What if we stopped asking kids (and the adults we love), “Why are you behaving like this?” and started asking “What happened to you?”
That one switch changes everything.
Trauma, so what?
Adverse childhood experiences (ACEs), or what many of us call trauma, expose a child’s brain to stress. Over time, that stress affects the body’s physical, immune, and emotional systems.
The ripple effects can include:
- Trouble with emotional regulation
- Struggles at school
- Lower career success down the road
- Higher risk of high blood pressure, heart disease, stroke, cancer, and liver disease
ACEs can look like:
- Domestic violence at home
- Parental separation or imprisonment
- A parent with a mental health disorder
- Abuse, neglect, or bullying
- Community violence or a natural disaster
Trauma affects every kid differently. I often see kids from the same family, experiencing the same traumas, and yet one kid is doing well in school and has an excellent network of friends, and their sibling is refusing to go to school and won’t leave their room. Here’s the key thing about screening for ACEs – it works best when we pair it with curiosity about how it’s affecting this person. That guides us to the next steps for that person:
- Thriving and not interested in talking? Great. Let them know the door is always open, and move on.
- Struggling? Maybe slipping grades, irritability, defiance, depression, substance use, or thoughts of self-harm. That’s when we offer an antidote.
Trauma, thank u, next
The antidote has a name: positive childhood experiences (PCEs).
In a 2019 JAMA study, Bethell et al. found that PCEs lower the risk of mental health problems for everyone, including people who have experienced ACEs.
I’m currently training to become a facilitator through HOPE (Healthy Outcomes from Positive Experiences), in a program with Tufts University, so I can lead workshops on PCEs. HOPE breaks the PCEs into four building blocks:
- Safe, nurturing relationships with caregivers, friends, and mentors
- A sense of belonging through family, cultural, or religious rituals, or through school and community activities like a sport, job, or arts club
- Space to talk about feelings and practice emotional regulation in a safe place
- A safe, stable environment
Which building block feels within your reach to offer a kid you care about today?
Positive experiences I can create
Sometimes there’s not much I can do about the situations my teen patients are living in. Some of them are genuinely heartbreaking. But here’s what I can do:
- Safe environment. My office can be a safe, consistent space.
- Be a nurturing presence. I celebrate their accomplishments – big (good test grade, getting a job) and small (showing up to school and the appointment, how nice their outfit or hair or jewelry looks) – and plan a hopeful future with them.
- Safe space for emotions. I ask about their feelings and dreams without criticism or judgment.
The one block I haven’t touched yet is a sense of belonging. I’m thinking a ritual like a secret handshake with each patient, our own special way to greet each other. (Stay tuned. I may be very bad at it – forgetful and stiff.)
The bigger picture
Every kid, family, and community has strengths and resources. HOPE gives me, as a pediatrician, a starting point and actionable steps I can lean on and share with patients and their caregivers.
As I grow into my role as a HOPE facilitator, I hope to share this message far and wide. And I hope it gives the caregivers in your life a simple framework for supporting the kids they love.