Dr Kiran Anand
kirananand0055@gmail.com
Childhood development is a continuous process involving the acquisition of skills across multiple interrelated domains, including physical, social, language, and adaptive functioning, which together enable children to attain their full developmental potential.
Early childhood represents a critical window for development, characterized by rapid brain growth and heightened neural plasticity. Exposure to adversity during this sensitive period can disrupt normal developmental trajectories and have long-lasting consequences. The global significance of early childhood development is reflected in its inclusion within the Sustainable Development Goals, particularly Goal 3, which emphasizes health and well-being across the life course.
What are adverse childhood experiences?
An adverse childhood experience (ACE) describes a traumatic experience in a person’s life occurring before the age of 18 that the person remembers as an adult and includes the follows:
* being the victim of abuse (physical, sexual and/or emotional)
* being the victim of neglect (physical and emotional)
* domestic violence
* parental abandonment through separation or divorce
* a parent with a mental health condition
* a member of the household being in prison
* growing up in a household in which there are adults experiencing alcohol and drug use problems.
What are the statistics regarding ACEs?
The magnitude of adverse childhood experiences is reflected in global and national data. The 2017 UNICEF report “A Familiar Face: Violence in the Lives of Children and Adolescents” highlighted that nearly 300 million children aged 2-4 years worldwide-approximately three in four-are subjected to violent discipline by their caregivers on a regular basis. Globally, an estimated 15 million adolescent girls aged 15-19 years have experienced forced sexual intercourse at least once in their lifetime. Alarmingly, data from 30 countries indicate that only about 1% of adolescent girls who experienced forced sex sought professional help.
In India, the 2021 National Crime Records Bureau (NCRB) reported a rise in crimes against children, with the crime rate increasing to 33.6% in 2021 from 28.9% in 2020. Furthermore, NCRB data for 2021 revealed the deeply distressing finding that 140 children were victims of rape and murder during the year.
Biology of ACEs?
Adverse childhood experiences (ACEs) can give rise to toxic stress, particularly when children are exposed to multiple adversities over time in the absence of stable, supportive relationships with caring adults that normally provide buffering protection. Such prolonged and excessive activation of the stress response leads to a sustained “wear-and-tear” effect on the body. Toxic stress adversely affects the developing brain and disrupts the maturation of key biological systems, including the immune, metabolic, and cardiovascular systems, thereby increasing the risk of long-term health and developmental consequences.
So, What are the lifelong consequences of ACEs?
Understanding the far-reaching consequences of childhood trauma is critical for developing effective strategies to interrupt intergenerational cycles of adversity and to support affected individuals.
Effects on physical health: Childhood maltreatment has been associated with long-term physical health consequences, including endocrinological disorders such as obesity and type 2 diabetes. Early exposure to adversity is also linked to an increased risk of cardiovascular diseases in adulthood, particularly hypertension and ischemic heart disease.
Effects on mental health: Exposure to adverse childhood experiences (ACEs) is associated with dysregulation of the stress response system, which contributes to adverse mental health outcomes in adulthood. Evidence from large epidemiological studies, including the CDC-Kaiser Permanente ACE Study, demonstrates that ACEs are highly prevalent and are strongly associated with health-risk behaviors, mental illness, reduced life potential, and premature mortality. Importantly, this study identified a graded dose-response relationship between the number of ACEs and the severity of negative health outcomes.
Childhood sexual abuse, in particular, has been linked to higher rates of major depressive disorder, anxiety disorders, suicidal ideation, suicide attempts, alcohol dependence, and illicit substance use. Additionally, ACE exposure is associated with increased engagement in risky behaviors such as non-suicidal self-injury (NSSI), defined as deliberate, self-directed injury to the body without suicidal intent.
Interventions to address ACEs:
“Vision is to promote optimal childhood development”
Addressing adverse childhood experiences (ACEs) requires a comprehensive, multisectoral approach that engages individuals, families, communities, and policymakers. Effective interventions must extend beyond individual-level strategies-such as psychosocial support and trauma-focused care-to include improvements in the proximal environment, including positive parenting practices and responsive caregiving, as well as the distal environment, such as the creation of safe homes, schools, play spaces, and violence-free neighborhoods.
At the community level, the World Health Organization (WHO) has recommended several evidence-based frameworks to prevent and mitigate ACEs. One such initiative is INSPIRE, launched in 2016, which outlines seven strategies to end violence against children: implementation and enforcement of laws; transformation of norms and values; creation of safe environments; parent and caregiver support; income and economic strengthening; access to response and support services; and promotion of education and life skills. INSPIRE supports countries in achieving Sustainable Development Goal (SDG) Target 16.2, which aims to end abuse, exploitation, trafficking, and all forms of violence against children.
Another key initiative is the Nurturing Care Framework (WHO, 2018), which provides a roadmap to enable children to survive and thrive and to maximize human potential. The framework emphasizes five core components: good health, adequate nutrition, security and safety, responsive caregiving, and opportunities for early learning.
In India, child protection is supported by a robust legislative framework, primarily through four key laws: the Juvenile Justice (Care and Protection of Children) Act (2000; amended in 2015), the Prohibition of Child Marriage Act (2006), the Protection of Children from Sexual Offences Act (2012), and the Child Labour (Prohibition and Regulation) Act (1986; amended in 2016).
Conclusion:
Breaking the cycle of adverse childhood experiences and their long-term consequences is an urgent public health and social priority. Ensuring that children grow up in stable, safe, and nurturing environments is essential for their well-being and for enabling them to achieve their full developmental potential. As responsible members of society, it is imperative to collectively reflect on whether we are doing enough to create a world that truly safeguards the rights and futures of all children.
The author is DM resident Pediatric Neurology (PGIMER Chandigarh)
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