The impact of adverse,experiences in the home on the. health of children and young,people and inequalities in. prevalence and effects, The impact of adverse experiences in the home on the health of children and young people. About the Department of Health Executive summary 4. Introduction 6, The Department of Health DH helps people to live better for longer through leading shaping and. funding health and care in England making sure people have the support care and treatment they Conceptual Framework 6. need with the compassion respect and dignity they deserve The Department takes a comprehensive. Methods and Scope 6, approach to tackling health inequalities that addresses the wider social determinants along with. differences in access to and outcomes from health services and one that promotes healthier lifestyles ACEs the Social Determinants of Health and Health Inequalities 6. for all DH has commissioned the UCL Institute of Health Equity to build on the work of the post 2010 Part A Adverse Childhood Experiences what are they and why are they important 8. strategic review of health inequalities the Marmot review to develop the evidence base around the. 1 What are Adverse Childhood Experiences ACEs 9, wider social factors that shape health outcomes and contribute to health inequalities and to support. programmes and policy making at local national and international level 2 Observed associations between ACEs and health 10. 2 a Injury and death during childhood 10,2 b Premature mortality and suicide 12. 2 c Disease and illness 13, About the UCL Institute of Health Equity 2 d Mental illness 14. The Institute is led by Professor Sir Michael Marmot and seeks to increase health equity through action 3 Pathways from ACEs to negative health outcomes 16. on the social determinants of health specifically in four areas influencing global national and local 3 a Link from ACEs to health harming behaviours 16. policies advising on and learning from practice building the evidence base and capacity building The 3 b Link from ACEs to the Social Determinants of Health 17. Institute builds on previous work to tackle inequalities in health led by Professor Sir Michael Marmot and 3 c Neurobiological and genetic pathways 17. his team including the Commission on Social Determinants of Health Fair Society Healthy Lives the 4 The importance of action 19. Marmot Review and the Review of Social Determinants of Health and the Health Divide for the WHO 4 a The economic case 19. European Region www instituteofhealthequity org 4 b Intergenerational transmission 19. Part B Risk factors for ACEs 21,5 Risk Factors 22,About this report. 5 a The context in which families live 22, This report was written for the Department of Health by Matilda Allen and Angela Donkin of the UCL 5 b Parental and family factors 22. Institute of Health Equity 5 c Household adversity 23. Part C Prevalence of ACEs 24, The author is grateful to the Department of Health and to all of those who contributed to the programme. of work and commented on the report A list of these expert reviewers and other contributors is 6 Prevalence in England 25. provided in an Appendix 6 a Maltreatment 25,6 b Household adversities 26. 6 c Clustering of ACEs 26,7 Variations in ACE prevalence 27. 7 a Variations by local area 27, 7 b Variations by poverty disadvantage or socioeconomic status 28. 7 c Variations by age 30,7 d Changes over time 31,7 e International comparison in prevalence 31. Part D Taking action on ACEs 35,8 The current policy landscape 37. 9 Improving the context in which families live 39,10 Tackling Parental and Family risk factors 43. 11 Tackling household adversity 45,12 Principles for Action 47. 12 a Early intervention and prevention 47,Crown copyright 2015. 12 b Integrated working 47, You may re use this information excluding logos free of charge in any format or medium under the terms of the. 12 c Proportionate Universalism 47, Open Government Licence v2 0 To view this licence visit OGL or email psi nationalarchives gsi gov uk. 13 Areas for further research 48, Where any third party copyright information has been identified you will need to obtain permission from the. copyright holders concerned Conclusion 49,References 50. The impact of adverse experiences in the home on the health of children and young people The impact of adverse experiences in the home on the health of children and young people. EXECUTIVE SUMMARY economic output 10bn in human and emotional costs. and approximately 3 1bn to government funded services. b National level, National efforts are needed to ensure that spending. 18 The cost of children in care is 2 9bn of which an and policy decisions do not lower the living standards. estimated half is spent on abused children 19 20 of families below a level needed to afford a healthy. life or increase inequalities Given that 34 of families. are currently receiving less than the minimum income. Adverse childhood experiences income outcomes and an impact on genetic epigenetic There are risk factors which increase. standard 27 a reversal of the economic fortune of, and neurobiological functioning which also impacts on the chances of being exposed to ACEs. Adverse childhood experiences ACEs are situations which families will be needed Addressing low wages and. health across the life course 3 10 11, lead to an elevated risk of children and young people In order to take effective action to reduce ACE prevalence insufficient benefits for families would help to reduce. experiencing damaging impacts on health or other social it is necessary to understand the risk factors for adverse health inequalities and reduce inequalities in childhood. outcomes across the life course This report addresses There are clear inequalities in the experiences While anyone can be exposed to ACEs wellbeing. the issue for those under the age of 18 who are abused prevalence of ACEs which leads to there is an increased risk associated with the following. or neglected live in households where domestic violence inequalities in impacts circumstances Tackling parental and family risk factors. drug and alcohol misuse mental ill health criminality or Parenting programmes have a range of benefits and some. There is a clear inequalities dimension to ACEs While all The context in which families live. separation are present or who live in care In many cases have been found to reduce child maltreatment 26 28. ACEs are present across society inequalities in wealth Families that are socially isolated live in poverty or deprived. multiple ACEs are experienced simultaneously 29 Making these available to a wider range of parents. disadvantage and the existence of poverty impact on areas or are of a low socioeconomic status are all at. the chances of experiencing ACE Children growing up and implementing them with the involvement of a range of. Approximately half of the English population have higher risk of exposure to ACEs than those that are not sectors could reduce ACE prevalence. in disadvantaged areas in poverty and those of a lower For example children who live in the most deprived 10 of. experienced one or more ACEs although this varies, socioeconomic status are more likely to be exposed to ACEs neighbourhoods have a 10 times greater chance of being Reducing household adversity. according to the type of ACE For example in one study. compared to their more advantaged peers and more likely on a child protection plan than children in the least deprived. 12 reported witnessing domestic violence before the age Local organisations and practitioners can work in multi. to experience clustering co occurring of ACEs 2 4 Aside 10 of neighbourhoods 21. of 18 but only 3 9 parental drug misuse 1 Experience agency teams to provide integrated responses that. from these socioeconomic factors there is a range of other. of adversity tends to cluster several ACEs co occurring recognise multiple needs and adversities and act holistically. risk factors for ACE including poor and harmful parenting Parental and family factors. and those who experience four or more adversities are at a and flexibly to better detect and respond to those facing. approaches and the relative stress under which families live Poor parenting low parental age and family structure have all. significantly increased risk of poor health outcomes across adversity at home National government departments. 