please help me with write essay with introduction and conclusion using the questions

Reading Reflection Paper # 2

This paper is based on the topic of adverse childhood experiences and expanded adverse

childhood experiences. You are asked to answer the following 4 categories of questions

referring to 3 sources of information: a) the film, b) readings from our Gold textbook

(specifically 8, 9, 10 chapters and c) a supplemental article related to Expanded ACEs.

Cite in the body of your paper at least 5 minimum citations. While you can cite more

than 5 times, you should cite at least once for each of the 3 chapters assigned, once

for the film, and once for the Expanded ACEs article.

There should be a minimum of 3 sources in your reference page (book, film, article).

Please watch the film below

https://www.youtube.com/watch?v=Hp6fZrzgiHg

READ: Gold text: Chapters 8, 9, 10.

Gold,

C

.

M. (2017)

.

The Developmental Science of Early Childhood: Clinical

Applications of Infant Mental Health Concepts from Infancy through Adolescence.

Published by W.W. Norton and Company. ISBN: 978

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0

-

393

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70962

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9

read the article below (Expanded ACEs)

Global and inclusive considerations for the future of ACEs research Kafui Sawyera, Samantha Kempea, Matthew Carwanab,c, Nicole Racinea,d,*

a School of Psychology, University of Ottawa, 75 Laurier Ave E, Ottawa, ON, K1N 6N5, Canada

b BC Childrens Hospital, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada

c Department of Pediatrics, University of British Columbia, 4500 Oak St, Vancouver, BC, V6H 3N1, Canada d Children's Hospital of Eastern Ontario Research Institute 401 Smyth Rd, Ottawa, ON K1H 5B2, Canada

ARTICLEINFO

Keywords:

Adverse childhood experiences Child maltreatment

Child abuse

Trauma

International questionnaire Assessment tools

1. Introduction

The Impact of ACEs

Research on Adverse Childhood Experiences (ACEs) has increased exponentially since the initial study nearly 30 years ago. There is now high-quality evidence that has been replicated across several studies showing that exposure to ACEs, including abuse, neglect, and household challenges, is common and increases the risk for adverse health, mental health difficulties, and risk behaviours across the lifespan (Hughes et al., 2017). ACEs have also been shown to be costly, accounting for a sig- nificant portion of a country's annual gross domestic product (Hughes et al., 2021; Struck et al., 2021). As such, preventing and addressing ACEs' consequences is an urgent public health concern worldwide.

Evidence shows that ACEs have both immediate and long-term out- comes on physical and mental health. There is a dose-response rela- tionship between the number of ACEs and the common risk factors for early death, including smoking, severe obesity, physical inactivity, depressed mood, suicide attempts, and substance abuse (Merrick et al., 2017) . The connection between ACEs and negative health outcomes is related to physiological stress responses and engagement in risky be- haviours to cope with stress (Crandall et al., 2019; Elvir-Lazo et al., 2024). Taken together, the impact of ACEs on wellbeing is vast and merit public health attention.

The specific effects of different types of ACEs remains a burgeoning

ABSTRACT

Exposure to Adverse Childhood Experiences (ACEs) can increase the risk of physical, mental, behavioral, and educational difficulties across the lifespan. ACEs research to date has largely had an individualistic approach, considering experience impacting one person within their own family. In order to be more relevant across so- cieties and cultures around the globe, there is a need to build on current ACEs research by also considering broader aspects of the social ecology including individual, societal, and cultural factors. This commentary dis- cusses the limitations of the current ACEs research and the need to also consider social and methodological aspects of adversity. The importance of considering protective factors is also discussed.

