Most counsellors, psychologists, psychotherapists and even psychiatrists will tell you that many difficulties in adulthood can be traced back to when you were a child.
I’m sure all of us can think of both bad and good things that have happened to us as we grew up. Some of us don’t remember much of our childhood, some can remember things from when we were two. Whatever has happened to us, there is a lot of research to show that the concept of attachment to a caring adult is very important to adult wellbeing. John Bowlby first published his theory in the late ‘60’s when he studied the effects on children of separation from their primary caregiver. There have been a variety of arguments suggesting that attachment to a caregiver is due to being attached to the person who feeds the baby. Bowlby put forward that it is evolutionary pressure, as attachment to a caregiver who protects you and nurtures you, promotes survival.
Children who are securely attached tend to develop better self-esteem and perform better in school with more successful relationships as an adult.
Adverse Childhood Experiences
In 1995 a study by the Centre for Disease Control was undertaken looking at the experiences of people in families registered in a Kaiser Premanente Medical Insurance scheme in San Diego. They found at least ten factors relating to adverse experiences including being a victim of any sort of childhood abuse, living with a parent with an addiction, mental illness or in and out of jail, and witnessing violence. Since then other events have been added including living through a natural disaster. The surprising finding was that as many as 68% of the middle-class population studied had at least one experience and 25% had more than two. Many studies on so called adverse childhood experiences (ACE’s) have been conducted since and positive correlations shown between those and future mental, physical ill health and early death.
The Otago cohort study also found correlations with a variety of conditions including depression, addiction, obesity and a higher incidence of cancers when looking at both prospective records of adversity and retrospective recording. Much research has now been undertaken so that most people agree that preventing adverse childhood experiences is probably one of the most effective things we could do to ease suffering and reduce health care expenditure.
The problem is that many of the issues that lead to abuse of children are hard to combat. They include poverty, colonisation, addiction, parental emotional dysregulation, often from multigenerational influences and are hard to prevent.
What We Can Do About It
Attempts are being made with a commitment from our current Labour government to increase income levels for families, there have been small attempts to “de-colonise”, but also missed opportunities by successive governments to decrease alcohol use. We are still living with the neoliberal, market led, investment policies leading to the disaster we find ourselves in when it comes to health, education, social services and infrastructure services of our country.
All this makes studies of factors that we can focus on to counteract the effects of ACE’s even more welcome. The history of the study of resilience focuses on protective factors which many researchers have shown include connection to a caring adult, family, school and community. The word connection echoes Bowlby’s experiments on secure attachment.
More recently there have been growing numbers of studies looking at positive childhood experiences PCE’s and the paper I have chosen to review is one of those.
The Value of Positive Childhood Experiences
The Wisconsin Behavioral Risk Factor Survey (BRFS) was expanded in 2014 and 2015 to include eight questions related to child poverty and neglect (2014) and six questions pertaining to factors promoting child and youth resilience. The 2014 survey questions were created by a team of experts in poverty and early childhood adversity. The 2015 questions were adapted from the Child and Youth Resilience Measure developed by Dr. Michael Ungar at the Resilience Research Centre at Dalhousie University in Halifax, Nova Scotia. An initial report analysing these data was published by Sege, Bethell et al and presented evidence for HOPE (Health Outcomes of Positive Experiences) in adults.
The most important factors they found important in acting as PCEs were:
Felt able to talk to their family about feelings
Felt their family stood by them during difficult times
Enjoyed participating in community traditions
Felt a sense of belonging in high school (not including those who did not attend school or were home schooled)
Felt supported by friends
Had at least two non-parent adults who took genuine interest in them
Felt safe and protected by an adult in their home
In Bethell’s 2019 paper she clearly showed that there is an inverse relationship between PCEs and adult depression and poor mental health even in the presence of adult-reported social and emotional support. In addition, even when ACEs are present the PCEs are still effective, and a similar dose response effect happens ie the more PCEs the better the adult mental health and the less depression.
It may be that PCEs assist adults to ask for help and therefore get more support. More research needs to be done, but in the meantime driving to increase PCEs and helping families to talk about their feelings, maintain traditions and stand together to support each other in tough times is obviously a start in the right direction. Schools can foster a feeling of belonging and encourage supportive friendships. Communities can be encouraged to take genuine interest in children and ensure they feel safe in their home.
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. doi:10.1016/s0749-3797(98)00017-8.
Aaron Reuben,Terrie E. Moffitt,Avshalom Caspi,Daniel W. Belsky,Honalee Harrington,Felix Schroeder,Sean Hogan,Sandhya Ramrakha,Richie Poulton,Andrea DaneseLest we forget: comparing retrospective and prospective assessments of adverse childhood experiences in the prediction of adult health Journal of Child psychology and psychiatry First Published: 20 September 2016 https://doi.org/10.1111/jcpp.1262
Positive Childhood Experiences Bethell, C., Jones, J., Gombojav, N., Linkenbach, J., & Sege, R. (2019). Positive childhood experiences and adult mental and relational health in a statewide sample: Associations across adverse childhood experiences levels. JAMA pediatrics, 173(11), e193007-e193007
Sege R, Bethell C, Linkenbach J, Jones J, Klika B, Pecora PJ. Balancing Adverse Childhood Experiences With HOPE: New Insights Into the Role of Positive Experience on Child and Family Development. Boston, MA: The Medical Foundation; 2017.
Sue Bagshaw (DNZM)