12 These risk factors are also universal but are again more been shown to correlate with ACE prevalence 15 22 23. the life course compared to those with no ACEs 2 4 It including Health and Education can support these efforts. likely to occur lower down the social gradient 13, is also probable that some ACEs are more likely to have by providing combined budgets and measurement tools. Household adversity, negative impacts than others although due to the fact that Due to inequalities in the prevalence of ACEs and the training staff to respond to adversities and acting as an. they are often experienced and measured simultaneously observed negative health impacts of ACEs it is likely that The presence of adversity in the home is an ACE in itself. advocate for positive policies across government, this is hard to ascertain ACEs are currently contributing to health inequalities There is and can have direct impacts on children s health and. also evidence that ACEs are transmitted across generations wellbeing 24 However it also increases the risk of other In addition all policies could usefully incorporate the. so that the children of parents who experienced ACEs ACEs For example parental abuse of drugs or alcohol principles of early intervention and prevention integrated. ACEs increase the risk of poor health has been detected in over half of parents who neglect their working and proportionate universalism Integrated working. in their own childhood are also more likely to experience. It is not always the case that children will be harmed ACEs 14 16 This perpetuates inequalities in health across children 25 for example can help both to detect and respond to. by exposure to ACEs for instance sometimes parental generations the risk factors for ACEs This should include a range of. separation can be protective of children s wellbeing for Action can be taken to tackle the partners including criminal justice health education and. example where domestic violence is present However risk factors for ACEs other services and staff who work with families. Acting to prevent ACEs could, evidence from England and elsewhere shows that children. improve health reduce inequalities Taking preventive action to reduce the prevalence of ACEs More evidence is needed on policy implementation and. and young people who are exposed to ACEs are at a, and save money and thereby improve population health therefore requires the relative benefits of programme options However from. greater risk of death or injury before reaching adulthood. acting on the risk factors identified Some current policies the evidence available it is clear that ACEs affect a large. and of premature mortality later on in life For example Taking action on the causes prevalence and impacts. for example the Troubled Families Programme 26 aim to proportion of the population and that they are impacting. women who were exposed to two or more ACEs before the of ACEs is therefore necessary in order to improve. do this However this and many other interventions are only on physical and mental health potentially reducing life. age of 18 have an 80 higher risk of dying by age of 50 health reduce inequalities within generations prevent. available for those with the very highest levels of need It expectancy and contributing to inequalities in health The. compared with those who were not exposed to any ACEs the transmission of disadvantage and inequality across. may be the case that many children who are exposed to evidence that shows a greater prevalence for those living. 5 Not only are those who are exposed to ACEs more generations and improve the quality of children young. ACEs but are not identified by local safeguarding systems in poverty or lower down the social gradient creates a clear. likely to die at a younger age than those who are not but people and adult s lives One study suggested that 12. would benefit from a proportionate universalism approach equity case for action There is also a clear economic case. they are also more likely to experience a range of illnesses of binge drinking 14 of poor diet 23 of smoking 52. universal in scope but recognising the increased burden for taking action Acting on known risk factors can help. including cancer heart disease lung disease liver disease of violence perpetration 59 of heroin and crack cocaine. faced by those lower down the social gradient This could prevention efforts to reduce adversity improve health and. stroke hypertension diabetes asthma and arthritis 2 6 8 use and 38 of unintended teenage pregnancy prevalence. act on the three risk factors as follows tackle health inequalities and a range of other desirable. ACEs also increase the risk of mental ill health the World nationally could be attributed to ACE experience below the. social and economic outcomes, Health Organisation estimates that 30 of adult mental age of 18 Reducing these rates would improve health and. Improving the context in which families live, illness in 21 countries could be attributed to ACEs 9 also save money 1. a Community level, The potential pathways by which ACEs could impact The cost of child maltreatment alone has been estimated Local programmes that tackle social isolation increase. on health outcomes include through an increase in health to total 735m a year 17 and reducing the health impacts community coordination and mitigate the negative. harming behaviours For example those who experienced of ACE could decrease pressure on the NHS and other impact of poverty the recession and austerity measures. four or more adverse experiences during childhood have an local support services In 2009 the costs of domestic on families may help to reduce stress increase resilience. increased odds ratio of 11 for using heroin or crack cocaine violence in the UK were estimated at 1 9bn in terms of lost and therefore reduce ACE prevalence. 1 a negative impact on educational employment and, The impact of adverse experiences in the home on the health of children and young people The impact of adverse experiences in the home on the health of children and young people. INTRODUCTION Fair Society Healthy Lives known as the Marmot Review. 13 set out the evidence of inequalities in health and the. These relate to ACEs and health in three ways Firstly. tackling the presence and impacts of ACEs is an important. social determinants of health in England and proposed six component of some of these policy objectives such. high level policy objectives in order to take action on the as giving children the best start in life and maximising. social determinants of health These were capabilities and control. Childhood and adolescence are key periods for contributions of a range of external partners including 1 Give every child the best start in life Secondly inequalities in the SDH could be contributing to. development growth and education and are of critical the Department of Health gained through a consultation inequalities in the prevalence of ACEs Deprived areas and. importance in shaping adulthood It is widely recognised process 2 Enable all children young people and adults to maximise families living in poverty who do not have a healthy standard. that just as supportive nurturing safe and happy childhoods their capabilities and have control over their lives of living are likely on average to have a higher prevalence. are necessary for later health and wellbeing if individuals The focus is on England but international evidence is. of ACEs see Section 7, live in damaging circumstances or are exposed to adverse presented where this is informative For example a long 3 Create fair employment and good work for all. conditions early in life this can have negative short and running American study on ACEs can provide evidence on Thirdly the presence of ACEs could impact on the SDH. long term health impacts that is informative for the English 4 Ensure a healthy standard of living for all. long term effects including for health so that children and young people who are exposed to. context In addition in some places we have used evidence ACEs are more likely than those who are not to grow up. 5 Create and develop healthy and sustainable places and. This report examines these negative circumstances for from across the UK rather than England alone as this was to live in conditions such as in poverty or with damaging. communities, children and young people aged 0 to 18 in England What the data available However there are policy and other employment that have a negative impact on their health. adverse childhood experiences ACEs are their health contextual differences between the UK countries and some 6 Strengthen the role and impact of ill health prevention see Section 3 represented in purple in the conceptual. impacts the likely pathways by which these health impacts results may vary depending on country framework below. occur and reasons for action are presented in Part A of the. report represented in blue and purple in the conceptual Adverse childhood experiences or ACEs is the term used. framework below in this report The scope of this definition is described in. Section 1 In some places within the report a wider set. In order to reduce the incidence of ACEs it is necessary of experiences or conditions are included for instance. to act on their risk factors in green in the conceptual subjective wellbeing or child poverty as they give an. framework These risk factors are presented in Part B of indication of the conditions in which children and young Intergenerational. the report people live transmission, There are clear inequalities in the prevalence of ACE and The report examines inequalities in ACE prevalence. those who are exposed are more likely to be of a relatively according to a number of different variables including. low socioeconomic status live in poverty or deprivation poverty and other socioeconomic factors However it. Prevalence plus variations by local area age time and is not within the scope of this work to address issues of. country are discussed in Part C intersectionality including how experience of adversity Adverse childhood experiences. varies by children s ethnicity gender disability sexuality. What works to tackle ACEs and some promising policy or the related issue of children as carers Context in Parent and Health harming Social. areas form the content of Part D the report s final section Household Maltreatments. which family behaviours determinants, The report covers children and young people aged adversities. families live factors of health, 0 18 and we use the term children and young people eg education. CONCEPTUAL FRAMEWORK