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ACEs too High? The role of education and communities

Posted by. Dr Pam Jarvis
Posted on 04 April 2019

blogs:Childhood and Education

​​​​​It is now nearly a year since the Resilience Movie was shown to an audience of 175 at The Light Vue Cinema in Leeds. This blog from Dr Pam Jarvis - Reader in Children, Youth and Education - reflects upon what Leeds ACEs have been doing over this time, in partnership with Leeds Trinity University and with Mowbray School in North Yorkshire. It considers what they have learned about ACEs over this time, particularly in discussion with the ACEs movement in Scotland, and reflects upon how the concept might be used to inform practice with c​​hildren and families in the future.​​

ACEs: the start of a movement?

In 1998, an extensive but relatively obscure study was published in the American Journal of Preventative Medicine. In this, a multi-disciplinary group of medical researchers outlined a remarkable set of statistical analyses. Their data had shown a clear correlation between ten identified adverse childhood experiences reported by participants and physical/mental health problems that later arose in adulthood. People with six or more 'ACEs', as they later came to be known were more likely to experience mental health problems, and thence to engage in health risk behaviours that rendered them statistically more likely to die 20 years earlier than people with none (Felitti et al 1998). The key findings are summarised on the graphic below (70-30 Campaign).

In the mid-2000s, film maker James Redford, son of actor Robert Redford, came across a newspaper article disseminating these findings. He was so impressed by their implications he decided that they should be communicated to the widest possible audience, so that there could be more general public understanding of the long-term impact of 'toxic' stress in childhood (Cocozza 2017). In 2016, Redford's film production company, Sundance, released a film entitled Resilience: the biology of stress and the science of hope.  The film has been widely shown across the world, and a very active ACEs information campaign led by Dr Suzanne Zeedyk (Connected Baby) and Tina Hendry (Re-Attachment) consequently sprang up in Scotland. By the summer of 2017 there had been 28 screenings of Resilience in Scotland, many of them sell-outs, and nearly 2500 people had seen the film (Zeedyk and Hendry 2017).

ACEs research has continued across the world. A key message from this area of research is that the way stress is stored within the human body is cumulative; the stress 'thermostat' becomes chronically set at too high a level, putting both physical and psychological health upon a knife-edge (Burke Harris 2018). A useful analogy is a central heating system that is constantly set at an uncomfortably high level, putting ongoing pressure upon the boiler, so that when the thermostat is advanced even further by stressors in the day-to-day environment, the boiler is prone to malfunction, including both burn-out and explosion. People with high ACEs are also highly vulnerable to temporary stress reduction behaviours such as smoking, over-eating, excess drinking and illegal drug use, in attempts to 'turn down the thermostat', which sadly work only temporarily, and in the long term, have the opposite effect as these behaviours damage the physical body.

When I opened a Twitter account in summer 2017, I was able to extend some existing professional connections, by making contact with the thriving ACEs movement in Scotland. I also discovered three other Leeds-based professionals who were interested in the ACEs concept, and together, we began to plan a showing of Resilience in April 2018, at the Leeds Vue Cinema, in The Light. Initially we were concerned that we would not manage to secure the 30 ticket purchases we needed to fund the film showing. However, we sold all 175 tickets available several weeks before the screening. We asked people who attended the screening to fill in a short, anonymous feedback slip on the film. When we collated this information, we found that we had received similar feedback to that elicited from the Scottish audiences:

Scotland (from Zeedyk and Hendry 2017)Leeds
I want to be part of something that could truly make a differenceWe can collectively make a change
Not enough people know about itEverybody can play a part
I work in the mental health sector and most, if not every one, of my patients has some form of traumaACEs affect everyone
I am currently running a nurture room in primary school. I notice these stress factors in a lot of my children, and I want other staff to understand it is realThe world needs to change
I have a huge interest in attachment issues and encounter them often in my job in education, working with Additional Support NeedsIt's not hopeless
ACEs information is needed in my local authoritySpread the word

​​​​In December 2018 we ran an ACEs information and Training day at Leeds Trinity University where professionals across the fields of education, psychology, early years, social work and the philosophy of ethics presented on their own perspectives of ACEs, and in January 2019 one of the attendees at the Leeds screening of Resilience organised a further screening at Mowbray Special School in Bedales, North Yorkshire. The Resilience DVD was purchased by the North Yorkshire Virtual School team for staff training, and 70 education and local authority professionals attended. The lively conversation at both events that followed the screening yet again generated many of the same questions and comments. 

