Ask DadPad, Being a Dad, Long Read
Ask DadPad: What are ACEs?
Posted on 4th June 2021
*** Trigger Warning ***
This article talks about the potential for serious harm to our children and how we, as adults, can sometimes contribute to this. We are hoping to present a view based on evidence and some opinion offered by experts to create an interesting and informative blog around the topic of Adverse Childhood Experiences (ACEs).
All about ACEs
For today’s blog post, we’ve decided to look at a fairly big and potentially scary topic for parents: ACEs. You might not have come across this term before, but ACEs – or Adverse Childhood Experiences – are something that most of us will undergo at some point during our infancy and therefore it’s important to know more about them.
According to the Manchester Safeguarding Partnership:
The term ACE is used to describe a wide range of stressful or traumatic experiences that children can be exposed to whilst growing up. ACEs range from experiences that directly harm a child… to those that affect the environment in which a child grows up…
Resources produced by the team at HeadStart Kernow also add that these adverse experiences can occur via either “a singular event” or “prolonged exposure to ongoing and/or multiple events/threats”.
Whilst there is no universally-agreed list of what constitutes an ACE, experiences acknowledged as being encompassed within the term include:
- abuse – physical, sexual or verbal
- neglect – physical or emotional
- parental separation – and/or any other situation in which a parent is ‘lost’ to the child
- household experiences – mental illness, domestic abuse, substance abuse
- imprisonment of a family member
You might wonder why this is relevant to you.
The first thing to note is that most of us will have experienced at least one ACE during our lifetimes. This first came to light via a major piece of American research conducted between 1995 and 1997, and which reported that “more than half of respondents reported at least one, and one fourth reported (at least) two categories of childhood exposure.” A more recent American study carried out in 2015-17 found that “almost two-thirds of surveyed adults experienced at least one ACE (61%), with nearly 1 in 6 adults experiencing 4 or more ACEs”. This all means that many of us will be coming to parenthood with our own burdens.
Further, a report from 2019 by the American National Center for Injury Prevention and Control noted that the more ACEs that a person experiences, the greater “the risk for negative health and life outcomes”, which includes: mental ill health; increased likelihood of risk behaviours, such as substance abuse; and limited educational, occupational and income opportunities in later life.
This is mainly because, for those who have experienced ACEs, it can be difficult to stay within what has been described as “the window of tolerance” which enables us to cope with the stresses and strains of everyday life in an effective manner. This idea was formulated by neuropsychiatrist Dr Dan Siegel who explained the way in which we function as existing within three levels. In the middle, is the optimal ‘window of tolerance’, where we can behave (learn, play, interact with others, etc) in an effective way. However, outside of this window, we can become either hyper (too much) or hypo (not enough) aroused. When we are hyper-aroused, we are over-active, unable to concentrate, irritable or angry, panicky or anxious, easily startled. Conversely, when we are hypo-aroused, we shut down; exhausted, withdrawn, depressed, frozen and numb. These latter two situations are clearly linked to the fight/flight (hyper) and freeze/flop (hypo) responses to traumatic events.
However, the good news is that – even for those of us who have experienced ACEs – all does not have to be lost. We spoke to Ness Little – Locality Co-ordinator and Parent & Family Lead at HeadStart Kernow – about all things ACEs, and she explained:
Most of us have experienced stressful events during our childhood. These shape us, but do not necessarily define us. It’s important to be accepting of ourselves as we are and also to know that we can take steps to change things. We should also be aware that our own experiences of stressful life events can influence our capacity for parenting, but once we become aware of this, we can take both responsibility and accountability to make things better in future.
At DadPad, our focus has always been about providing dads with what they have needed but which (at least until fairly recently) they have not had access to – i.e. good, evidence-based, supportive, practical information, written specifically with and for them. We also know, however, that society’s dads of the future need to:
- not only learn about all the new, positive behaviours and skills that they need to get started as a dad;
- but also get to know themselves, understand their own strengths and weaknesses, in order to explore and act upon what needs to be changed about themselves and their existing behaviours.
This will then open the door to each individual dad putting in place:
- better conditions for themselves, and
- building solid foundations from the earliest point possible,
all of which will pave the way for him to be a major positive influence during pregnancy, birth and beyond, as the research shows and predicts that fathers can be.
Our aim with this article, then, is to give ideas and suggestions on how we can minimise the risk of serious incidents of trauma, abuse or neglect happening to our children; how we can lessen the impact that unavoidable stressful events have on our children, and how we can work with them as a positive and emotionally-available parent to help them build resilience; and where to go for help if we feel that we, as a parent, need it.