eg poverty eg parenting eg domestic and neglect. income eg education, throughout to mean this However we have also provided violence. social isolation income, The conceptual framework provides an outline of the topic information where possible on data by age and tried to. social protection, areas that are discussed in this report and how they relate to include significant evidence related to children over age 5 policies. each other The arrows represent correlations connections since this has been less thoroughly examined in previous. or possible pathways but do not show evidenced causation reports. because in many areas the current evidence is suggestive of. causation but it is not proven ACES THE SOCIAL DETERMINANTS OF. HEALTH AND HEALTH INEQUALITIES,METHODS AND SCOPE, The term social determinants of health SDH refers to. This report draws on published peer reviewed articles the conditions and circumstances in which we are born. Health morbidity physical and mental and early mortality. academic research reports and longitudinal studies and grow live work and age These conditions are shaped by. third sector organisations In addition policy documents inequalities in power money and resources and therefore. and analyses of policy impacts are included It is not a are unequal in their distribution 13 14 This inequality in the. systematic literature review but showcases a selection of social determinants of health contributes to inequalities in. evidence in order to inform the areas for action presented health outcomes In England between the most and least. in Part D It is also based on the experience and expertise deprived local areas there is a difference of 17 years in the. within the UCL Institute of Health Equity and the number of years that people live in good health. The impact of adverse experiences in the home on the health of children and young people The impact of adverse experiences in the home on the health of children and young people. ADVERSE CHILDHOOD EXPERIENCES, What are they and why are they important A What are adverse childhood experiences ACES. The term adverse childhood experiences ACEs was There are clear conceptual difficulties in this field Research. originally coined in an American study on the impact of literature policy frameworks and local interventions often. Key messages adversities across the life course 2 Adverse childhood use different definitions or classifications of ACEs and. experiences have since been defined as intra familial therefore comparing findings across contexts can be. WHAT ARE ADVERSE CHILDHOOD EXPERIENCES ACES AND WHY ARE THEY IMPORTANT events or conditions causing chronic stress responses in difficult. the child s immediate environment These include notions of. maltreatment and deviation from societal norms 5 This is The first type of adverse experiences child maltreatment. ACEs refer in this report to maltreatment sexual Through an impact on the social determinants. the general definition used in this report has clear damaging effects on the child or young person. physical or emotional abuse neglect and household of health particularly evident is a negative. Household adversities vary in their impact on children. adversity adult s in the household with mental impact on educational employment and income. Despite the term childhood these adversities can be and their development and later health For example. illness substance abuse problems or criminality the outcomes each of which has an impact on. experienced by anyone In this report we include evidence many children whose parents have diagnosed mental. presence of domestic violence or parental separation health. on children and young people below the age of 18 with illness or who are separated do not experience negative. or living in care experienced from the ages of 0 to 18. Through an impact on genetic epigenetic and a focus on those over five where possible due to less of outcomes However these are included in the definition of. Children and young people who are exposed to ACEs neurological functioning a focus on older children in the existing literature The UN ACEs in this report as they can increase the risk of poor. have an increased risk of negative health outcomes Convention on the Rights of the Child defines children health and wellbeing For example the Early Intervention. across the life course The costs of child maltreatment and household as those under 18 and this is also the case in English Foundation has stated that witnessing domestic violence. adversity are high One estimate puts child legislation 30 and abuse between parents can have similar long term. At the most extreme maltreatment can result in death maltreatment alone at 735m a year consequences for a child to physical abuse that is targeted. or injury under the age of 18 either at the hands of ACEs or adverse experiences within this report refer to at the child 32 In addition the scope of this work places. someone else or as a result of suicide or self harm An English study has suggested that 12 of binge particular emphasis on conditions within the home and. Maltreatment, drinking 14 of poor diet 23 of smoking 52 of the majority of the literature also include this wider group of. ACEs are also related to premature mortality In men violence perpetration 59 of heroin crack cocaine Physical abuse household adversities. the risk of death before the age of 50 is 57 higher use and 38 of unintended teenage pregnancy. among those who experienced two or more ACEs prevalence nationally could be attributed to ACEs Emotional abuse However household adversities can also increase the risk. compared with those who experienced none In creating a clear need for prevention for personal. Sexual abuse of child maltreatment 15 and so in Part B we examine this. women the risk is 80 higher societal and economic reasons relationship and included these household adversities as a. Neglect risk factor, An increased risk of disease has also been found to Wider social and economic conditions such as. be present among those who experienced ACEs This poverty and neighbourhood deprivation can also Household adversity1 There is also a case for including material or social context. includes heart disease cancer lung disease liver have negative impacts on the health and wellbeing or resources within the scope of household adversity. disease stroke hypertension diabetes asthma and of children and young people but are not included in Domestic violence This encompasses physical for example living in extreme poverty or deprivation could. arthritis the definition of ACEs in this report psychological sexual financial and emotional abuse and be seen as an adverse experience In this report we have. includes controlling and coercive behaviours 31 not included these wider contextual factors as ACEs in. ACEs have a clear correlation with mental health Clear inequalities in terms of prevalence and line with the position taken in the majority of the literature. outcomes across the life course The World Health distribution of ACEs according to socioeconomic Substance misuse there are adults within the home with. However this is not to suggest that they are merely. Organisation WHO estimates that 30 of adult mental factors are shown in Part C Part D presents drug misuse or addiction problems including alcoholism. background factors that should not be acted upon As. illness in 21 countries could be attributed to ACEs actions to reduce ACEs that focus on improving the is discussed in Parts B and C these are clear risk factors. Mental ill health there are parents or other adults within. context in which families live The clear inequalities for ACE prevalence and tackling the unequal distribution. ACEs often cluster and being exposed to many ACEs the home with diagnosed or undiagnosed mental illness. in prevalence of ACE mean that some children of power money and resources and specifically negative. heightens the risk of poor health and other outcomes and young people are more at risk of poor health Criminality parents or others who usually live in the home economic circumstances that result from this is an. outcomes than others thereby potentially increasing are either in prison or on probation essential strategy to reduce the prevalence of ACEs as. There are three potential pathways by which ACEs, health inequalities well as reducing inequalities in childhood development and. may impact on health, Separation parents are separated or divorced or one or. experiences more generally ACEs must be seen as one. Those who experience adverse conditions are more both parents are dead. Through an increase in health harming behaviours part of a range of circumstances experiences and contexts. likely to be children of parents who themselves were. such as substance or alcohol misuse smoking which impact on families and which must be considered. exposed to ACEs This intergenerational transmission Living in care children are looked after by the state in. sexual risk behaviour violence and criminality holistically in order to be tackled successfully. of adversity is another form of inequality that could a care setting or elsewhere sometimes referred to as. or behaviours leading to obesity For example, reduce social mobility looked after children and young people. those who experienced four or more ACEs have,an increased odds ratio of 11 for using heroin or. crack cocaine, 1In some of the literature this set of adverse experiences is called household dysfunction. The