When Adverse Childhood Experiences (ACES) Underlie Problem Behaviors

Updated July 2021

Four-year-old Wyatt was struggling in preschool, suddenly defying directions, and demanding more attention than usual. Nap time became a particular challenge. He would slither on the floor, trying to avoid his cot, in the process disturbing others trying to sleep. Frustrated, his teachers would ask him to stop bothering others, giving him few minutes to comply. When Wyatt didn’t comply, a teacher or helper would try physically directing him back to his cot. Usually, that made him panic and kick anyone close by. When he kicked, a helper restrained him, often causing him to kick and fight back even harder. Eventually, Wyatt was asked to leave his preschool.

What his teachers didn’t know was that Wyatt’s parents were going through a divorce, and he had been listening to them argue violently every night for months.

Often when we investigate the underlying causes of problematic behaviors, we find a challenge or lack of resources in some area of a child’s life. Psychologist Ross Greene calls the lack of resources “unsolved problems or lagging skills”.  Certain extreme risk factors, including a range of “adverse childhood experiences,” are known by the acronym ACEs.

Kaiser conducted the original ACE Study in collaboration with the Centers for Disease Control (CDC) in California from 1995 to 1997. Over 17,000 patients completed surveys about their early childhood experiences and their current health and lifestyle. The researchers surveyed adults about their history of various childhood adverse experiences including:

  • Physical abuse
  • Sexual abuse
  • Emotional abuse
  • Physical neglect
  • Emotional neglect
  • Intimate partner violence
  • Violent treatment of the patient’s mother
  • Substance misuse within the household
  • Household mental illness
  • Parental separation or divorce
  • Incarcerated household members
  • (I (MD) would add misunderstood sensory and wiring differences, especially if treated with compliance and behavior-based treatment which can cause excessive stress to many vulnerable neurodivergent children).

The researchers found that the more cumulative adverse childhood experiences an adult had, the more likely the person was to have health, interpersonal, and behavioral problems throughout their lifespan. The study was among the first to bring attention to early-childhood risk factors and the impact of trauma. It showed that it’s useful to learn about and consider each child’s history.

It is important for teachers and parents to understand that when a child experiences stressful life events, the child’s thresholds for emotional and behavioral control decline. No matter how much the child may want to comply with what is being asked of him, sometimes he simply can’t.

Many of our children who have been exposed to stress or trauma have difficulties with emotional and behavioral control, as did Wyatt.

How can we detect whether a behavior signifies a stress response or intentional misbehavior? A few hints:

*If a child’s behavioral and emotional challenges increase after she is asked to comply, consider this a stress response. It’s likely that what we’re asking of the child exceeds her ability to cope.

*Try to warmly engage with a child who is having behavioral struggles and see if the challenging behaviors decline. Often they will because stress levels decrease when human beings feel safe.

When we punish children’s stress responses (fight-or-flight behaviors), we can cause more stress and—even worse—if a child is suffering from ACEs, we can generate additional mental health problems.

When children like Wyatt experience ACEs, their nervous systems are more vulnerable. If we take away human engagement from such a child, we can cause him to be even more vulnerable. That explains why many children in our social systems of care experience decline in their mental health. They are treated with disciplinary measures instead of social engagement, which is what they need in order to develop behavioral control. Secure relationships are the starting point to helping vulnerable children overcome their behavioral challenges and learn to regulate themselves in appropriate and healthy ways.

I share more about this paradigm shift in treating trauma and emotional challenges in a new self-paced  CE course and in the book Beyond Behaviors.