Your role as a dad
The best place to start is of course to remind you of the hugely important role that you have to play throughout your child’s life. We touch on this point regularly within our DadPad blog posts on being a dad, but it’s so crucial that we’re going to keep on mentioning it without apology!
If you’ve not yet read it, we recommend having a look at our article from last July in which we talked all about bonding with your baby: why it’s important, how to help it happen, and how a dad’s bond differs from a mum’s. Within the context of ACEs and helping your child build resilience to the inevitable challenges and stresses of life, it’s worth reminding ourselves of the words of evolutionary anthropologist Dr Anna Machin on how the father-child bond can be critical:
In the first instance, the attachment between the mother and the child is inward-looking, exclusive, based on affection and care. The dad's attachment is also, obviously, capable of being affectionate and caring but on top of this there's an extra bit: his job is to challenge, to be the secure base from which the child goes out into the world to investigate what is going on. His role is to teach the skills - behavioural, linguistic, cognitive - that will enable that child to deal with life's challenges, assess its risks, and leap over those hurdles; to deal with failure, but also with success. We live in the most complex social and technological world, and dad's job is to turn the child's face to that world and say: "Here is the world and I am going to teach you how to be successful in it."
As well as building this secure and positive bond with your child, it’s also important for you to:
- be aware of potential situations of high risk, and have strategies to hand which will enable you/your partner/other care givers around your child to minimise and prevent those risks occurring; and
- working to become a positive parent to your child
We’ll explore these points in more detail below but, before we do, we want to emphasise to you that we used the phrase positive parent rather than perfect parent. The reason for that is simple: none of us are perfect parents, and none of us will ever be perfect parents. All any of us can do is to do the best that we can for your children.
Remember that those images that we see on social media of what look like families giving their children the most idyllic childhoods are merely very carefully curated moments: we can’t see what mess and chaos is the other side of the camera; we can’t know how many attempts have been taken to capture that perfect shot; and we can’t be certain that the rest of that day wasn’t utter carnage, with babies, children and parents screaming and shouting at each other. Don’t judge yourself against what you see, or what you think you are seeing, online.
Further, Ness reminded us that it is completely OK not to be 100% attuned to your child; after all, life gets in the way. She pointed us to figures from developmental psychologist Professor Ed Tronick, who has said that “even exceptional parents are only 30 percent attuned to their children, but even this level of attunement can lead to secure attachment if parents are willing to repair the ruptures that occur between them and their children” (and there will be more about rupture/repair later!).
Preventing serious harm
A really important thing that you can do as a dad is to take all steps necessary to try and prevent any incidents of serious harm occurring to your baby or young child. Sometimes, these situations can occur only too easily, with just a momentary lapse of concentration or calm. With the stresses and strains of early parenthood – lack of sleep, crying baby, additional responsibilities and worries, plus also possible deterioration in your and/or your partner’s mental health – the risk only increases.
So, what can you do to minimise the danger?
Firstly, and potentially most importantly, it’s worth being aware of the statistics with regard to parents and caregivers losing control and shaking or otherwise injuring (and sometimes even killing) their babies. Previously known as ‘shaken baby syndrome’, it’s now more widely referred to as abusive head trauma (AHT). According to Dr Suzanne Smith from ICON, AHT “affects one in 4,000-5,000 infants every year and is one of the most serious forms of physical child abuse”. She also cites research from Kelser et al from 2008 which found that 70% of all shaken babies are shaken by men.
Smith’s investigations found that there are a number of factors which increase the likelihood in children and babies suffering violence in the home, including stress and the “effect infant crying and other behaviours, such as poor sleeping patterns and difficulties in feeding, have on parents, [which can lead to a] reduction in coping ability, poor parent/child interaction, reduction in self-esteem, exhaustion, frustration and anger.”
It’s therefore really important – as a new parent – to be aware of the risks that your current situation presents you with. It’s really easy to hear news reports of terrible things happening to babies at the hands of their parents and thinking “Oh, I’d never do anything so awful”, but all it can often take is just a momentary loss of self-control…
Developing an awareness and to have coping strategies to hand are therefore crucial. One of the biggest stressors as a new parent is a crying baby, and that’s why the ICON programme was developed.
We discussed the ICON programme – which has as its central message “Babies cry, you can cope” – with Dr Suzanne Smith back in October, and the blog post that we wrote contains lots of great information and advice from Sue, plus links to short YouTube videos, on the core elements of the ICON programme:
- Infant crying is normal and the crying will stop.
- Comfort methods will sometimes help and the crying will stop.