impact of adverse experiences in the home on the health of children and young people The impact of adverse experiences in the home on the health of children and young people. Observed associations between ACES and health Table 1. Summary of the strength of the evidence on health outcomes and child maltreatment WHO 2013. Health outcome Physical abuse Emotional Neglect Sexual abuse. In this section we use evidence from studies conducted although protective factors can increase resilience this Depressive disorders. in other countries in particular the USA because studies does not make children and young people invulnerable Anxiety disorders. on the long term impacts of ACEs have been running for a or impervious to harm experiencing severe or multiple. Suicide attempts, longer period of time there than in the English context While adverse experiences is likely to be damaging to children and. exact impacts may vary a detected association between young people regardless of how high their resilience levels Drug use. ACEs and health outcomes in another country particularly are 34 STIs risky sexual behaviour. one of similar wealth and development is likely to suggest a. similar association would be found in England However we One UK based study has found that those who experience Eating disorders. do know that the strength of association may be different neglect at an older age are likely to experience worse Obesity. within the two countries because differences in social outcomes compared with their younger counterparts. 36 This is supported by American evidence which finds Childhood behavioural conduct disorders. protection levels and social care for example are likely to. modify the effect Further work to strengthen the English that maltreatment experienced during adolescence had a Type II diabetes. evidence base would be beneficial stronger and more pervasive effect on later adjustment. Alcohol problem use, including in areas such as criminality substance misuse and. The evidence in this section varies in strength and in some other health damaging behaviour 37 Cardiovascular disease. areas conclusive studies have not yet been conducted Smoking. Table 1 shows how the WHO summarises the strength of. the current evidence regarding maltreatment household. 2 a Headaches migraine, adversity was not included in its scope Injury and death during childhood Personality disorders. Not everyone who is exposed to one or more ACEs will At their most extreme the presence of ACEs can result Self harm. experience negative health outcomes a review of children in death during childhood In 2012 13 there were 69 Arthritis. and young people who had experienced ACEs found homicides of children aged 0 15 across the UK 38 The. Hypertension, that a large proportion do appear to be functioning presence of ACEs can also increase self harm and suicide. adequately or well 33 The type of ACE the number of among children and young people There were 170 suicides Ulcers. ACEs experienced and the length of time over which they of 15 19 year olds in the UK in 2013 135 of which were Chronic spinal pain. are experienced can impact on the risk of negative health in England and Wales This was split into 112 male and 23. outcomes female 39 Part C on prevalence of ACEs gives further Schizophrenia. information on hospitalisation rates for injury among children Sexual re victimisation as an adult. In addition contextual factors can increase resilience and young people and how they vary by local area Self. the ability to bounce back from adverse experiences Sexual perpetration. harm suicide and injury rates among children and young. Supportive peer relationships the impact of schools people are likely to reflect in part the presence of ACEs Allergies. potentially family wealth and a range of other factors can However there is a lack of clear data on this relationship Cancer. reduce vulnerability of children to poor health and wellbeing. outcomes as a result of adversity 34 35 However Neurological disorders. Underweight malnutrition,Uterine leiomyoma,Bronchitis emphysema. Chronic non cyclical pelvic pain,Non epileptic seizures. Robust association,Plausible outcome limited evidence. Plausible outcome emerging evidence,Source from 15. The impact of adverse experiences in the home on the health of children and young people The impact of adverse experiences in the home on the health of children and young people. Premature mortality and suicide Disease and illness. A British study published in 2013 used longitudinal data of A different study of the same birth cohort 1958 examined The US ACE study found a relationship between the Figure 2 shows data from a 2013 survey of 4 000 English. a set of over 15 000 individuals born in 1958 to determine what risk factors were present at age seven that predicted number of ACEs and the presence of diseases in adulthood adults which demonstrated increased odds of developing. mortality rates by 50 The authors found that in men later suicide The authors found that emotional adversities including ischemic heart disease cancer chronic lung a range of diseases according to the number of ACEs. the risk of death was 57 higher among those who had such as parental death or separation and living in care had disease skeletal fractures and liver disease 2 experienced The graph shows particularly high risks. experienced two or more ACEs compared to those with an association with risk of suicide This risk was graded associated with experience of four or more ACEs. none Women with one ACE had a 66 increased risk the highest was for persons with three or more adversities Other studies have also found relationships with a risk of. stroke 6 and the development of cancer 7 hypertension Figure 3 is based on the same data and shows the amount. of death and those with two or more ACE had an 80 40 Surveys conducted from 2010 2013 in eight Eastern. diabetes asthma 8 arthritis angina pectoris and of time that passes on average before individuals are. increased risk versus those with no ACE 5 The definition European countries found that respondents who reported. osteoporosis 6 US research has also found a three fold diagnosed with a major disease according to the number of. of ACE used included maltreatment living in care and at least four ACEs had increased odds of 49 for attempting. increased risk of lung cancer for those with six or more ACEs experienced The graph shows that those with more. some household adversity measures offenders parental suicide 41 This is a particularly high figure which may not. ACEs and found that this cohort were roughly 13 years ACEs have a higher rate of diagnosis at younger ages By. separation mental illness or alcohol abuse in the home be reflected in the English context but it does demonstrate. younger on average when first detecting symptoms than the age of 69 among those who experienced four or more. Figure 1 shows these rates for men and for women the potentially disastrous impacts of ACEs. those without ACEs 42 adversities during childhood only approximately two in 10. Although the overall proportions are small the relationships. people have not been diagnosed with a major disease. between mortality and prevalence of ACEs are clear. Figure 1 Figure 2, All cause mortality rate by age 50 according to prevalence of adverse childhood experiences Changes in risk of disease development with increased history of ACE English survey data 2013. British men and women 2008,7 male 5 2 or 3 ACEs,female 4 ACEs. Adjusted Hazard Ratio,dead by 50,0 1 2 or more,Number of Adverse Childhood Experiences. Disease Type,Source Data from 5 Source 3, The impact of adverse experiences in the home on the health of children and young people The impact of adverse experiences in the home on the health of children and young people. 2 d A study of the 1958 British birth cohort study estimated The graph shows varying impacts of different ACEs over. the impact of childhood adversities on psychopathology2 time For example some ACEs such as divorce of parents. Mental illness across the life course 48 This is one of the few studies and being looked after have a higher impact on mental. Research has shown that the presence of ACEs can to physical abuse in childhood or other adverse childhood that focus on older children rather than the 0 5 age illness at younger ages which then declines over time. increase the chances of children and young people experiences 9 range Figure 4 summarises some of the results related to. experiencing mental illness or a low level of mental adversity in the home. wellbeing including low self esteem depression and Some groups are more at risk of adverse mental health. relationship difficulties 43 45 In addition WHO Euro impacts than others for example a British cohort study. reports that post traumatic stress disorder has been found that looked after children and young people were Figure 4. reported in as many as a quarter of abused children 15 significantly more likely to be depressed dissatisfied with Increased odds ratio of psychopathology associated with various types of ACE by age UK 2008. Not only can experience of ACEs impact on childhood but life and have low self efficacy which relates to feelings. also there can be a lasting impact on adult mental health of control over one s life 46 After adjusting for family 6 0. The WHO World Mental Health Surveys estimate that 30 socioeconomic status residential care was associated with. of adult mental illness in 21 countries could