The Problem with ACEs?

The concept of ACEs raises a rather more critical discussion within academia, rooted in the prospect that it may create a self-fulfilling prophecy, depicting individuals simplistically as victims of circumstance with little ability to control their own destinies, leading to stereotyping and stigma (Edwards et al 2017).

Callaghan (2018) also voiced concerns about medicalisation and individualisation of the problem, questioning the usefulness of the ACEs concept. She, too articulated a concern about government attempts to individualise social problems, quoting the 'early intervention' and 'troubled families' agendas, drawing attention away from the root causes of ACEs, poverty in particular. She raised a concern that professional distance would be heightened, and the coercive control that is frequently present in dysfunctional families minimised. Both she and Edwards et al (2017) raise a concern about the original tick sheet research tool being used for individual screening by non-psychologists.

I would agree that a tick sheet approach is most definitely a problem, and this led to consider a similar issue that had arisen during my experience in community education in the 1990s, when the advent of educational managerialism, leading to a tick sheet approach to progression destroyed the unquantifiable learning and organic relationships that unfolded in the community education experience: 'creat[ing] the conditions for holes to form within the fabric of human connection'(Jarvis 2017a online).

Becoming less human?

In late 2017, I commented upon a worrying phenomenon that was emerging in English schools; the practice of 'zero tolerance' of children's problematic behaviours, linked to schools' concerns about the impact of these upon achievement statistics that played a large part in their OFSTED rating: We enter a 'through looking glass' situation in which the school no longer exists to serve the pupil; the pupil exists to serve the school' (Jarvis 2017b, online).

In the ensuing article I reflected upon the use of 'seclusion rooms' in primary schools and the off-rolling of children whose eventual exam grades might impact negatively upon the school's achievement statistics, including children with special needs.

In early 2019, the practice of 'flattening the grass'- adults intentionally creating fear in cohorts of children via abject humiliation- came to light in the education media, the TES (2019, online) claiming that two academy chains promoted the practice of  teachers 'aggressively shout[ing] at pupils as part of a "ritual humiliation" and "public shaming" to instil discipline'.

While such practices are clearly disturbing, considered in the context of the gradual shift from education as a community venture towards a 'new managerialism' model, they do not come as a complete surprise:

While the nurturing of learners has an outcome dimension in education, for example, the care-related gains from education are generally not measurable in the short term within a metric. The inevitable, if unintended, correlate of evaluating merit through measurement is that the core principle of caring in health, education and other public services is subordinated to output.

Lynch (2014, online)

One third of British children live in families that are officially poor (Child Poverty Action Group 2019), putting them at risk of high ACE loads, while the education budget has been consistently reduced in real terms over the past decade (Sodha 2019), while enormous stress has been placed on schools to produce better academic results (Hutchings 2015). The thermostat is thus being turned up on the children and their parents from several directions. The core question that emerges is how concepts might now be drawn from the contested field of ACEs research to inform reflection about how we might move forward in a more humane direction.

Imagining a more human future

One of the first problems that arises within the situation in which English education currently finds itself is the spectre of the tick sheet. My worst ACEs nightmare is the possibility that education managerialists might one day produce an ACEs tick sheet to be casually added to the growing personal data file that is collected on children attending English state schools (Defend Digital Me 2018). In this, I am in total agreement with Edwards and Callaghan's calls for caution.

However, as a teacher, I would propose that the ACEs concept has a value that transcends its origins in 'big data', if we can leave the tick sheet in its initial incarnation as a mass research tool, and focus upon the messages that emerged from the ACEs research, and how their dissemination in Resilience inspires and empowers communities to create fresh ideas about human societal relationships. Drawing from my own 25 years of experience across the education sector, it seems to me that over the past three decades we have been influenced by the wider culture to create some very dysfunctional processes; for example the over-centralisation of education policy, the hagiography of purely summative assessment and the construction of learners as results-capital.

The ACEs concept offers a challenge to educators to create a culture that is more in harmony with the evolved biology and psychology of the human being, designed to ameliorate toxic stress rather than to add fuel to the flames, for both learners and teachers.