- It’s OK to walk away for a few minutes if the baby is safe and the crying is getting to you.
- Never ever shake or hurt a baby.
The ICON team’s “I am unshakeable” video is intended to particularly appeal to men:
Coping with lack of sleep is another ‘biggy’, and we’ve again looked at this in a previous blog post. Within our “Why won’t my newborn baby sleep through the night?!” article from last summer, we spoke with sleep experts Mandy Gurney (from The Millpond Sleep Clinic in London) and Jane Armstrong (from the Hunrosa Sleep Clinic in Cornwall) who helped us compile 10 top tips on how to survive those first 12 weeks with a newborn:
- Grab sleep opportunities whilst you can
- Accept offers of help from others
- Don’t be afraid to turn visitors away
- Remember to eat!
- Expose baby to natural lighting patterns
- Reduce lighting and stimulation at night
- Keep your baby close by at night
- Don’t wake baby to change her nappy
- Don’t rush to interact with baby the minute you think she’s awake
- Be kind to yourself!
You can find out more about each of these points and much more – including gaining an understanding of a newborn’s sleep patterns and links to further sources of information and support, all of which should help you cope with this testing period of your lives as new parents – via that blog post (linked above).
It’s also important to be aware of your own mental health and to seek help if you feel you might need it. We’ve written some blog posts on postnatal depression in dads and also on ways in which you can support your own and your partner’s mental health during the perinatal period. We’ve also got a new blog post coming up later in the month, from Georgie, sharing ideas on where to go to seek the support and help that you need.
The reason we’re flagging up your mental health at this point is not only because mental ill health within the household is viewed as an ACE, but also because research has found that – in men – the symptoms of PND present differently than they do in mums. For example, dads are more likely than mums to become irritable, angry or aggressive, all of which increase the risk of harm occurring to your baby. Further, you’re also more likely to start consuming more alcohol or drugs, all of which could again put your baby at greater risk of harm.
The good news is that, if you can reach out for help (start by chatting with your GP or your Health Visitor about your concerns), your symptoms should soon be under control and the risk to your family reduced. It also means that you’ll be able to be become a more engaged, available and interactive dad to your family once again, all of which will help your baby feel secure and loved.
Getting help to reduce other risk factors
We know that the situation within the household that a child grows up in can give rise to ACEs, too. For example, if there is domestic violence, alcohol or substance abuse, or parental absence due to imprisonment, these will all have a major impact on your child.
Becoming a parent is – for many of us – a great opportunity to reflect on our current life situation and consider whether now is the time to make changes for the better. If you feel that this might apply to you, then do grab at this chance with enthusiasm and determination. Whatever your situation, and whatever the changes that you feel you might need or want to make, speaking with your GP or the community midwife supporting your family is the best place to begin. They will be able to connect you with relevant local support services in your area who can help you in your quest for making a better life for your family.
Parental separation at any point in your child’s life will also – obviously – impact on them, and therefore addressing any potential issues in your relationship with your partner is also a really important thing to do once you realise that you are expecting a baby together. Having a baby will put pressure on any relationship, so taking positive steps at the earliest opportunity is a very good thing to do. Keeping the lines of communication open with baby’s mum is always important – take time to discuss together your individual hopes, fears, and worries about becoming a parent. Make sure that you listen to each other, and properly acknowledge and appreciate each other’s concerns. What could each of you do, for example, to help reduce those fears? And it’s also never too early to start discussing your views on all aspects of parenting – discipline, expectations, education, etc. Are you both on the same page and, if not, what can you do to try and understand the other’s point of view?
Once again, if you feel that you have a problem that is slightly bigger than the two of you can handle, don’t be afraid to seek external help. Once more, your GP or midwife will have appropriate contacts for you if you want or need them.
Hopefully, an awareness of the impact that a failure to change could have on your children might be the biggest incentive you will ever need.
Dealing with the ‘stuff that happens’
Of course, a good number of the events that can cause stress and upset to our children are often completely outside of our control, and/or are things which will happen to most of us at some point in our lives. This includes: death or ill-health of a family member, friend or pet; moving house; changing schools; parents splitting up; parent losing their job; and – don’t forget – occasionally losing our temper with/shouting at our child. At a lower level, there’s also things like falling out with friends, having the odd scary experience, and facing challenges at school (etc) which take them outside of their comfort zone.
