The story of a Tennessee mother denied an abortion and help in raising a premature baby. Life unravels. We too often focus on abuse in the household when abuse by public officials remains in the shadow.

Two recent research reports suggest that anti-poverty policies can help prevent child abuse and neglect. These policies include providing economic support to families challenged by job loss and more generous state policies that reduce food insufficiency.

Social policies can reduce income disparities in brain structure. In those states providing more generous cash benefits for low-income families, income disparities in hippocampal volume were reduced as were patterns for internalizing psychopathology.

The on-going Baby’s First Years research ( https://www.babysfirstyears.com/ ) examines the impact on mothers and babies of modest cash gifts as a model of poverty reduction. It turns out that a little money goes a long way and affects the development of babies’ brains. “Early childhood poverty is a risk factor for lower school achievement, reduced earnings, and poorer health, and has been associated with differences in brain structure and function. Whether poverty causes differences in...

While infants and toddlers are often left out of the policy discussion, a breadth of developmental research highlights that these early years may have the largest impact on long-term health, well-being, academic, and economic outcomes. Early investments in social programs that reduce disparities and improve family security across a range of social determinants of health will have great benefits in reducing childhood adversity.

A just-published article reports that the American College of Preventive Medicine (ACPM) recommends against pediatric ACE screening but strongly supports continuing surveillance of ACEs along with protective factors in the population as a way to identify public health and other policies that can prevent adversity and toxic stress. Their report highlights Dr. Robert Anda’s (and colleagues) commentary that notes that ACE scores are neither a diagnostic tool nor predictive at the individual...

“Mental Health Is Political,” a guest essay by Professor Danielle Carr in the New York Times (9.20.2022), asks “What if the cure for our current mental health crisis is not more mental health care?” She argues that what has been called an “’epidemic’ of mental illness” medicalizes what is primarily a social and political problem – that is it makes it a medical problem to be dealt with through treatment rather than a larger social problem to be addressed through changes in social policy and...

" Emi Nietfeld argues in her new memoir [that] it places all blame for not succeeding on individual, ignores bias, inequities" In an interview published in The Harvard Gazette , Nietfield explains: “My biggest problem with the cult of grit is that it takes social problems like racism, child abuse, and violence, and places the responsibility to deal with them onto the backs of individuals. In recent years, it has become a panacea for essentially any issue. Instead of addressing the underlying...

“The insidious effects of childhood poverty disrupt nearly every aspect of child development. The Adaptation to Poverty-related Stress Model posits that one of the key mechanisms through which poverty disrupts healthy development is a combination of heightened exposure to poverty-related stress and reliance on specific coping strategies to manage stressors that may contribute directly to symptomologies….”

The state in which a baby is born and lives in their first 3 years can make a difference in whether they have a strong start in life. But even more critical than the apparent geographic differences are the disparate experiences among babies of different races, ethnicities, and income levels, with inequities starting even before birth. Often driven by systemic racism, these disparities persist even in states where babies overall are doing better than in other states. A nation that tolerates...

The new PACEs Science 101 summarizes only part of the science of positive and adverse childhood experiences. It leaves out much of the social epidemiology and social science of positive and adverse childhood experiences that, along with neuroscience, are at the heart of PACEs science. As a result, it largely fails to address primary prevention through policies that can diminish inequities in the distribution of adverse and positive childhood experiences in a population.

More attention is paid to ACEs’ effects than to causes, inequities, or interventions. Incorporating ACEs into broader frameworks of determinants of health is a better way to go.

Adversity in childhood can be prevented by going upstream and creating social policies that support optimal familial environments in early childhood. Such policies could focus on parenting, parent mental health and substance use, and poverty reduction, among other targets.

During the last two years, a devastating pandemic has exacerbated longstanding inequalities and disrupted vital services, while a groundswell of social activism has brought broader public attention to the deeply embedded inequities of institutional and systemic racism. These converging challenges have intensified the demand for fresh thinking about the future of the early childhood field.