area of research. Given that maltreatment and household dysfunction often co-occur, it is challenging to isolate the individual contributions of each adversity type (Dong et al., 2003; Dong et al., 2004; Dube, Wil- liamson, Thompson, Felitti, & Anda, 2004). Compared to household dysfunction, maltreatment experiences such as sexual abuse, physical abuse, and physical neglect have been found to have more substantial effects on mental health (Brayden, Deitrich-MacLean, Dietrich, Sherrod, & Altemeier, 1995; Salokangas et al., 2020). In terms of short-term outcomes, physical abuse and sexual abuse often result in physical in- juries, stress-related somatic complaints, hypervigilance, elevated levels of stress hormones, sleep disturbances, and changes in appetite (Trau- ma-Informed Care in Behavioral Health, 2014). Emotional abuse and sexual abuse frequently lead to heightened levels of anxiety, fear, and sadness, emotional lability, difficulties with attention and memory, challenges forming and maintaining healthy relationships with peers and adults, and an increased likelihood of displaying disruptive or risky behaviours (Trauma-Informed Care in Behavioral Health, 2014). Furthermore, physical neglect and emotional neglect are associated with elevated stress levels, difficulties forming secure attachments to care- givers and significant adults, delayed growth and development due to malnutrition or lack of adequate care, and potential consequences such as poor academic performance (Compton

K. Sawyer et al.

ACEs Measurement

The original ACEs measure (Felitti et al., 1998) included items related to childhood abuse (i.e., psychological abuse, physical abuse, and sexual abuse) as well as household dysfunction (i.e., caregiver substance abuse, parental mental illness, domestic violence, and incar- ceration of a caregiver). Subsequently, items related to emotional neglect, physical neglect, and parental loss/divorce were included to form the 10-item version that is most used in research today (Dube et al., 2001). As the ACEs literature has grown, the need to expand the defi- nition of ACEs beyond the original conceptualization has emerged. Indeed, several calls to include other adversities, such as poverty, racism, placement in foster care, bullying/peer victimization, and neighbourhood violence, which are also strong predictors of adverse developmental outcomes, have been made (Finkelhor et al., 2015).

In 2018, the World Health Organization created the Adverse Child- hood Experiences International Questionnaire (ACE-IQ), which expanded on the 10-item version of the ACEs to include items related to bullying, peer violence, exposure to community violence, and exposure to war or conflict (World Health Organization, 2020). Created with the intention to be more internationally relevant, the ACEs-IQ measures ACEs in countries around the world. Although the 10-item version continues to be dominant in ACEs research (Madigan et al., 2023), there is potential that this may shift as the ACEs-IQ gains momentum and is being implemented.

Based on ACEs research over the last 25 years, there are limitations to the 10-item questionnaire that need to be addressed to make it more globally applicable. First, questionnaire items need to capture adverse experiences outside those that occur in Western contexts and those in the broader social ecology, rather than focus exclusively on familial factors. Second, the ACEs questionnaire primarily uses a cumulative risk framework, which limits the consideration of the timing, type, and severity of adversity exposure and may minimize a thorough under- standing of ACEs in a global context. Third, ACEs research needs to move beyond a deficit model to ask additional questions about protective factors. This broader approach enhances understanding of factors that can mitigate risk. This commentary calls for a more global perspective and understanding of ACEs.

2. Moving ACEs beyond the western context

Adverse Childhood Experiences (ACEs) have garnered considerable attention in recent years for their profound impact on individuals' health and well-being. However, much of this research has been con- ducted within WEIRD (Western, Educated, Industrialized, Rich, and Democratic) contexts. More than 90% of previous studies reporting on ACEs prevalence have been conducted in Europe or North America (Madigan et al., 2023). These research practices often overlook the broader social ecologies that shape childhood experiences (Amundson & Afifi, 2020).

It is important to note that sociocultural inequalities also exist within WEIRD contexts, significantly influencing outcomes across different subpopulations. Consequently, there is a substantial gap in under- standing the prevalence of ACEs in low and middle-income countries and within various subpopulations of WEIRD contexts, such as marginalized and racialized groups or those facing socioeconomic in- equalities. Furthermore, it remains unclear which community and social adversities may most strongly predict health and mental health out- comes in these diverse settings. A recent meta-analysis highlighted that ACE prevalences have been reported in 22 different countries, encom- passing 206 studies published from 1998 to 2021 and involving a total of 546,458 adult participants. The regions represented included North America, Europe, Asia, Australia, New Zealand, South America, Africa, and the Caribbean (Madigan et al., 2023). Despite extensive research on ACEs, most data is derived from adult surveys in high-income countries, emphasizing a significant lack of research on youth and individuals in

Child Protection and Practice 3 (2024) 100054

low-to-middle-income countries (Gilbert et al., 2024).