be attributed an increased odds ratio of four for depression 47 5 5. psychopathology 16 years,5 0 psychopathology 23 years. Odds ratio where no experience 1,psychopathology 45 years. Figure 3 4 5, Cumulative proportion of individuals not diagnosed with a major disease with age unadjusted survival at period end. England 2013 4 0,Cumulative proportion not,diagnosed at period end. 0 0 Adversity type age of measures available,0 9 10 19 20 29 30 39 40 49 50 59 60 69. Survival period Source using data from 48, Note This is controlling for sex and socioeconomic status There are higher rates for unadjusted rates. Note Respondents reported year of first diagnosis with a doctor or nurse with cancer CVD diabetes type 2 stroke. respiratory disease and liver digestive disease, 2Psychopathology was measured using tools which capture a range of symptoms including affective and anxiety disorders. and depressive episodes, The impact of adverse experiences in the home on the health of children and young people The impact of adverse experiences in the home on the health of children and young people. Pathways from ACES to negative health outcomes Further results from the US ACE study have shown the. association between ACE and later smoking for example. potential 52 53 Evidence also shows that maltreated. children are more likely to have menial or semi skilled jobs. 16 of smokers reported verbal abuse in childhood as young adults and are more likely to be unemployed than. compared with 8 of non smokers and 14 reported their non maltreated peers 52. physical abuse compared with 7 of non smokers 49, English evidence supports these US findings 3 for There is significant evidence linking childhood maltreatment. The evidence presented above on the correlations between An English study published in 2014 found a correlation example those with four or more ACEs have been found to with poor educational outcomes 54 60 This includes. ACEs and health experiences does not determine causation between the number of ACEs experienced and health have odds ratios of three for smoking 1 evidence that verbal abuse contributes to lower language. or what pathway might be involved in this causation Data harming behaviours3 The increased odds ratios associated test scores for 10 year olds 57 and that abused children. in this area is more limited but some emerging evidence with four or more ACEs varied from two for poor diet to 11 A study using longitudinal data from the 1970 British Cohort have lower grades lower educational attendance and more. shows promise for incarceration Heroin or crack cocaine use also showed Study also found that those who were looked after as placements in special education programmes 56 Evidence. a significantly increased odds ratio of 11 The authors children were significantly more likely to smoke and have has also shown that maltreated children particularly those. conclude that resistance to commercial cultural and other criminal convictions 46 Generally admission to care at who were neglected had lower test scores and grades in. environmental pressures to adopt health harming behaviours a later age tends to result in increased risk of negative reading and maths 59. Link from ACES to health harming appears to be related to childhood stressors with nurturing outcomes for example admission to care after the age of. behaviours ACE free childhoods increasing personal resilience 1 10 was associated with an increased odds ratio of three for Other studies have shown an impact of household. smoking and six for adult criminal convictions 47 adversities on the SDH for example data from the 1970. It is possible that exposure to ACEs during childhood and Figure 5 using data from the US ACE study shows the British Cohort Study has shown a clear association between. adolescence increases the likelihood of an individual later increased risk of outcomes such as anxiety and health Studies of the association between ACE and obesity in maternal mental health and children s educational attainment. adopting health harming behaviours including substance harming behaviours e g drug use for those who have the 1958 British birth cohort show that the risk of obesity and future household income 61. misuse alcohol misuse smoking sexual risk behaviour experienced one or more ACE in the home and clear increased by 20 to 50 for several adversities 50. violence and criminality or behaviours leading to obesity gradients in risk by number of ACEs experienced English evidence has also showed adjusted odds ratios of Evaluating the full impact of the pathway from ACE to health. six for unintended teenage pregnancy among those who via the social determinants is complex as many studies. experienced four or more ACEs compared with those who of the impact of ACE control for educational attainment. Figure 5 experienced none and eight for violence perpetration 1 socioeconomic status or other SDH which therefore makes. ACE score and relative risk of a range of disturbances USA 2006 it harder to isolate these as pathways In general a greater. The adoption of these behaviours can be seen in the short relationship can be seen between ACE and health outcomes. 12 term mostly during adolescence but sometimes before when these factors are included often as unadjusted. 11 1 ACE and in the longer term during adulthood They impact on figures However this may be due to common causes. health directly through an increased likelihood of disease for example family poverty in childhood can increase the. accidents or violence and in some cases for example chances of experiencing ACE and increase the chances of. 9 3 ACEs criminality impact on the wider conditions in which people being unemployed later on in life In addition US studies. Adjusted odds ratio, 8 4 or more live the social determinants of health need to be replicated in the English context before strong. conclusions can be drawn,Link from ACES to the social 3 c. determinants of health Neurobiological and genetic pathways. 3 As described in the introductory section of this report the Finally there may also be a link between ACE and. social determinants of health SDH are the conditions in health that occurs through the direct impact of ACE on. which we are born grow live work and age and the impact neurobiological and genetic functioning. 1 that these conditions have on our health, Studies have suggested a relation between trauma which. can result from maltreatment other ACEs and brain, Experiencing ACEs may have an impact on three key social. dysfunction or neurobiological impacts that can affect later. determinants of health educational attainment employment. health 3 10 11 It is likely that part of this link is due to. and income For example a US study found lower rates. increases in damaging responses to stress 10 These. of success in employment and education among those. who were maltreated in childhood Of men in the sample alterations to stress responsive neurobiological systems. can impact emotional regulation somatic signal processing. maltreated as children 45 graduated from high school. substance abuse sexuality memory arousal and aggression. compared with 65 of non maltreated men for women,11 The pathways are summarised in Table 2. this was 52 compared with 71 51 There is evidence,Source using data from 10. that ACEs can impact on future employment and earning. Note These odds ratios were adjusted for age sex race and educational attainment. Full definitions for each of the areas are given in the full article. 3These were unintended teenage pregnancy early sexual initiation smoking binge drinking cannabis use heroin or crack. cocaine use victimization from violence violence perpetration incarceration poor diet and low physical exercise. The impact of adverse experiences in the home on the health of children and young people The impact of adverse experiences in the home on the health of children and young people. Links from trauma to observed adult outcomes via neurobiological effects. The importance of action, Demonstrated neurobiological defects from early trauma Area of function or dysfunction. Hippocampus amygdala and medial prefrontal cortex atrophy Anxiety panic depressed affect hallucinations and. It is clear that acting to reduce the prevalence of ACEs substantial and that early identification of maltreatment. and dysfunction that mediate anxiety and mood problems substance abuse. would be likely to improve health both in the short and may lead to significant downstream savings 64. long term and this is a key reason for action In addition. Increased locus coeruleus and norepinephrine activity Smoking alcoholism illicit drug use injected drug use. inequalities in the prevalence of ACEs mean that health 4 b. decreased by heroin and alcohol use Intergenerational transmission. inequalities are likely to be increased through inaction There. are two further reasons for action the high economic costs There are clear intergenerational links in exposure to ACEs. Amygdala defects role in sexual and aggressive behaviour and Early intercourse promiscuity sexual dissatisfaction. and the intergenerational transmission of ACEs In general those children who experience ACEs are more. deficits in oxytocin with impaired pair bonding perpetuation of intimate partner violence. 