Something remarkable is happening in Scotland. A resurgence of interest in children’s emotional experience is underway, especially experiences of fear and anxiety.
Tens of thousands of people throughout the country are now curious about how childhood suffering changes a person’s biology. They want to understand the science showing that experiences of uncertainty and alarm and loss can lead to increased risk of lifelong struggles with physical and mental health. They want to know why relationships are a robust protective factor against that risk, and most of all, they want to know how to help.
The banner under which this grassroots interest has coalesced has come to be known as the “ACE-Aware Movement”. ACE is an acronym for the term “adverse childhood experiences”, which comes from a seminal study published in 1998. Drawing on a sample of 17,000 people in the US, the research was able to show that traumatic childhood experiences – such as domestic abuse, sexual abuse, a parent in prison, a parent with mental health problems – were strongly associated with negative adult health outcomes. Those outcomes included heart disease, liver disease, diabetes, as well as alcoholism, drug dependency, suicide and many others.
The association with such outcomes feels surprising for many members of the public. They haven’t imagined that a condition like diabetes could be in any way associated with childhood distress. It can feel unexpected to realise that an adult’s demeanour influences not only a child’s behaviour, but their very physiology. That’s a key reason I think the ACE study has proved so engaging: it gives us profound insights into our own humanity.
This Scottish groundswell has emerged over the past 18 months. Arguably, it began in the summer of 2017, when interest in a documentary film by the title Resilience: The Biology of Stress and the Science of Hope exploded across Scotland. The film tells the story of the ACE study and explores what communities in the US are doing to prevent and mitigate the harmful impact of ACEs, saving both lives and money.
The film may have had such impact because it builds on discussions about ACEs that have been taking place for the past decade in Scotland, led by organisations like the Violence Reduction Unit, who invited one of the study’s co-authors to Scotland in 2007. Sir Harry Burns, during his tenure as chief medical officer from 2005 to 2014, talked continually about ACEs in his work with the public.
Last month witnessed one of the latest landmarks in Scotland’s ACEs journey. A national conference was held at Hampden Park in Glasgow, under the ambitious title "Making Scotland the World’s First ACE-Aware Nation". The two-day event drew nearly 2,500 attendees from the general public, keen to learn more about how the knowledge of ACEs is being used to make positive change in Scotland. Such massive attendance had not originally been anticipated by the two small independent organisations who hosted the conference. One of those was TIGERS, which oversees modern apprenticeships for young people. The other was Connected Baby, which works to help the public understand the science of connection, and of which I am the founder.
I have spent a lot of time thinking about why the conference drew such large numbers, not only from Scotland, but across the UK and beyond. What brought together lawyers and teachers and GPs and social workers and family support staff and civil servants and local councillors and early-years practitioners and parents and young people and so many others? What generated the societal impetus for this unprecedented gathering, with so many people willing to think about ACEs not just through a medical lens, but as an issue of attachment wounds, social justice, human rights? Why did attendees leave feeling hopeful and inspired, given they were confronting the uncomfortable issue of childhood distress?
I think the answer is two-fold. First, we were talking about relationships. Yes, we were talking about stress and trauma and adversity, but we were not stopping there in our analysis. The real focus of the conference was relationships, as protective and healing “interventions”. Second, we were enabling attendees to see what they could do personally to help. The conference enabled them to visualise steps they could take to make their own and others’ lives better. They felt empowered by the stories told of individuals and organisations already taking action. They left knowing, in whatever words they might choose, that adults’ responses co-regulate a child’s stress-response system to distressing events. They left determined to talk about this information with others.
I know there are many who are cautious about this groundswell. They are concerned about the use of scoring tools, like the 10-item questionnaire used in the original ACE Study. They are concerned that the 10 experiences named in that questionnaire may be perceived as the only causes of suffering that count as ACEs. They are concerned that people will not think deeply enough or curiously enough, and may thus consider themselves to be sufficiently "trauma-informed" on the basis of a single viewing of the film Resilience. They are concerned that the emphasis on kindness and compassion is trite.