3. Considering ACEs at the community and societal levels

Although the traditional ACEs framework provides valuable insights into the impact of early-life stressors on health and well-being, there has been a narrow focus on individual experiences and experiences within the family (Afifi et al., 2020). This perspective overlooks the broader social ecologies that shape childhood, which can lead to underreported rates of childhood adversity. Examples of community and societal ad- versities include war, racism, colorism, community-wide poverty and barriers to basic resources, community violence (e.g., gangs, gun shootings), and environmental hardship (e.g., pandemic, pollution, natural disasters). Considering these kinds of adversities is essential for accurately characterizing children's experiences, especially within in- ternational populations. It is also important to consider that the impact of broader ACEs is not universal, with the impact of ACEs varying based on individual factors. For example, during the COVID-19 pandemic, individuals with power and privilege continued to have greater access to resources that protected them from many of the physical, psychological, emotional, and financial consequences faced by less privileged, marginalized, and oppressed groups (McGowan & Bambra, 2022).

In addition to adversities that occur at the community level, struc- tural factors play a pivotal role in shaping childhood adversity. Racism, colonialism, poverty, and inequality are structural determinants that disproportionately affect marginalized and racialized communities (Antwi-Boasiako et al., 2022; Petion et al., 2022). Children growing up in materially deprived neighbourhoods or facing discrimination due to their race or ethnicity are exposed to unique stressors that can have long-lasting consequences. These structural inequalities exacerbate the risk of ACEs and contribute to health disparities later in life (Bonnie et al., 2022). There is considerable overlap between the social de- terminants of health theory and community and societal adversities. Research stemming from the social determinants of health theory ac- knowledges that adversities such as racism significantly impact chil- dren's socioemotional and behavioural development (Berry et al., 2021). For example, exposure to racism is associated with birth dis- parities and mental health difficulties in children and adolescents (Trent et al., 2019). A more comprehensive approach must consider ACEs in concert with other structural adversities as core health-shaping experi- ences. Expanding the ACEs framework to include adversities like racism would integrate and reflect the research supporting these realities.

Considering broader community and societal factors within ACEs research necessitates a shift in research methodologies and intervention strategies. Longitudinal studies that capture the cumulative impact of multiple adversities across different levels of the social ecology are crucial for understanding the complex pathways through which ACEs influence health outcomes. This may include better systematic collec- tion of vital sociodemographic information as part of administrative health data. Furthermore, interventions to prevent or mitigate ACEs must adopt a multi-level approach that addresses individual and struc- tural determinants (Amundson & Afifi, 2020). This may involve imple- menting policies to reduce poverty and promote community cohesion.

4. Expanding methodological considerations of ACEs

The current 10-item ACE measure is primarily used by summing the items of the questionnaire to obtain a cumulative score. This total score has been consistently associated with poor health and mental health outcomes in a dose-response fashion (Waehrer et al., 2020). The greater the number of ACEs, the poorer the outcomes. However, this simplistic approach overlooks the individual impact of each ACE and the specific characteristics of adverse exposures, such as timing, type, or severity (LaNoue et al., 2020; McLaughlin & Sheridan, 2016; McLennan et al., 2019, 2020, 2024). For instance, research indicates that children are particularly vulnerable to adverse health effects when exposed to

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K. Sawyer et al.

stressors at a young age (Flaherty et al., 2006).

Furthermore, the type of adversity experienced can have diverse

effects on brain and physiological development, leading to a wide range of implications for health outcomes (Berman et al., 2022; McLaughlin & Sheridan, 2016). In addition, the reliance on a cumulative approach overlooks the importance of exposure levels. The biological, psycho- logical and physiological mechanisms that unfold following acute adversity differ from those triggered by chronic adversity (Anda et al., 2020). Finally, summing questionnaire items to create scores linked to negative outcomes suggests that individuals with ACEs will inevitably face poor outcomes. This perception is reinforced by much of the existing literature, which tends to focus on the harmful effects of ACEs across the lifespan. However, it is essential to note that ACEs are not deterministic. Expanding ACE measurement beyond the original 10 items to be more comprehensive will provide a more nuanced under- standing of how ACEs influence future health outcomes.