4 a likely to have a parent who has also experienced ACEs This. Hippocampus role in memory storage and retrieval Memory storage and retrieval perpetuation of disadvantage from one generation to the. The economic case next contributes to societal inequalities as it places an extra. hippocampal and amygdala size reduction in childhood trauma. deficits in memory function Calculations in the US have estimated that the cost of new burden on those children who come from disadvantaged. cases of child maltreatment that were identified in one year backgrounds increasing the risk of ACEs across generations. Repeated stress and distress via glucocorticoid pathways Body weight and obesity 2008 is in the region of US 124bn 62 This is made up. This intergenerational transmission of adversity has been. leads to increased intra abdominal and other fat deposits of increased costs of childhood health care child welfare. reported in relation to child abuse 15 mental ill health 61. special education criminal justice adult medical costs and. and substance misuse 65 Exposure to domestic violence. Repeated stress and distress via several pathways leads to Sleep high perceived stress productivity losses. and other forms of violence increases the risk of becoming. increase in other physical problems, Some economic costing has also been calculated for the both a victim and perpetrator of violence in adolescence and. Multiple brain and nervous system structure and function Co morbidity trauma spectrum disorders UK or England context later life 66 67 sometimes called the cycle of violence. defects including monoamine neurotransmitter systems 16 One study has suggested that approximately a third. For example in 1996 the annual cost of child maltreatment. of parents who were maltreated in childhood will maltreat. in the UK was estimated to be 735m 17 while in 2004 UK. their own children 68 In part this may be due to children. Source Adapted from 10 figures estimated 1 14bn of social service funding was being. modelling the behaviour of their parents when they grow. spent on children for reasons for abuse and neglect 63. up and not having a positive experience to learn from and. In 2009 the costs of domestic violence in the UK were replicate Parenting programmes that teach about good. estimated at 1 9bn in terms of lost economic output parenting could help to break this cycle 69. The areas of genetics and epigenetics also may provide More research is needed in order to ascertain the extent of. 10bn in human and emotional costs and approximately. links between ACE and health It has been suggested that these pathways whether impacts vary by age of the victim A 2015 US study examined the pathways by which ACEs. 3 1bn to government funded services 18 The cost of. exposure to prolonged activation of physiological stress and whether they occur at lower less serious levels of experienced in childhood increase the risk of intimate partner. children in care is 2 9bn of which an estimated half is. responses due to events chronically unsupported by positive maltreatment or household adversity as well as in cases aggression in adulthood 70 The study found that among. spent on abused children 19 20, and secure relationships causes deleterious modifications to where children are severely neglected or abused men post traumatic stress disorder mediated the relationship. biological systems neuroendocrine inflammatory immune In the England context a study has suggested that 12 of between sexual abuse and intimate partner aggression. involving epigenetic modifications that may or may not binge drinking 14 of poor diet 23 of smoking 52 of and substance abuse mediated the relationship in men. be reversible 5 This then increases morbidity and early violence perpetration 59 of heroin crack cocaine use and and women It concluded that programs geared towards. mortality as individuals are less able to adapt to negative 38 of unintended teenage pregnancy prevalence nationally aggressors should address abuse sexual physical and. exposures and more likely to engage in damaging health could be attributed to ACEs 1 meaning that tackling ACEs psychological which occurred during childhood and recent. behaviours 5 could reduce the high level of cost associated with these substance abuse and PTSD post traumatic stress disorder. behaviours or outcomes In addition many of the health These programmes should be implemented for men and. impacts described in Section 2 are costly for the NHS and women 70. other parts of the public sector, However experiencing one or more ACEs in childhood or. The variation of cost estimates and the fact that many are adolescence is not fate it does not mean that the individual. outdated makes it hard to know the exact financial cost is destined to perpetuate these conditions in relation to their. of maltreatment and other ACEs In addition definitions own children Most people who are maltreated do not go on. and methodologies used vary between calculations For to maltreat their own children and most of those who were. example the 1 14bn figure cited above for social service exposed to violence do not go on to perpetrate or be a victim. funding only relates to the annual cost of services directly of violence More research is needed on the factors that. provided for children in need and those who are looked enable these people to break the cycle although it appears. after it does not include longer term economic costs The that having a higher socioeconomic status and sufficient. fact that many incidences of ACE are not officially detected economic resources may help For example English evidence. and recorded also makes cost estimates hard to quantify has found that father s mental illness ceased to have an. However as guidance from the National Institute for Health impact on their children s attainment and development where. and Care Excellence NICE on child maltreatment states the family had higher socioeconomic resources 71. the figures we do have available demonstrate that the. economic costs associated with child maltreatment are. The impact of adverse experiences in the home on the health of children and young people The impact of adverse experiences in the home on the health of children and young people. RISK FACTORS FOR ACES, Risk factors are cumulative meaning the more a family or. child experiences the more vulnerable they are 15 and Key messages. often co occur and are interlinked However as the NSPCC. states we cannot say that any single factor or collection RISK FACTORS. of factors causes maltreatment it is nonetheless Risk factors for ACEs are interlinked and often co. possible to identify certain contexts and environments occur Distinguishing the individual impact of any one. that are more frequently associated with child abuse and risk factor is therefore complex. neglect 38,The socioeconomic context in which families live. impacts both on ACEs directly and on other risk,factors such as household adversity or parenting. style The contextual factors that have been shown,to act as risk factors for ACEs include. Poverty low socioeconomic status,and disadvantage,Unemployment. Deprived communities,Social isolation, Parenting style and capability have been linked to. the prevalence of ACEs This interacts with other,family risk factors including age of parents and. family structure, Household adversity is a type of ACE but also acts. as a risk factor for child maltreatment In cases where. children have been neglected or abused household,adversities including parental substance misuse. separation or absence mental ill health and domestic. violence are more likely to be present,All of these risk factors do not occur equally. or randomly in the population and are more,concentrated lower down the socioeconomic. gradient This results in inequalities in the,prevalence of ACEs see Section 7. The impact of adverse experiences in the home on the health of children and young people The impact of adverse experiences in the home on the health of children and young people. Risk factors associated with their offspring reporting maltreatment during. childhood 85 Parents who maltreat their children are also. families are more common lower down the social gradient. which are also risk factors In some cases for example in. more likely to use harsh discipline strategies less likely to use which there is domestic violence or other conflict in the. positive parenting strategies and more likely to respond to home separation may be beneficial for the child and reduce. negative but not positive behaviours 86 87 the chances of maltreatment In addition while factors such. as family structure can increase the risk of child maltreatment. One element of knowledgeable parenting is having,5 a Unemployment. appropriate expectations and accurate understanding of. the absolute risk is still low for example in the UK. Studies that find a relationship between ACEs and longitudinal study cited above only 3 5 of all single mothers. The context in which families live children s development Some studies have found links. unemployment rarely control for income in order to ascertain had children registered for child abuse or neglect 77. Difficult and challenging social economic and cultural factors between higher unsuitable expectations of children and. the effect that unemployment might have over and above or. lower understanding of developmental processes and child. impact on families and increase the stress on parents and. separate from the increased risk of low income However 5 c. families All of these will likely increase the risk and likelihood maltreatment 88 89. some studies do mention unemployment specifically as a Household adversity. risk