Adverse Childhood Experiences (ACE) study of 17,000
adults was the first major research to reveal the extent of
polyvictimization. Almost two-thirds of participants reported
at least one adverse experience, while more than one in five had
three or more such experiences. The more adverse experiences
a child has, the more problems those experiences are likely to
cause, Holden said.
The problems may also continue on into adulthood. The
ACE study and other research have found that adverse child
experiences are linked to diabetes, cardiovascular disease
and even cancer in adulthood, Holden said. Part of the
reason may be that maltreatment in the first three years of
life — and the resulting release of stress hormones — can
affect brain development and compromise the immune
system, research has found. Meanwhile, children’s social and
emotional health can suffer from an insecure attachment
style and negative ideas about themselves and others that can
affect later relationships.
The good news: Many children are resilient. In fact,
studies find that about one-third of children exposed to
violence experience no negative consequences. “The key
finding is that resiliency is not a personality trait but rather
is better characterized as a mindset,” Holden said, explaining
that resilient children view their vulnerabilities as areas for
development instead of personality flaws. What’s needed, he
said, are interventions to help all children develop this kind of
Promoting positive parenting
Finding ways to promote resiliency among parents is also key,
said Mary E. Haskett, PhD, a psychology professor at North
Carolina State University.
Most child maltreatment prevention efforts focus on
families who are already struggling with parenting challenges.
And child abuse prevention messages have typically emphasized
that abusive parents are toxic to kids and defective in some way.
“The message has been that there are these people out there,
essentially with horns, called abusive parents,” Haskett said.
“They are different from the rest of us.”
But that isn’t accurate or helpful to families, said Haskett.
Instead, the field should widen prevention efforts to target all
families, she said.
“If everyone in a community is being supported around
challenges related to parenting because we basically all
experience those challenges, there’s less stigma around asking
for help,” she said. “We’re not saying, ‘I’m a bad parent,’
we’re saying, ‘I need some help with a current challenge I’m
Triple P, the Positive Parenting Program, is one such
program. The evidence-based program offers five levels of
intervention, starting with universal prevention messages
delivered via the media that emphasize that parenting can
be challenging for everyone. One message, for example,
emphasizes that potty training is something any parent might
struggle with. Subsequent levels of intervention offer support
to parents having minor to moderate struggles, with the most
intensive intervention reserved for high-risk parents. “Parents
get what they need and only what they need,” said Haskett.
Results from the ACE study — which found positive effects
for children with nurturing parents as well as negative outcomes
for those with a history of maltreatment — support this shift to
a public health approach to preventing child maltreatment, said
The shift is already happening, thanks to the health
implications revealed by the ACE study. The Public Health
Leadership Initiative at the U.S. Centers for Disease Control
and Prevention (CDC), for instance, encourages public health
and other agencies to take responsibility for preventing child
maltreatment instead of expecting child welfare agencies to take
on the sole responsibility.
“The CDC said, ‘We’re not going to focus on child abuse
prevention per se,’” said Haskett. “Instead, they said, ‘We’re going
to talk about supporting safe, stable, nurturing relationships.’”
While the shift is subtle, she says, it communicates a more
positive message of universal prevention.
Protecting versus controlling children
It’s especially important to change the way parents and society
at large discipline children, said Robert D. Macy, PhD, founder
and president of the International Trauma Center in Boston
and a founding member of the National Child Traumatic
Stress Network. Children, Macy argued, are being punished for
normal development and their experience of trauma.
“This requires a revolution — from society controlling the
child to society protecting the child,” he said.
For hundreds of years, society called for strong discipline of
children and even termination of parental rights for parents not
using corporal punishment to control their children’s behavior.
The same philosophy of trying to control children looms today.
These days, such efforts tend to target racial and ethnic minority
youth, said Macy, pointing to the disproportionate minority
racial and ethnic representation in the juvenile justice system.
“Kids are being punished for their development,” said Macy.
APA has its own universal parenting program,
ACT Raising Safe Kids. This evidence-informed
program is in hundreds of communities in the
United States and in Brazil, Colombia, Ecuador,
Greece, Japan and Peru. The program is
helping thousands of parents and caregivers
from all backgrounds and at all levels of risk
learn positive parenting skills that prevent child
maltreatment. For more information, visit www.