Adverse Childhood Experiences (ACEs) and Attachment

What is Attachment?

Attachment refers to the pattern of the relationships we have had with our parents or carers early in our lives. It is the emotional bond that forms between a parent and child from birth and has a huge impact on our development. The way a parent or carer responds to their child will impact on the child’s attachment style. This attachment style becomes a template for how we build future relationships with others in our lives, and also a template of how we feel about ourselves and other people. If we have experienced a relationship with a parent or carer which has been positive, we will develop a positive template for other relationships as well as positive feelings about ourselves and others. But sometimes how children are cared for is not so positive, for various reasons, and this can make it harder for people to make and maintain positive relationships in the future, manage their feelings and behaviour, or feel good about themselves or others. When our early attachments have been negative and these lead us to go on to have difficulties with relationships and our mental wellbeing, this can sometimes be described as attachment difficulties.

What are Adverse Childhood Experiences?

Adverse Childhood Experiences (ACEs) are “highly stressful, and potentially traumatic, events or situations that occur during childhood and/or adolescence. They can be a single event, or prolonged threats to, and breaches of, the young person’s safety, security, trust or bodily integrity.” (Young Minds, 2018).

Examples of ACEs:

• Physical abuse
• Sexual Abuse
• Emotional Abuse
• Living with someone who abused drugs
• Living with someone who abused alcohol
• Exposure to domestic violence
• Living with someone who has gone to prison
• Living with someone with serious mental illness
• Losing a parent through divorce, death or abandonment

In a 2014 UK study on ACEs, 47% of people experienced at least one ACE with 9% of the population having 4+ ACES (Bellis et al, 2014).

Impact of ACEs

Just like attachment, experiencing ACEs can have an impact on our future physical and mental health, and often ACEs can be barriers to healthy attachment relationships forming for children. Some of the effects of ACEs on our physical and mental health are:

• An increase in the risk of certain health problems in adulthood, such as cancer and heart disease, as well as increasing the risk of mental health difficulties, violence and becoming a victim of violence.
• An increase in the risk of mental health problems, such as anxiety, depression, and post-traumatic stress. 1 in 3 diagnosed mental health conditions in adulthood directly relate to ACEs.
• The longer an individual experiences an ACE and the more ACEs someone experiences, the bigger the impact it will have on their development and their health.

Some of the other things exposure to ACEs can impact, are:

• The ability to recognise and manage different emotions.
• The capacity to make and keep healthy friendships and other relationships.
• The ability to manage behaviour in school settings.

Difficulties coping with emotions safely without causing harm to self or others.

CAMHS support

Not everyone who has experienced ACEs, or has experienced some difficulties in their attachments may need CAMHS support. But, CAMHS can offer advice and support in a number of ways to help children and young people manage some of the impacts of ACEs, or after having difficulties within early attachment relationships.

Because ACEs affect everyone differently, CAMHS professionals will always complete an assessment to try and find out what has happened to you and how it is affecting you so that the right support can be arranged.

Sometimes CAMHS will work with parents or carers to think about how they can support their child to cope with what has happened and provide healthier care to help their child develop. Children who have experienced ACEs or have developed insecure attachments need particular caregiving approaches to thrive that may be different from some more conventional styles of caregiving, and CAMHS provides support in identifying how parents and carers can change their approach to best meet the needs of their child. CAMHS may also provide family therapy or other ways of working together with parents and children together. Finally, it can also sometimes be useful for children and young people to have their own support, and CAMHS may offer a range of different types of therapy or support, such as Cognitive Behavioural Therapy (CBT) which helps with anxiety, depression and trauma amongst other things, or Eye Movement Desensitisation and Reprocessing Therapy (EMDR) which also helps with trauma. However, the young person may need other support first to help them learn ways to cope with or manage strong feelings or other difficulties, or to help them spend time building up trust with the CAMHS professional.  We can also help link young people up with other local community services, if this is what they want.

What can carers do to help their child

Parents and carers have a responsibility to keep children and young people safe from harm and sometimes need support themselves to protect families from ACEs. When children are already affected by ACEs, parents and carers may need support to alter their caregiving style to fit with the additional needs of their child. Seeking to learn about and adopt healthy caring styles can make the biggest difference to children’s emotional wellbeing, and is the foundation needed for children to use therapeutic support themselves if needed.