factor 15 and it may be the case that unemployment While some of these findings refer specifically to younger. Throughout this report some ACEs are grouped under the. increases the chances of children experiencing ACEs children it is likely that damaging parental relationships with. Poverty low socioeconomic status disadvantage term household adversities These are domestic violence. perhaps due to increased stress in the home children over the age of five and some parenting practices. Most parents who live in poverty are disadvantaged or have parental separation living in care and parents or caregivers. may be related to ACEs One study also found that poor. low socioeconomic status do not maltreat their children Deprived communities who have substance misuse problems including alcoholism. parenting was a background factor for adolescent physical. However there is evidence that low economic status and mental ill health or who are in prison or on probation As. The WHO states that maltreatment tends to be more abuse 22 However in some cases parental behaviours that. having insufficient economic resources can act as a risk factor well as having directly negative impacts on children and. common in families in deprived communities These areas may have been abusive or neglectful for a younger child are. for child maltreatment 38 72 For example there is evidence young people as outlined in the previous section on health. can lack social capital the institutions relationship and not so damaging for older children 90. that women from poorer childhood homes were twice as impacts these also increase the chances of them being. norms that shape a society s social interaction and may. likely to have suffered from abuse or neglect and three times Causation in this area is hard to ascertain and it is likely that exposed to maltreatment For this reason they are included. have many alcohol outlets 15, as likely to have suffered from more than one form of abuse poor parenting and child maltreatment also have common here as risk factors. than those from more affluent childhood homes 73 US The impact of local deprivation has also been seen in UK causes such as poverty or parental substance misuse. In England an examination of the household conditions. research has found that children in households with an annual studies children who live in the most deprived 10 of Parenting therefore interacts with and is related to other risk. present in cases of child death or serious injury shows. income below 15 000 in 1993 were 22 times more likely to neighbourhoods have a 10 times greater chance of being factors. the presence of domestic violence in more than 60 of. experience harm as a result of maltreatment compared with on a child protection plan and an 11 times greater chance of cases parental mental illness in 60 of cases and parental. those in families with incomes over 30 000 74 More recent being taken into care than children in the least deprived 10 substance misuse in 42 of cases 94 However deaths. US research has also found a clear relationship between 21 This may have an impact separate from the likely lower There is some evidence that younger parents may be more. and serious injuries represent a very small fraction of all child. material factors and child maltreatment 75 This includes a incomes and increased poverty of families in this area in part likely to maltreat their children than older parents 15 91 For. protection cases there are many less serious or immediate. random assignment study where a gain in income resulted through a lack of local services or community conditions which example a longitudinal study of British parents found that. impacts which also reveal household adversity as a risk. in a reduction in child abuse and neglect compared with a increase stress for families and do not provide sufficient social parents who were younger than 20 had a three times greater. factor For example further research shows that more than. control group 76 While random assignment is rare other support There is also evidence linking violent neighbourhoods risk of having a child placed on the child protection register. 34 of under 18s who have lived with domestic violence. studies have shown a correlation between reductions in to an increased risk of child maltreatment 79 before the child s sixth birthday 77 It may be the case that. have been abused or neglected by a parent or guardian. income and increases in child maltreatment 75 younger parents are more likely to be exposed to other risk. 25 and parental abuse of drugs or alcohol or both has. Social isolation factors such as poverty and unemployment compared. UK longitudinal research has found that an indicator been detected in more than half of parents who neglect their. There is some evidence that parents who maltreat their with their older counterparts and that this increases the risk. of deprivation derived from measures of paternal children 24. children are more isolated more lonely and have less social of child maltreatment 23 and likelihood of poor parenting. unemployment overcrowding living in rented or council US research supports these findings parental substance. support than those who don t 80 81 This may be in part. accommodation and not having access to a car had the Family structure abuse has been found to be a contributing factor for. because social isolation increases stress and those who are. strongest association with child maltreatment out of all the Children living in single parent families have been shown. isolated have a lack of positive parenting role models or a between 30 and 60 of maltreated children in the welfare. risk factors included in the study 77 to be at increased risk for maltreatment 15 74 92 A UK. lack of pressure from others to conform to positive parenting system and children whose parents abused alcohol were. The association between poverty and maltreatment is most behaviours 82 cohort study of more than 14 000 individuals also found a approximately three times likelier to be abused and over four. commonly explained by stress factors linked to unemployment relationship between family structure and child maltreatment times more likely to be neglected when compared with those. Evidence on the protective nature of parental social networks single parent and reordered with step parent families both whose parents were not substance misusers 31. low income and depleted resilience including social isolation. mental ill health domestic abuse and substance misuse 33 has found that they protect against poor outcomes for had a higher risk of children becoming placed on local child. children 83 and increase the amount of positive interactions Child maltreatment particularly sexual abuse in institutional. 38 For example parents with a low income are four times protection registers The odds ratio was three times higher. mothers have with their children 84 Social networks provide care settings has received much publicity recently Overall. more likely to feel chronically stressed than parents with higher in these families However the authors report that this odds. a shared understanding of parenting 84 and a buffer to the prevalence across the population is not possible to ascertain. incomes 78 The NSPCC states in relation to social status ratio drops substantially when other factors are controlled. challenges of parenting 12 with certainty but one study from 1992 found that out. and child maltreatment the most common explanation centres for suggesting that while important the effects of family. of 1 000 children in institutionalised care in the UK 158. on the stress factors that are associated with unemployment structure are modified by the confounding roles of parental. and low income such as social isolation and mental ill health. 5 b background and socioeconomic environment 77 Having. reported that they had been sexually abused 95 This figure. is now out of date however and prevalence may have. Poverty can also erode parents resilience to deal with these Parental and family factors larger numbers of children in the household has also been. changed significantly since then A 2013 National Crime. stress factors 38 Therefore acting to reduce poverty may be linked to an increase risk of neglect 93. Parenting Agency report found that children cared for by institutions. a good way to reduce the incidence on ACEs this is discussed It is not clear whether living with only one parent is the actual were more vulnerable to abuse due to the structure and. further in Part D There is some evidence that links parenting with child. risk factor for child maltreatment or whether this is indicative status of institutions and the power of the adults working in. maltreatment For example a retrospective study in the UK. Further information on English prevalence of ACEs according of poverty or low socioeconomic status since one parent them 96. found that incompetent parenting by mothers such as being. to measures of socioeconomic status deprivation or wealth is. impatient irritable or giving too little time and attention was. presented in Part C on prevalence, The impact of adverse experiences in the home on the health of children and young people The impact of adverse experiences in the home on the health of children and young people. PREVALENCE OF ACES,C Prevalence in England, Calculating the prevalence of ACEs is complex it is However despite these issues with the data it is clear that. Key messages considered that those cases