Turning up ACEs in Canterbury By Fi Rice

In a deck of cards there are four aces. Often they help you win. But over the course of a childhood four ACEs are not a winning hand. Instead, they may be a sentence of chronic disease, dysfunction and even early mortality. Of course these ACEs are not cards – they are Adverse Childhood Events.

In a previous post in this series I wrote about my interest in Kathleen Liberty’s findings around PTSD effects on children born during the Canterbury Quakes. A higher level of post-traumatic effects were seen in these children, even those born at the beginning of the quake sequence in 2010, by the time they were old enough to enter school.

I had the privilege of hearing Liberty speak at the 2017 Collaborative Trust AGM. During the evening she introduced the concept of ACEs and how these were relevant to the earthquake research she undertook. I was so pleased to find a New Zealand practitioner who was aware of the ACE research and saw its potential for youth health. My first exposure to the ACE research had been a couple of years previous and no one I spoke with, in Christchurch at least, was familiar with it.

In her 2017 eBook Reducing Stress in Schools Liberty reports the effects of ongoing toxic stress in the context of the Juniors Study, which focused on the effects of earthquake exposure on the behaviour of school entry children. In it she examines the relationship between ACEs, PTSD and toxic stress on human biology.

Of course not all stress has a negative effect. But toxic stress caused by trauma is neurobiologically damaging. During school years it will impact a child’s learning and overall school experience. The Canterbury Quakes were an ongoing natural disaster that lasted for years, including a recovery period that brought floods and fires. Coupled with the cumulative stressors affecting both individual families and wider communities, our children had the potential to experience a lot of trauma. ACE study data shows that trauma can have lasting effects on a developing brain and body, right into adulthood.

The original research into ACEs was conducted in the 1990s by the US Centers for Disease Control and Prevention (CDC) to explore the connection between childhood trauma and life-long health problems. The ACEs Too High website tells us:

“… people with an ACE score of 4 are twice as likely to be smokers and seven times more likely to be alcoholic. Having an ACE score of 4 increases the risk of emphysema or chronic bronchitis by nearly 400 percent, and attempted suicide by 1200 percent.”

ACEs aren’t without criticism. This year the Tes (Times Educational Supplement) published two pieces about why practitioners should hesitate to apply ACE research. Concerns include:

Whether the science around ACEs holds up
That the testing is incomplete and excludes some types of trauma
It is limiting and patronising to reduce people and their experience to a single numeric score
That ACEs could, unintentionally, disempower or retrigger both children and adults.

While I’m no expert, I think these are valid concerns that need consideration. Personal experience also tells me that an understanding of ACEs can be valuable, especially in the right context. Liberty is not using ACEs as her sole lens, but as part of a broader tool-kit. In Reducing Stress in Schools she shows how ACE data dovetails with findings about PTSD and the neurobiology of toxic stress.

A deeper understanding of how our biology drives behaviour has helped Liberty and others to develop strategies such as Calm Down room décor and the Play-Eat-Learn intervention that can help support our tamariki at school. As a parent of a school-age child on Christchurch’s east side I continue to follow Kathleen Liberty’s work with great interest.

ACEs Science 101. (2014). https://acestoohigh.com/aces-101/

Childhood trauma: The ACEs campaign - cause for worry or celebration? | Tes News. (2018). https://www.tes.com/news/aces-campaign-cause-worry-or-celebration

Childhood trauma: Why I worry about the ACE-aware movement’s impact | Tes News. (2018). https://www.tes.com/news/why-i-worry-about-ace-aware-movements-impact

Liberty, K. (2017). Reducing stress in schools: information for principals, teachers and parents about stressed children in disaster-struck communities and how to help them in difficult times. Christchurch: Kathleen Liberty. https://archive.org/details/ReducingStressInSchools2017