1. Attachment matters

Babies are born with the instinct to attach to a small group of adults, and this is necessary for healthy psychobiological development. Where this process is disrupted, for example where the adults are too preoccupied with their own problems to give the child sufficient attention and affection, or the adults taking care of the child are constantly changing, biological studies correlating poor cortisol function with infant attachment problems have highlighted a potential harbinger of the 'toxic stress' syndrome described by the ACEs research (Jarvis 2014). This has implications for later development. For example, Wetz (2009) found that those who left the school system with no qualifications were most likely to be young people who had a history of complex emotional and social changes in early childhood, and who commonly reported feelings of isolation that prevented them from taking a full part in learning activities during their schooling. This could be avoided by ensuring that parents of young children receive sufficient financial and social support, and that non-family education and care provision is funded to a level that permits high adult to child ratios and a salary/ career structure for practitioners that prevents high staff turnover. In this way, if we invest in the future emotional stability of an infant population, we would avoid even higher levels of spending in mental health and criminal justice as they move into later childhood and adult life. 

2. ​Kindness matters

Adults modelling additional anger and stress-creating behaviours (such as 'flattening the grass') to children whose stress-coping systems already operate at too high a setting in practices inevitably make matters worse, not better. Instead of taking the attitude there is something 'wrong' with a child with consistent behaviour problems, professional adults should be available to properly explore the question 'what happened to you' (Jarvis 2018a). If we reconstruct chronic 'problem behaviour' as 'distressed behaviour' we can reframe the problem and address it more positively. And yet again, the money spent on this would be recouped in later savings in the mental health and criminal justice sectors.

Of course, not all minor, mischievous child and teen infractions fall into the 'consistent behaviour problems' category. Routine child development education in the latter years of secondary school, along with higher level study in this area during Initial Teacher Training would produce parents and teachers who have less difficulty in defining major from minor issues, and responding in kind.

3. Not all adversity is toxic

Craig (2018) explored this issue, highlighting the difference between supportive challenge that stretches children's skills, supporting a growing confidence and independence, and over-demanding challenge with insufficient support provided, which is likely to lead to feelings of humiliation and demotivation, particularly if the child in question is already experiencing toxic stress in the home environment. In early childhood, caring adults can most helpfully provide a 'stress innoculation' through co-regulation, modelling and scaffolding the skills that children need to move into self-regulation. Adult monitored play-based learning with peers is an important vehicle for the development of this crucial life-skill, in which children learn to self-correct in unpressurised activity (for example whilst building a model or painting a picture), to build peer relationships and to deal with minor conflicts whilst managing their own emotions. Carers can offer support for this process by offering distraction, reappraisal, soothing and response modulation (Silkenbeumer et al 2016). In a professional early years setting, this process is most likely to occur within the sustained shared thinking with adults that unfolds within the continuous provision environment of the play-based early years environment (Jarvis 2018b). Shonkoff et al (2015) found that just one supportive adult-child relationship in early childhood could blunt the impact of ACEs, concluding 'resilience requires relationships' (p.7); that a high ACE load does not have to be a self-fulfilling prophecy. Their summary of important resilience factors is illustrated in the following diagram (70-30 Campaign).

4. 'Storying' lives 

​As Callaghan (2018) points out, a human being's individual experience of adversity is not constructed in memory as a mechanical catalogue of incidents, but as a story woven into ongoing life events. Human beings learn most comfortably through narrative (Jarvis 2009) and stories (Willingham 2013), and there are some recent indications that this may be even more strongly the case for people with high ACE loads. For example, recent research has indicated that while high ACE loads tend to decrease impulse inhibition, which may create problems within a classroom, the ability to shift attention quickly is a more positive facet of this quality: 'an aspect of cognitive flexibility, which is thought to underlie abilities such as creativity' (Makin 2016 online). This finding also raises the therapeutic potential of the arts in working with children with high ACE loads.

In the 1960s, a now-famous slogan arose in the Women's Movement: The Personal is Political: 'personal problems are political problems. There are no personal solutions at this time, there is only collective action for a collective solution' (Hanisch 1969, online). It seems to me that fifty years later, our quest to become ACE aware, and by so doing, heal our public services, places socio-economically deprived communities in a very similar position. The route to healing communities cannot be forged through managerialism and accountability, but through community and local political action, in which we become more curious and investigative about the lived experiences of others, and less dismissive, data-obsessed and judgemental.