ACE Exposure and Childhood Outcomes

Introduction 

Stress and its effects on cognition are central to numerous psychological research studies. Adverse childhood experiences (ACEs) by definition are consequential traumatic events that children are exposed to for a substantial period of time. ACEs may be identified as childhood exposure to maltreatment (e.g., physical, verbal, or sexual abuse) or severe family dysfunction (e.g., domestic violence; substance abuse; incarcerated loved one; loss of a parent due to death or divorce; history of chronic or mental illness). Felitti et al. (1998) found that ACE exposure can lead to problematic health outcomes in adulthood such as heart, lung, liver disease, cancer and other injuries. Long-term nicotine use was also strongly associated with self-medicating efforts in dealing with the negative effects of ACE exposure among adults (Anda et al., 1999). While a great deal of literature has previously focused on ACE exposure outcomes in adulthood, this literature review will highlight the early childhood outcomes of ACE exposure being linked to problematic behaviors and below-average academic trajectories that puts children at risk of falling behind. Obtaining a better understanding of a child’s ACE profile can equip caregivers and school professionals with the knowledge to explore the possibility of these varied measures of stress associating with different aspects of cognitive development. It is vital to detect potential manifestations of stress exposure in early childhood in order to provide essential resources that might mitigate its adverse effects in adulthood. 

ACE exposure and its outcomes in primary school 

Blodgett et al. (2018) conducted a study exploring the relationship between children’s exposure to trauma and its impact on their academic success. The researchers collected children’s demographic and academic records (measuring risk), exposure to traumatic events (measuring ACE exposure), and its outcomes during childhood. Teacher reports were gathered through a survey about students ranging from kindergarten to sixth-grade. The questionnaire was adapted from Felitti et al. (1998) that measured exposure to ACEs (e.g., physical, verbal, and sexual abuse, neglect, and dysfunctional family environment) where an affirming answer to these questions indicates that the children have experienced a particular traumatic experience based on their knowledge.

In addition to the questionnaire, the assessment of risk was measured by the student information provided by the schools sampled in the study, which entailed report card grades, attendance records, and behavior reports. Measurement of ACE risk is defined by the prevalence of ACE exposure across certain demographics. The researchers did not find a gender or grade level to be significantly correlated to a greater prevalence of ACE exposure. However, a positive relationship between the prevalence of ACE exposure and socioeconomic status and race was present. They found that ACE exposure is more prevalent among students enrolled in a special education and free and reduced meal program (an indirect measure of student economic hardship) and children from Black and Hispanic backgrounds. As ACE exposure increases, students are more likely to fail to meet grade-level standards, have poor school attendance, and exhibit internalizing (maladaptive behavior turned unto self; e.g., social withdrawal, anxiety) and externalizing (maladaptive behavior expressed outwardly; e.g., aggression, impulsivity) behaviors that interfere with their own or their classmates’ learning.  

Similarly, Jimenez et al. (2016) examined young children’s behavior and academic outcomes and their correlation with ACE exposure. The data used for this study was extracted from a secondary analysis of data collected from the Fragile Families and Child Wellbeing Study, addressing ACE measures of child maltreatment (physical, sexual, psychological abuse, and neglect) and household dysfunction (substance use, mental illness, domestic abuse, and incarcerated loved one). Caregiver reports in this sample were of the children’s known exposure to ACE at five years of age. Academic outcomes were gathered from teachers’ evaluations on a 5-point Likert scale, far below average to far above average, (e.g., literacy skills, science and social studies, and math) during their students’ last month of kindergarten. Among the 1007 children in this sample, 55% were reported to have experienced one ACE and 12% experienced more than three. Children who had been exposed to three or more ACEs were more likely to be reported to have poor language and literacy skills, attentional problems, and aggression. 

The findings of Blodgett et al. (2018) and Jimenez et al. (2016) both implied that increased ACE exposure in early childhood are associated with poor academic performance and increased behavioral problems. Stressful encounters of school age children are already linked to negative outcomes that are identified as hindrances to their learning. Both studies only provided a nonclinical sample which does not involve providing direct treatment or interventions for ACE exposure. Nevertheless, school professionals are a firsthand witness to the decline and improvement of a child’s academic trajectory, therefore the two studies’ utilization of their reports to assess a child’s ACE profile points to the importance of an educator’s perspective and potential role in diminishing the negative effects of their students’ stressors. 

