Don’t Know Why Your Kid Has Behavioral Problems? Your Own Childhood May Hold Clues
If you’ve been to your doctor lately, you may heard about the ACEs quiz, a simple tool to measure childhood trauma.
Such trauma includes abuse, neglect, and other severe hardships that researchers call “Adverse Childhood Experiences,” or ACES, which are linked to an increased risk of heart disease, depression, diabetes and other health problems as children get older.
But the impact of such trauma doesn’t stop there. Recently scientists at the University of California at Los Angeles found that severe stress during parents’ own childhood makes it more likely they’ll have children with behavioral health problems.
I was particularly interested in the study due to my own handful of ACEs, most of them due to growing up in the shadow of my mother’s bipolar disorder, which was not diagnosed until decades later.
My mother liked to clean late at night and was also afflicted by migraines so agonizing she was confined to bed for hours with the shades drawn. By age three, then, I could be found most mornings standing on a kitchen chair, fixing cereal for breakfast. After that I would dust all the furniture and
draw a new set of pictures to show my mother when she woke up. “Oh my, how nice, just look at that,” she would exclaim. But I was never quite sure when my mother — beautiful and high-spirited, with the most wonderful laugh — would turn from Nice Mommy into Scary Mommy. Something was tearing at her from the inside, and back then I was pretty sure it was me.
Fast forward to the present. I have my own children now, and although my own childhood, though imperfect, was still a deeply loving one, I’ve wondered if the shadows from that time will reach out to haunt my kids. I work at the Center for Youth Wellness, a nonprofit devoted to raising awareness of the ripple effects of childhood trauma and what parents can do about it. I couldn’t wait to talk with the intergenerational study’s lead author, Dr. Adam Schickedanz of the David Geffen School of Medicine at the University of California at Los Angeles.
Schickedanz is a researcher, an assistant professor of pediatrics at UCLA, and a pediatrician focused on improving health for vulnerable kids and communities. Although parental abuse in childhood has been associated with offspring’s developmental delays and social and emotional problems as well as the risk of mistreatment, he said, this study was the first to find that the long-term behavioral health damage from ACEs “extends across generations from parent to child.”
The study, published in Pediatrics, examined data on thousands of parents and children who took part in a special 2014 supplement to the longest-running household survey of its kind in the world, the Panel Study of Income Dynamics (PSID). This longitudinal survey from the University of Michigan — which collects data on employment, income, health, child development, and many other topics — has traced four generations of families from 1968 to the present.
In parents with four or more ACEs, Schickedanz and his team found their children had double the risk of ADHD (attention deficit hyperactivity disorder) than parents with no ACEs. They also found parents with four or more ACEs had children with more than four times the risk of developing emotional disturbances, which, Schickedanz explained, “is shorthand for depression and anxiety and conduct disorders.”
Trauma’s echoes across generations
How was the behavioral health damage from ACEs passed down? “Well, that is the $64,000 question,” Schickedanz said. “The possible mechanisms include behavior, biology, parenting practices, and some epigenetics and environmental cues…The big answer is ‘all of the above.’”
With the parents, the researchers used a tool called the Kessler 6 Psychological Distress Scale to explore specific scales of emotional distress, such as depression and anxiety symptoms; they also measured what caused the parents’ aggravation, asking such questions as How frustrated do you feel in your parenting role? How much of your life did you give up to parenting? How often do you feel angry at your children?
The team found that parents with a history of childhood trauma were more likely to report higher levels of aggravation and frustration as parents and to experience mental health problems, Schickedanz said. Interestingly, a mother’s childhood experiences had a stronger negative effect on a child’s behavioral health than the father’s.
What links the findings of parents’ emotional distress and aggravation, he said, “is they’re all disruptive to connections early in life, particularly connections with caregivers.” (However, these mechanisms explain only about 25% of the effect on children’s behavior and mental health, he noted; more study will be needed to figure out the rest.)
By screening for ACEs early on, Schickedanz said, health providers can help identify high-risk children and parents and get them help sooner. “It’s a huge opportunity to interrupt the intergenerational cycles of adversity and inadequate parenting that are really self-perpetuating,” he said.
“Of course, if you screen for ACEs, it would be good to have both adult and pediatric mental health services available,” he added. “These services are critical, but they are in woefully short supply.”
Schickedanz, a pediatrician, is sympathetic to struggling parents. “It’s hard if you grow up without having a clear and healthy model of what healthy parenting looks like,” he said. “Without knowing how to be an effective caregiver, parenting can be really frustrating, confusing and aggravating — at least more so — for parents who didn’t have healthy models.”
Changing the family playbook
For Schickedanz, it is frustrating that the government funds little if any research devoted to parenting. “It’s amazing that with new parents it feels like we’re starting from scratch. As a country, we haven’t invested much in families and have overlooked all these really fundamental aspects of family life. So parents rely on what they’ve seen.”
One of the most important things parents can do, he said, is to think about where their parenting style comes from. “Often a stress situation will elicit a deep-seated pattern of behavior” that may not be what the parent wants, he said. “We know our experiences so well — we return to our family playbook. We need to seek out other options.”
A particularly intriguing question is why the children of some parents with four or more ACEs did not have behavior problems. “It appears that some parents had resilience factors — protective factors — that helped protected their children against worse outcomes,” said Schickedanz. It’s a question he and other researchers hope to explore in the future.
Schickedanz is currently planning a study on the possible impact of grandparents’ ACEs on their grandchildren. Meanwhile, he hopes that other scientists studying ACEs will take advantage of “the really incredible data on early adversity” that the Institute for Social Research at the University of Michigan collected in 2013 and published in data sets known as the CRCS and CDS (see references). The data sets include information, he said, on “nine out of 10 of the canonical ACEs” used in the landmark ACEs study from Kaiser Permanente and the CDC. “I’d love to get the word out” about this extraordinary resource, he added.
Parenting with ACEs
Looking back at our childhood, we sometimes find the missing pieces. As an adult, it was an enormous relief to find out my mom had bipolar disorder, formerly known as manic depression. My mother’s inexplicable rages and migraines eventually disappeared, and after some time in therapy, the protective closeness I had always felt with my father eventually enveloped my mother and me.
As for my own early setbacks, I keep an eye out for certain triggers. If you have ACEs, for example, you may find it harder than other parents to stay calm when your kids are acting up or you’re under stress. Here is some evidence-based counsel:
— Take a deep breath when you’re stressed out. