Jackie Tolland and Jonathan Sher

When playing poker, it is incredible luck to have four aces. However, being dealt four aces in the game of life is very unfortunate for a child. 

ACEs, in this case, stands for Adverse Childhood Experiences. These indicators of ‘toxic stress’ range from maltreatment to poverty and from family violence to substance abuse. International research reveals that experiencing four (or more) ACEs dramatically increases the likelihood of bad consequences, including life-long mental and physical health problems.

Adverse childhood experiences have become important in how professionals and policymakers think, talk and act. For example, The Government’s Programme for Scotland, 2017-18 promises: “We will reduce the impact of adverse childhood experiences suffered by vulnerable young people.”

Thousands of people viewed and discussed an ACEs-related documentary, ‘Resilience’ during a remarkable 2017 screening/discussion tour throughout Scotland. Other organisations, including Parent Network Scotland, arranged separate viewings and conversations about adverse childhood experiences and ‘toxic stress’.  PNS’ screening was for parents, since they’re crucial in making needed attitudinal and behavioural shifts. Parents provided valuable feedback on the impacts of being labelled as a family with ACEs.

It is indisputably right and necessary to do everything possible to assist children who face or endure serious harm. Responding compassionately, early and effectively to reduce the trauma of multiple ACEs deserves to be a high priority for everyone working with families.

However, we are concerned that Scotland’s well-intentioned ACEs movement might go ‘pear shaped’. We offer three cautions.

  1. Avoid an inaccurate and unhelpful ‘us’ and ‘them’ mindset. The original ACEs studies were conducted with adults in America’s Kaiser Permanente’s health plan. Their recollections of adverse childhood experiences (i.e. their ACE scores) were analysed alongside the company’s record of their health status/care.

The people studied were generally at least middle class and well educated. Yet, a surprisingly high proportion of them had multiple ACEs. Low-income Americans were not included because they could not afford this private health care plan.

Adverse childhood experiences exist in every corner of Scottish society, too. It would be wrong to focus solely on the ‘usual suspects’ – the 20-25% regularly classified as ‘vulnerable’. Scotland has an opportunity, and obligation, to take seriously the adversities being experienced right now by children simply assumed to be fine because of their relatively ‘privileged’ families.

The ACEs movement could be a unifying force across Scotland – creating common ground between service providers and the people they serve. Perpetuating the ‘us’ and ‘them’ divide will not build the respectful, empathic relationships needed to reduce anyone’s ‘toxic stress’.  

  1. Support, rather than ‘blame and shame’, parents. The original research was conducted among adults looking back; not with children and young people currently experiencing adversity. Working well with the parents of the original, adult participants was a non-issue for Kaiser Permanente.

But, it is front and centre for Scotland today. This offers a brilliant chance to take actions resulting in better lives and life chances for the young. Such actions should also help parents acknowledge, and move toward resolving, the ACEs from their childhoods. That toxic legacy continues to (mis)shape their attitudes and behaviours, as people and as parents.

Parent Network Scotland operates its peer groups on the ‘airplane oxygen mask’ model; i.e. parents get the ‘oxygen’ they need first, so they can then better assist children. Still, It takes time and compassion to support parents (and practitioners) as they acknowledge and reflect upon their own lived experiences, in order to reach the healthier lives they seek.

If the longstanding tendency to regard mothers, fathers and carers as the ‘problem’ continues, then we lose the benefits from treating parents as respected partners in overcoming ACEs. It would be a mistake to pour old whines into new bottles.

  1. Give preventing ACEs the same priority as overcoming them. Scotland’s ‘tradition’ is to wait for a crisis before taking meaningful action. As a society, we talk a better prevention game than we play. Keeping adverse childhood experiences from happening in the first place is always the less costly and more effective option. Effective therapeutic responses to harm remain a necessity.

But, what Scotland needs most is action on ACEs that balances prevention and intervention. That means dealing with the social and economic inequalities that lead to ACEs. It also means engaging and empowering families. The combination of collective and individual action can break the toxic cycle. Let’s help each generation (dealt too many ACEs themselves) deal ever-better hands to the next generation.

Jackie Tolland is the Glasgow-based Chief Executive of Parent Network Scotland. Dr Jonathan Sher is an Edinburgh-based independent consultant on preconception health, education and care.

January 2018