Background
Scotland’s excess mortality: alcohol, drugs, suicide and violence
Conceptualising the impact of negative experiences
Adverse childhood experiences
Complex trauma
Attachment
Allostatic load
Toxic stress
Modelling a relationship between childhood experience of adversity and adult health outcomes
-
exposure to potentially harmful experiences (characterised as ACE for children, and as “complex trauma” for a wider range of experiences in children and adults)
-
the response to those experiences as influenced by attachment style and psychological development: securely-attached children (and parents) are likely to respond adaptively to stress, whereas insecure or disorganised attachment styles often predispose to further stress.
-
the consequences of those experiences, in terms of allostatic load, toxic stress, psychological development and adult attachment style
Definitions | ||
---|---|---|
Exposure | Adverse childhood Experiences | An epidemiological measure of childhood abuse, neglect, and family dysfunction, which can be assessed in adults using a ten-item Adverse Childhood Experiences (ACE) questionnaire. ACEs include emotional and physical abuse or neglect, sexual abuse, and exposure to household violence or substance misuse. ACE would include most forms of childhood trauma. |
Complex Trauma | A psychological construct that relates childhood traumatic experiences to adult emotions and behaviour. A particular focus on health harming behaviours, and on service responses to those problems. | |
Response | Attachment | A fundamental aspect of human development: infants’ biological instinct to develop a relationship with at least one caregiver for safety and protection. Over time, the “attunement” developed in such relationships helps the child to regulate their feelings and make sense of the world. Secure attachment develops when parents consistently respond to their child’s needs. Patterns of “insecure” attachment include resistant, avoidant and disorganised types. Attachment theory has also been applied to adult relationships. |
Consequences | Allostatic Load | The physiological consequences of chronic exposure to fluctuating or heightened stress, which may lead to physical, behavioural and cognitive effects. |
Toxic stress | Prolonged activation of the body’s stress response, occurring when a child experiences strong, frequent, and/or enduring adversity without the protection of a supportive adult relationship. Such adversity could arise from the burden of longstanding poverty, and the forms of ACE described above. Integrates aspects of both exposure and “resilience” to traumatic experiences. |
-
is consistent with concepts of “critical periods” for childhood development, and of a cumulative burden of allostatic load through the lifespan [78].
-
is consistent with structural and social models of health, but emphasises important non-socio-economic influences [78].
-
links some adult outcomes to childhood risk factors, creating a potential feedback loop which could persist even if the initiating external socio-economic circumstances were to remit.
-
argues that harm caused by exposure to ACEs and toxic stress can potentially be prevented or modified by secure attachment experiences.
A political dimension to parenting and adversity
Current evidence for the model and excess mortality in West Central Scotland
Adult morbidity and premature death
Experience of childhood adversity and toxic stress
-
Increased rates of “household dysfunction” in Scotland (eg substance misuse, imprisonment, mental illness) in households with children
-
A higher prevalence of parenting indicators associated with insecure attachment (eg maternal stress or distress, or lack of paternal engagement)