Structured clinical interview or the cultural formulation interview, both developed by the American Psychiatric Association, can provide more detailed information about adversity. These tools can capture childhood experiences, cultural backgrounds, family dynamics, and other environmental factors with greater detail and nuance than the ACEs questionnaire alone. However, addressing the complexity of measuring data from these interviews is beyond the scope of this paper.

5. Consideration of protective factors, adaptation, and interventions

The evidence demonstrating the direct detrimental impact of ACEs on individual health and well-being has been extensively documented (Hughes et al., 2017). However, not all children exposed to ACEs have poor outcomes. Some children demonstrate adaptation skills despite adversity exposure, inferring that the exposure to ACEs is not deter- ministic (Oshri et al., 2020). There is evidence that protective factors such as social support, supportive family relationships, access to edu- cation and healthcare, positive peer relationships, and a sense of belonging within one's community can mitigate the impact of adversity (Racine et al., 2022). Given the importance of protective factors, the World Health Organization created a platform of strategies to support the response and prevention of violence against children, including several protective factors such as fostering safe environments, parent and caregiver support, economic strengthening, education, and life skills. Considering these preventative and protective factors is essential to reducing ACEs internationally and having a more globally relevant approach to ACEs research (World Health Organization, 2016).

Additionally, growing evidence suggests that for some individuals and in small amounts, ACEs may also lead to adaptive changes in an individual's behaviour, cognition, and neurobiology, particularly in response to chronic stress (Racine et al., 2023; Riggs et al., 2006; van et al., 2020). Specifically, heightened vigilance in response to perceived threats, increased empathy towards others experiencing adversity, and enhanced problem-solving skills are adaptive responses that may emerge in individuals exposed to ACEs (Ellis et al., 2017). Thus, un- derstanding sources of protection and adaptation in addition to exposure to childhood adversity will provide a more holistic understanding of the implications for child health and inform the development of preventa- tive approaches and interventions.

A related consideration is that research examining feasible in- terventions for ACEs lags far behind the literature describing their im- pacts. Most promising research points to mental health support, with less conclusive data on other modalities (Lorenc et al., 2020). There remains a paucity of interventions linked directly to the described or hypothesized pathophysiology underlying ACEs-associated ill health (Kirlic et al., 2020). The future of ACE research needs to support a shift in study that includes evidence-based interventions that can be imple- mented and applied globally to improve population health.

Child Protection and Practice 3 (2024) 100054

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6. Future directions

The global health burden of ACEs necessitates public health sur- veillance and action to reduce exposure and mitigate poor outcomes for those affected. The field of ACE research has matured, and it is time to consider factors relevant beyond Western contexts and that occur in social spheres outside the family, including community and societal levels. Research should account for exposures relevant to children across cultural and geographic contexts. It should capture the characteristics of adversity and protective factors that enhance adaptation. In future, a focus on strategies to reduce a broad consideration of ACEs should guide international, regional, and municipal policies to enhance child well- being and health.

CRediT authorship contribution statement

Kafui Sawyer: Writing - review & editing, Writing - original draft. Samantha Kempe: Writing - review & editing, Writing - original draft, Project administration. Matthew Carwana: Writing - review & editing. Nicole Racine: Writing - review & editing, Writing - original draft, Supervision.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Answer those questions using citations of the book, film and the Expanded ACEs article

1. Reflecting on your own (PCE) Positive Childhood Experiences in Your

Community:

Think back to your childhood or that of someone close to you. Were there individuals or

groups in the community who played a supportive role during difficult times?

Reflect on one or two specific positive experiences or community members that had a lasting

impact. How did their actions contribute to a sense of safety, belonging, or resilience in your

life or the life of someone you know?

2. Tables turned: Now or in the future. Your Role as a Community Member

in Supporting Families

Consider your current or future role in your community, whether as a student, professional,

or volunteer. In what ways do you think you can help support children and families who may

be experiencing adverse situations? What role do you see yourself playing now or in the

future in fostering such environments for others? (Big, medium, little impact all matters!)

3. The Film you watched.

??? If you watched the shorter video with Dr. Perry...comment on the new learning and

connections for you. What aspects of the film caused you to pause and reflect?

4. Final question: Expansion of ACEs article

What are your thoughts on the concept of "expanding ACEs"?