I agree these are important issues to reflect on. I would worry too, if this was what I saw happening. That is not, though, what I am witnessing. I have not heard an unbridled emphasis on scoring. I have not come across people restricting their definitions of suffering. I have not seen people’s life journeys reduced to an arbitrary ACE score. I have not seen us become trapped in individualising biological explanations that fail to pay attention to context and environment. I have not seen a shift toward more diagnostic labels or an acceptance of the dichotomy of “them” versus “us”.
Instead, I have watched people open their minds and hearts to others’ suffering. I have observed them become more willing, sometimes courageously so, to offer care and kindness and patience to others. I have seen blame dissolve into curiosity. I know we have a very long way to go, with rates of mental illness, suicide, drug use, poor educational outcomes and many other challenges on the rise. But I am also more hopeful than I was 18 months ago. And I am only one voice amongst thousands of others.
Stories, not data, are proving to be the most powerful element of this movement. Chris Kilkenny’s story of poverty and hunger, two banal but crippling ACEs, is currently driving change in schools. Michelle Brennan-Jones’ story of tackling her alcoholism as a result of finally understanding her own childhood ACEs featured recently on STV news. Jennifer Riley tells the story of how becoming a trauma-informed parent helped her feel more confident in understanding her children’s behaviour.
Pitteuchar East Primary School in Glenrothes, Fife, tells the story of shifting its language, replacing the common phrase “challenging behaviour” with “distressed behaviour”. Children 1st tells the story of discovering just how many adults in its organisation had suffered childhood trauma, in the process of training every single member in trauma-awareness. TIGERS tells the story of how relationship-led practice reshaped its business, benefiting not only employees, but the young people and partners it serves in unexpected sectors like construction. Bainsford Primary in Falkirk tells why it got rid of behaviour charts, and Big Bird Nursery talks of how it changed its drop-off procedures. Lawyer Iain Smith recounts how ACE-awareness has changed the way he practises law. Retired police officer Graham Goulden says that had he known this information earlier, he would have been a better police officer. Business owner John Gibson tells the story of donating £20,000 so that low-paid parents could attend the ACE-Aware Nation Conference, because he believes everyone in our society must be part of this conversation. All of these stories are now in the public domain.
Some of my favourite stories have not yet made it into print. There is the football coach who said: “This would explain the behaviour of that young lad on my team. I only learned about this stuff a month ago, but already it makes sense.” There is the young man who burst into his headteacher’s office at Portobello High School saying, “Miss, see all this new stuff we’re doing in the school? I finally feel like I can learn because things are calmer and I’m not on edge the whole time.” And there is the trauma survivor in his fifties, who left the conference saying: “It feels like, at last, people are beginning to really get what I experienced as a child.”
These stories are the evidence of this movement’s impact.
The Scottish grassroots movement seems to be succeeding in embracing the single most important insight to emerge from ACEs science: the ultimate impact of adversity stems not from the stressors themselves, but from the presence or absence of reliable relationships that can help a child cope with the stress. More and more people are empowered by the realisation that where we cannot (yet) eliminate traumatic circumstances, we can at least help by refusing to leave children alone in their suffering. And guess what? Companionship comforts struggling adults too, and once they feel less scared, they can begin to heal.
Much debate awaits, some of it undoubtedly heated. That is because there are now more voices in the conversation. The science of ACEs has moved beyond professional and academic circles, where it sat for 20 years, and is now in the hands of the public. To quote from the film Resilience: “If we can get this into the hands of the general population, they will invent very wise actions.”
If the “simplistic” language of kindness and compassion is generating a new urgency for addressing the suffering caused by ACEs, then I am relieved. I hope our nation’s children will forgive us for having taken a decade to finally get here.
Dr Suzanne Zeedyk is an honorary fellow in developmental psychology, based at the University of Dundee. She is also the founder of the organisation Connected Baby, which co-hosted the ACE-Aware Nation Conference in Glasgow in September