If any of these things happen to your child, it’s important not to beat yourself up over it, or panic that their childhood and life chances have been ruined; in fact, as Dr Dan Siegel has noted, these ‘ruptures’ are inevitable. In fact, it’s been established that experiencing a few upsetting situations during childhood is actually a positive thing. After all, none of us will go through life unharmed, and we therefore need to experience a few knocks and a little bit of life stress and negativity during childhood in order to help us build that resilience and learn how to bounce back.
Resilience is key to dealing with the challenges that life throws at us, as explained by HeadStart Kernow:
Resilience enables us to cope when things are challenging and helps us adapt to changes in a more positive way. Resilience can enable individuals to transform potentially traumatic stress into tolerable stress and therefore can reduce the negative impact a situation has on a person’s life.
These incidents – and, crucially, how your child learns to cope with them – will give them comparable situations to reflect back upon when another stressful or worrying event happens. You can also use those experiences to talk through and reflect back with your child – e.g. “Do you remember when … happened and how we dealt with it?” or “Is this situation similar to how you felt when … happened?”.
The impact that any or all of these ACEs have on your child can be mitigated or reduced by what are referred to as ‘protective factors’ around the child. Child mental health experts Lucas Shelemy and Dr Pooky Knightsmith have identified four core protective factors (two of which are person-centred, and two of which are social factors) that will help to protect, promote and improve the resilience of children and young people:
- Parents – having a relationship with a parent(s) (or other care-giver) which is nurturing, caring and rule-enforcing
- Peers – being socially connected to a supportive group of friends
- Problem-solving – being able to problem solve and communicate
- Passion – having a personal interest, skill or hobby that the child highly values
The most important of these for you to be aware of is that you have the potential to be a core protective factor for your child, and again this is where having already formed a positive and strong bond and attachment with your child from the earliest opportunity will help. You should then also step in and do all that you can to help your child cope, as this will minimise the negative effect that the experience has on them.
One specific example which Ness shared with us – and one that many children will be exposed to – is parental relationship breakdown. As a dad, what’s critical is for you to remain focused on not just maintaining a good, positive relationship with your child, but also to do the same with your former partner. No matter what you might be feeling inside, you need to work to remain positive about your child’s mum in front of your child. Remember that you are here to provide your child with an example of a positive male role model, and how you behave now could influence the extent to which your child is able to form positive male relationships in adulthood.
Also, don’t miss the fact that the parent-as-a-protective-factor needs to also be rule-enforcing, so don’t worry about saying ‘no’ to your child. Again, Ness gives us great advice on the best way to do this, to help your child learn and understand. She said:
It's good for children to have explanations. If you need or want to stop your child from doing something, then use phrases like: "Daddy is saying 'no' because...". This gives your child the narrative on why it's not safe, etc. And don't forget that children in early stages of development don't have the capacity to compromise.
Strategies for successful communication
There are a number of ways in which you can help your child through ACEs, one of which is the ‘Rupture Repair Cycle’. We found this great explanation of it via a Parenting Resource website article:
Resilience doesn’t happen as a result of everything going smoothly, all the time, in a consistently even relationship. When a parent and child have been dealing with anger, distress or upset feelings – in other words a ‘rupture’ in the relationship – it’s important to repair the situation. To repair the rupture when a child is upset, the caregiver provides calm and reassurance until the child has returned to a calm state. That’s what help a child to build resilience.
However old – or young – your child is, you can still take steps to help them ‘repair’. Let your child know – via speech and via non-verbal communication – that you are working with them to help them. Ness Little explained that, in a young baby, this can be done via things like holding your baby close, making eye contact and gently reassuring them: “It’s ok. You’re ok and dad’s ok.”
Ness emphasised to us the value in taking responsibility for our own feelings and emotions in times of crisis and the value also in finding means of communicating them to your child in a positive way. If you find that a situation is getting to you, for example, Ness suggests telling your child: “Daddy’s just going to take two minutes, because I’m feeling a bit upset…”. As emphasised within the ICON programme (explained above), it’s totally ok (and actually a very good idea) to briefly walk away from circumstances in which you can feel that you are becoming stressed or angry, in order to calm yourself and regain your composure – having first ensured that your child is in a safe location and that no risk of harm can come to them (place them in their cot or a playpen, for example, if they are still tiny).
Helping your child to communicate their own emotions and feelings with you – and learning how to recognise what they are trying to tell you – is also a really important practice for you to develop as a family. Ness reminded us: “How children behave is a means of communicating, either when they don’t have the verbal or emotional narrative or as a result of learnt behaviour.”
To help you help your child unlock their emotions, Ness told us about two strategies that can be particularly useful as your child gets older – PACE and WINE.