which come to the attention many children and young people have been exposed to. of statutory services represent only a minority of the full adverse experiences and there is clear need for greater. prevalence For example the NSPCC estimates that for action to reduce the prevalence of ACEs For example. PREVALENCE OF ACES, every child subject to a child protection plan or on a child recent English survey data found that almost half of adults. protection register another eight children have suffered had experienced one of nine ACEs during childhood 1. Approximately half of the English population have Approximately 60 children per 10 000 were in care. maltreatment 38 Classifications by official services may. experienced one or more ACEs during childhood or in England as of March 2014. also oversimplify for example data on reasons for a 6 a. adolescence, ACEs tend to cluster and an ACE count of four or child being in need is suspect because social workers are Maltreatment. Rates for maltreatment alone are also high the more ACEs experienced is particularly associated required to give a single reason when almost all situations are. NSPCC estimates that over 25 of all young adults with lower outcomes across the life course multi factorial In some cases this leads to reporting of only A 2013 English survey of adults found that 6 3 of. up to 17 years old in the UK have experienced neglect or abuse as these categories trigger services when respondents reported experiencing sexual abuse 14 8. severe abuse or neglect at some point in their Although ACEs occur across society and no one others such as household adversity would result in no action physical abuse and 18 2 verbal abuse 1 The NSPCC. childhood is immune from adverse experiences there is an Survey data that asks parents or guardians about ACEs their estimates that over 25 of all young adults in the UK have. increased risk associated with being in a lower children have been exposed to can be subject to under experienced severe abuse or neglect at some point in their. English survey data which asked participants if position on the social gradient Children and young reporting Survey data of adults about their own childhood is childhood Table 3 shows how this varies by age type of. they had been exposed to a range of household people living in deprivation in poverty or who are also widely used in this area but has been criticised as being maltreatment and gender. adversities up to the age of 18 reported the of a low socioeconomic status are more likely vulnerable to reporting bias. following prevalence levels to be exposed to one or more ACEs than their. socioeconomically better off peers This inequality. Alcoholism 9 in the prevalence of ACEs could be contributing to. inequalities in health, Drug abuse 4 Percentage of 0 10 and 11 17 year olds estimated to have experienced a range of maltreatment UK 2011. International comparisons show that England does,Mental illness 12. well compared with similar countries on some Age Maltreatment type Male Female Total. Incarceration 4 maltreatment indicators but performs relatively. poorly on some household adversities such as 0 10 Any neglect in childhood 4 9 5 2 5. Domestic violence 12 domestic violence,11 17 14 8 11 8 13 3. 0 10 Severe neglect in childhood 3 3 4 2 3 7,11 17 9 9 9 8 9 8. 0 10 Severe physical violence by parent or guardian 0 9 0 7 0 8. 11 17 3 1 4 4 3 7, 0 10 Contact or non contact sexual abuse by anyone 0 7 0 5 0 6. in the past 12 months,11 17 6 8 12 2 9 4, 0 10 Emotional abuse by parent or guardian in the past 12 months 1 7 2 0 1 8. 11 17 2 4 3, This data also refers to the UK not to England alone 7 964 cruelty and neglect offences of under 16s and 23 663. The NSPCC report does not provide a further breakdown sexual offences of under 18s were recorded by police in. by country but some official data does referring to overall England and Wales 97. numbers rather than percentages For example in 2012 13. The impact of adverse experiences in the home on the health of children and young people The impact of adverse experiences in the home on the health of children and young people. 6 b As was mentioned earlier in the report some of these. household adversities are more likely to be associated with. Variations in ACE prevalence, Household adversities a higher risk of negative outcomes than others This report. Substance misuse places less focus on the less serious household adversities. A 2013 study of 4 000 English residents aged 18 69 found in particular parental separation However many studies. that 9 1 of adult respondents had lived at some point include a set of ACEs and do not disaggregate by type It. during childhood with a household member who abused can be seen from these prevalence rates however that 7 a The domestic violence rate per 1 000 population in 2010 11. even if parental separation were not included a significant varied from the lowest rate of 4 3 in Nottinghamshire. alcohol and 3 9 with a drug misuser 1 Variations by local area and Nottingham to the highest of 26 9 in Hartlepool. percentage of the population would still be exposed to one. Mental ill health or more ACEs Some types of ACE for example childhood abuse reported Middlesbrough Redcar and Cleveland and Stockton on. In the same study 12 1 reported mental illness in the to police have such low incidence rates that it is not possible Tees excluding the City of London 103 The rate of looked. home of parents or other carers 1 6 c to come to conclusions about prevalence by geographical after children also varies by local authority the lowest. being 20 per 10 000 in Wokingham and the highest at 152. Criminality Clustering of ACES area Others are not collected at a local level However a. range of indicators of childhood wellbeing development and per 10 000 in Blackpool 100 The variations in prevalence. 4 1 of English adults reported the incarceration of a parent. Many studies of ACE occurrence have found that they related factors are available on the Child and Maternal Health sometimes occur along a social gradient where those who. or other household member during childhood 1, tend to co occur or cluster For example the US ACE Observatory ChiMat website 101 for each local authority live in less deprived areas or localities with lower poverty. Separation study found that the clear majority of patients in our study including some relating to looked after children parents in rates experience lower rates of ACEs This is discussed. Separation can refer to parental divorce or separation or who were exposed to one category of childhood abuse or treatment for drug and alcohol misuse hospital admissions further in the following section. the death or absence of one or both parents In the study household dysfunction were also exposed to at least one for self harm and domestic violence Figure 7 presents an. referenced above 22 6 of respondents reported parental other 2 example. separation 1, This suggests that there may be common risk and protective. Domestic violence factors for a range of ACEs and that tackling these could. In the study referenced above 12 1 of respondents reduce incidence of a range of adverse experiences In Figure 7. reported domestic violence in the home 1 Official data addition it has been suggested that clustering increases the Hospital admissions caused by unintentional and deliberate injuries in children 0 14 years per 10 000 resident. suggests that 25 of young people in England and Wales risk of harm and that the experience of four or more ACEs population England upper tier local authorities 2012 13 ChiMat. have witnessed at least one episode of domestic violence is a threshold above which there is a particularly higher risk. and abuse by the age of 18 98 of negative physical and mental health outcomes 2 4 This. can be seen for example in much of the data presented in. Living in care Section 2 where there is a clear gradient in health impact by. Children in care refers to those children and young people number of ACEs experienced and a particularly heightened. who are looked after by a local authority 99 As of March risk for four or more ACEs. 2014 there were 68 840 looked after children in England. This is equivalent to 60 children per 10 000 the majority of Figure 6 shows that a greater clustering of ACEs is also present. whom 62 are in care due to experiences of abuse or in more deprived areas which increases the risk of poor health. neglect 100 outcomes as a risk of ACE exposure in these areas. Number of ACEs experienced by deprivation quintile England 2013 64 4 89 2. 100 89 3 103 0,90 103 1 117 9,80 118 0 142 4,2 or 3 ACEs. 70 1 ACE 142 5 214 1,of respondents,least deprived most deprived. Crown copyright OS Licence 10020290,Deprivation quintile.
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A recreational vehicle, a vehicle displaying restricted plates, a government-owned vehicle, is not an apportionable vehicle; except that a truck or truck tractor, or the power unit in a combination of vehicles having a gross vehicle weight of 26,000 pounds (11,793.401 kilograms), or less, nevertheless may be
Character Education: Responsibility ... Berenstain Bears Trouble at School, Jan Berenstain ... Responsibility Activities: Complete an activity to go along with your lesson. You may choose to incorporate an activity into your lesson at any time. Oftentimes visuals and experiments are very effective at the beginning and will get your students excited about the lesson. Let's Work Together ...