circuit breaker in the transmission of risk, yet!” she concluded.
Using trauma-informed practices, we can better support and build resilience in our children and youth, as well as understand adults who have been through adverse childhood experiences.
The contributor is a Singaporean writer and journalist based in New York. Shane’s work has appeared in Esquire Singapore, Salon.com, Surface magazine, Yahoo! News, and Marie France Asia. Find Shane on Twitter at @itsShaneTan.
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