The PACE model provides a means by which we can let our child know that they are accepted and understood, whilst also giving them safe opportunities to explore their own feelings and emotions. The letters stand for:
- Playfulness – using a light and playful tone in your voice when you communicate with your child, so as not to create too much pressure or fear
- Accepting – reassuring your child that you accept them and all that they are feeling, thinking and experiencing emotionally (although this is not, of course, the same as saying that you accept the way that they behaved, which might have been harmful or hurtful)
- Curiosity – wondering with the child about the meaning behind their behaviour, which again lets them know that their feelings or emotions were valid and that you understand – e.g. rather than “Why did you do that?”, ask “I wonder if you did that because…?”
- Empathy – letting your child know that their emotions and feelings are important to you, and that you want them to be able to share them with you again, when life gets tough
The WINE model also helps you structure your conversations with a child in a positive, encouraging and empathetic way:
- Wonder – “I wonder if…you are missing Grandad/something bad happened at school today?”
- Imagine – “I imagine that…must make you feel sad/might have worried you?”
- Notice – “I notice that you…looked unhappy when Mummy was talking about him/didn’t want to play with James in the park after school?”
- Empathy – in the light of their responses to the above three prompts, you can again demonstrate empathy, as discussed above – for example:
- “I know how that feels – I really miss Grandad, too.”
- “I’m so glad you’ve told me that.”
- “It’s ok. I’m here with you and you’re not alone.”
If your child (or you) struggles to name their emotions, there are some great, fun videos on YouTube which you can watch together, including one from Sesame Street and one using footage from the Inside Out film.
By the way, if you’re not 100% certain what empathy is, we think that this video has a great way of explaining it, and how it differs from sympathy:
A key quote, for us, is what Dr Brené Brown says at the end of that video:
Rarely can a response make something better. What makes something better is connection.
But what about ME?
Of course, as mentioned back at the start of this article, becoming a parent may lead to you reflecting upon and examining events that happened within your own childhood, and this may not always be a positive experience. You may have come up against ACEs that have shaped you in a negative way, but don’t want those incidents to impact on your own children.
For many of us, simply reading something like this blog post – and perhaps also some of the links to further reading, below – may help us start to explore and deal with those emotions, enabling us (as Ness says) to “name and tame those feelings”. Discussing events with our partners or close friends may be enough for many of us to take the steps that we need to move on from our past and make a fresh start with our own children, being better informed on how to help them build resilience.
However, for some of us, more help may be needed. If this is the case, then it’s important that you do reach out to someone who can provide the support that you require. A good starting point will always be your GP, or your family’s Community Midwife or Health Visitor. Show them this article, if that helps, and let them know that you think you might benefit from talking to someone about your own childhood experiences in order to be able to be the best dad that you can be to your new family.
As an alternative to that, your local council/local authority will have what’s called a ‘single point of access’ through which you can refer yourself to help. The best way to find this is to type in ‘single point of access’ and the name of your county (or other local government area) into an internet search engine.
Most local authorities will also have a ‘Family Information Service’ (or FIS) page on their website, and many of these will have links to support for parents, especially in relation to parenting/parenting courses/etc, so this might also be worth a look. Visit the Coram Family and Childcare Trust webpage, click on the ‘Family Information Services’ option and enter your postcode to find the link for the FIS page for your county.
Finally, if you live in Cornwall (and even if you don’t), Ness has made us aware of their SPACE (Supporting Parents and Children Emotionally) programme. You can find out more about this via their webpage and/or by emailing the team via firstname.lastname@example.org.
She also asked us to let you know about Cornwall Council’s forthcoming online Parents’ Wellbeing Course, which will run across five weeks from Monday 7th June 2021 (and which will feature, among the various expert speakers, Julian from DadPad!). If you’d like to find out more about this course and/or sign up for the course, please visit the Cornwall Council Facebook page.
In conclusion, then, it’s important to remember that:
- Most of us will experience some form of ACEs during our childhood;
- No parent is perfect – we all have our own emotional baggage; BUT
- What matters most is how we support our child to build the resilience needed to deal with the things that happen to them
Further reading and references:
Beacon House: Resources
Felitti et al (1998): Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults – The Adverse Childhood Experiences (ACE) Study [aka The CDC-Kaiser ACE Study]
Jersey Psychology and Wellbeing Service: The Window of Tolerance – Supporting the wellbeing of children and young people (Information and ideas for families and schools reconnecting after lockdown)
National Center for Injury Prevention and Control: Adverse Childhood Experiences Prevention Strategy
Parenting Resource: Rupture and repair
Smith, S (2016): Abusive Head Trauma – The Case For Prevention