By Loren McCullough and Dr. Robert Sege
Healthy Outcomes from Positive Experiences (HOPE) National Resource Center
In this blog, we report the results of a survey of ACEs Connection members that shows that positive childhood experiences appear to counteract the long-term effects of childhood adversity. In the face of worldwide changes in childcare and schooling, researchers have become even more invested in understanding the impact of PCEs on health and how they interact with ACEs. Within our sample of the ACEs Connection community, this survey was designed to help us better understand the interactions between early experience and health.
As members of the ACES Connection community know, childhood adversity is a known risk factor for chronic adult health problems. While the original ACEs study published in 1998 showed the undeniable impact of ACEs, relying on ACEs screening alone presents an incomplete picture of true well-being. Positive experiences occur alongside ACEs, and also influence health. These positive experiences have been measured by researchers in the same way as ACEs, and reveal a much different picture of those in categories of highest adversity - the true potential for resilience and healing.
From a survey of over 300 participants from the ACEs Connection community, we found that at every level of ACEs exposure, positive childhood experiences (PCEs) decreased the proportion who reported a diagnosis for chronic depressive disorders. Respondents were asked to answer a series of questions about their ACEs score, current health conditions, and their frequency of experiencing a set of 7 PCEs. A PCE score was also calculated, indicating the number of kinds of positive experiences that they could recall often or very often in childhood.
Here is a bit more detail: From 379 total respondents, 91% were female, 90% were white, 86% were educated at the college level or higher, and 61% reported income over 75k/yr. Over half of these were married, and 78% reported being currently employed. 75 participants reported not knowing their ACEs score, and were not included in the charts below.
ACEs were measured by personal report; of the 304 participants who knew their personal ACEs score, over 50% had experienced four or more ACEs, markedly higher than the national average - CDC reports indicate that in April of 2020, approximately 17% of adults reported over 4 ACEs. Within a community concerned about the effects of childhood adversity, it is no wonder that our sample had a higher average of ACEs.
Examination of PCEs helps explain how community members are resilient, even with this high burden of childhood ACEs. As can be seen in the graph below, almost 30% of those reporting 4 or more ACEs also claimed 3-5 PCEs. As such, we see evidence that adversity does not happen in a vacuum: positive experiences can and do exist even when also faced by high levels of childhood adversity.
As expected, those with more PCEs tended to report fewer ACEs. All participants without ACEs also reported at least 2 PCEs; those with no PCEs had at least 3 ACEs. People with lowest levels of PCEs made up over 60% of those with high ACEs scores.
The effects of PCEs becomes clear when we examine reported health outcomes. Of our respondent group, 159 reported having been diagnosed by a doctor or medical professional with a depressive disorder. These respondents—comprising over half of those who knew their ACEs scores - showed correlations with ACEs and PCEs. Each type of childhood experience affected the likelihood of reporting depression.
The CDC has reported that many common chronic diseases, including depression, can be attributed to childhood exposure to adversity. This survey suggests that healthy effects of PCEs on depression were clear: respondents with 6-7 PCEs made up only 22% of those with diagnosed depression, while those with 0-2 PCEs comprised almost 50%.
The effect of PCEs on depression stands out especially among those who reported high ACEs scores. Those with 0-2 PCEs amounted to 42% of the respondents with depression, those with higher PCE scores made up less than 20%. Results from this population reflect a buffering effect of PCEs against chronic depression. Our population reflects the importance of positive influences on a childhood that may be heavy with adversity, as these PCEs protect against the chronic harm done by ACEs.
The results of this survey indicate a pattern of remarkable strength in ACEs Connection community. Although many of us have experienced significant childhood adversity, when positive experiences occur alongside ACEs our results show a decreased reporting of diagnosed depression - the most common chronic disorder among those who took the survey. While this population is distinct from larger U.S. samples, they establish a pattern of strength that inspires a focus on the positive.
Adverse experiences are an important part of the bigger picture of childhood experience. We can now add that positive childhood experiences can protect against toxic stress and adult depression. The effects of a high ACEs score can be mitigated by the power of nurturing relationships, a safe environment, and community support to break the chain of toxic stress. By focusing on the positive and endeavoring to build opportunities for PCEs where they are needed most, providers and parents have the ability to foster these protective factors for children facing an ACE-heavy world.
Please have a look at our website https://positiveexperience.org, or email HOPE@tuftsmedicalcenter.org to find out more.
Thanks to Gail Kennedy for her insight and assistance in the production of this survey. The HOPE team is thankful to the ACEs Connection community for their participation.
Title image courtesy of Dr. Robert Sege.
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