"At the end of 2020, more than 50 million people were facing hunger, up 15 million from the year before, according to data from Feeding America , an anti-hunger organization. Millions of Americans have turned to food banks, with four out of 10 doing so for the first time during the pandemic." "Child poverty affects an estimated 9.6 million children and costs the U.S. as much as $1.1 trillion each year, according to a 2019 report from the National Academies of Sciences, Engineering and...

Reports of ACE data highlighting likelihood ratios -- for example, those with 4+ ACEs are “2.0 times as likely to report fair/poor self-rated health” as those with no ACEs -- are highly deceptive if applied at the individual level. In this case, predicting an individual's fair/poor self-rated health based on a high ACE score would be wrong over 80% of the time in California. ACE data do, however, provide important population level predictions to help guide public health and social policy.

A recent report – FOCUSING THE LENS: Language and framing related to the experience of adversity in childhood -- challenges ACEsConnection members and Communities to join an “an inclusive and deliberate process of field-building” and a collective reappraisal of the language we employ to describe childhood adversity.

ACEs research has highlighted the significant public health challenges that childhood adversity and toxic stress create. Surgeon General Harris is right to give priority to addressing those challenges, but public health officials have better alternatives than universal ACE screening to respond to them.

"The science of the developing child is clear: Infants and toddlers need loving, stimulating, stable, and secure care environments with limited exposure to adversity. However, to date states have lacked clear guidance on how to effectively promote the environments in which children thrive.’ This Roadmap provides a guide to policies that promote environments where kids can thrive.

Social science evidence from the National Survey of Children's Health helps place California's ACE screening mandate in context. The data suggest California does not do well in providing developmental screening in pediatric care -- a much more direct method than ACE screening to detect problems arising from toxic stress and adversity. See https://www.acesconnection.com/blog/painful-questions-what-happens-when-doctors-uncover-adverse-childhood-experiences

This excellent article reviews arguments for and against universal pediatric screening for ACEs in California. It also highlights Dr. Nadine Burke Harris' concern concern that if we know ACEs science, it is irresponsible not to take action. She indicates that she has not heard alternative proposals for action from critics of screening. However, such alternatives exist and include universal pediatric developmental screening and policy initiatives aimed at primary prevention of adversity.

An important new report based on data from the National Survey of Children's Health identifies significant economic and racial disparities in the frequency of adversity among children ages 0-3. Adversity in Early Childhood: The Role of Policy in Creating and Addressing Adverse Childhood Experiences from the Center for American Progress underlines the importance of social policy initiatives to advance primary prevention and racial and economic justice. See...

Although Covid-19 is on the top of everyone’s list for attention, the posting earlier this week of a link to Dr. Robert Anda, et al.’s paper, Inside the Adverse Childhood Experience Score: Strengths, Limitations, and Misapplications [ajpmonline.org] should also be front and center because it raises profound questions for everyone involved in the ACEs movement. On the surface, the article is a pointed critique of ACEs screening. But it is much more than that. It raises fundamental questions...

The ACEs research by Drs. Felitti, Anda and colleagues focused attention on the important consequences of childhood adversity for adult health. Of course, as many in the resilience-building movement recognize, adversities affect children’s health and life trajectories as well. When we recognize the powerful impacts of harsh life circumstances for children and families, it becomes clearer that social policies to strengthen household and community resources are needed as well as...

The ACEs research by Drs. Felitti, Anda and colleagues emphasizes only household deficits, not family and community assets. To understand fully the effects of adversity and to build resilience, we need to recognize those assets and their unequal availability to households across divides of race, class, gender and locale. Resilience is not only or mainly a quality of individuals alone; it is a quality of individuals in interaction with resources in their social environments. For more, see the...

Finding the Missing ACEs : The ACEs research by Drs. Felitti, Anda and colleagues has spawned a growing and influential social movement on behalf of trauma-informed practices and institutions. However, the ACEs research misses entirely the social contexts of households such as extreme poverty and racism that can themselves create toxic stress. Broader measures of adversity can provide a more accurate picture of the varying likelihood of toxic stress among children in differ by race, class...