Stress reduces behavioral flexibility in infants 

Under acute stress, the brain utilizes the unchanging “habit” memory over the more flexible “cognitive” memory (Schwabe et al., 2010). The presence of habitual response implies that the ability to be flexible, adapt in novel situations, and acquire new knowledge has been damped. Although previous research have found that young infants are not likely to show a physiological response to stress, studies have shown that acute stress does impact early cognition and evoke changes in their cortisol levels, albeit being the minority (van Bakel & Riksen-Walvaren, 2004; Lewis & Ramsey, 1995). Exploring the possibility of reaching either conclusion, Seehagen et al. (2015) contributed to this expanding literature by investigating the immediate effects of acute stress in children’s behavior. A group of 15-month-old infants was split into two: the first group experienced a series of unfamiliar episodes (e.g., meeting a stranger, playing with a strange toy, separating from parents) that were meant to induce stress, while the other half was left to play with their parents, ensuring a stress-free condition. Both stress and no stress groups were taught to perform a habitual action (pushing a button that led to an engaging effect). In the testing phase of the experiment, the researchers observed what the infants would do once the habitual action no longer produced the expected outcome. They found that the infants in the stress condition continued pushing the button to see the same effect even when it no longer worked, while the infants in the no stress group stopped doing the ineffective action and tried other efforts to see a different outcome. The stressed infants maintained a fixed strategy instead of adapting to a new environment by changing one’s behavior, which shows the opposite of what the no stress group has done to effectively solve the problem. 

Maternal stress, environmental stressors, and cognitive development

Studying infants’ response to stressful environments is vital in the process of navigating the effects of ACEs because its implications might shine a light on their academic performance in the future. Closely examining an infant’s learning in the context of their environment might be able to reveal where and how interventions to stress-related deficits can be pursued. Troller-Renfree et al. (2022) looked at a multidimensional approach to investigate the effects of stress in 12-month-old infants. In this sample, mother-child pairs who came from a low-income background were included. The researchers collected data from mother-reported questionnaires about their children’s socio-emotional and language development outcomes and different sources of ACE exposure that applied to each dyad’s experience. Stress was measured in two categories from the questionnaires: psychological appraisal of stress (perceived and parenting stress) and environmental stressors (household chaos, economic stress, neighborhood safety). The main focus of this study was to highlight the fact that stress can come from various sources, thus exploring the possibility of these measures associating with different aspects of cognitive development. The researchers concluded that both categories, psychological appraisal of stress and environmental stressors, were significantly linked to higher reports of infants’ internalizing and externalizing behaviors and emotional dysregulation. Deficits in emotion regulation marks the impact of stress in their infants’ socioemotional development which is pertinent to infants' ability to follow routines, such as sleeping and eating. As for language outcomes, psychological appraisal of stress is the only measure that was significantly linked to children’s lower reports of language milestone achievements. 

This study illustrates that different sources of stressors can be linked to different aspects of children’s cognitive development. Some stressors are more likely to increase both problematic behaviors and reduce outcomes in language development—or only impact one and not the other. However, it is worth noting that indirect measures of stress such as maternal stress and poverty might account for alternate explanations. Living in a low-income household, mothers are more likely to report higher maternal psychological stress, thus resulting in their poor rating of a child’s language development. Moreover, they may not be able to provide cognitive stimulation that fosters language development for their children due to their lack of resources. Having more time to spend with their child to engage in educational efforts could also bridge this gap. Overall, Troller-Renfree et al. (2022) presents the importance of reviewing ACE exposure in children through multiple lenses for the purpose of providing resources specific to their needs. 

Conclusion

As demonstrated by these studies, an increased exposure to stress is related to an increase in behavioral problems and poor academic performance among elementary school age students (Blodgett et al., 2018) and kindergarten students (Jimenez et al., 2016). Reduced cognitive flexibility, (Seehagen et al., 2015) and lower reports of socioemotional and language development (Troller-Renfree et al., 2022) are observed in infants that have experienced stress, directly or indirectly. This research proposes a real concern for a child subjected to stressful situations and its serious implications for their academic success and cognitive development, even during early life. Understanding these associations can help caregivers and school professionals to plan and execute interventions that support children amidst dealing with a large variety of stressors. A nuanced evaluation should be implemented in schools, especially in early education, as adults apart from primary caregivers that are around children for a great deal of time are educators and other school personnel. The motivation for this intervention is not only to prevent a potential declining trend of academic outcomes, but also to limit the threat of ACE exposure that can develop as precedents of mental and physical health issues in adulthood. 

References

Blodgett, C. & Lanigan, J.D. (2018). The association between adverse childhood experience (ACE) and school success in elementary school children. School Psychology Quarterly, 33(1), 137-146.

Jimenez, M.E., Wade, R., Jr., Lin, Y., Morrow, L.M., & Reichman, N.E. (2016). Adverse experiences in early childhood and kindergarten outcomes. Pediatrics, 137(2)

Seehagen, S., Scheneider, S., Rudolph, J., Ernst, S., & Zmyj, N. (2015). Stress impairs cognitive flexibility in infants. Proceedings of the National Academy of Sciences, 112(41), 12882-12886.

Troller-Renfree, S.V., Hart, E.R., Sperber, J.F., Fox, N.A., & Noble, K.G. (2022). Associations among stress and language and socioemotional development in a low-income sample. Development and Psychopathology, 34, 597-605.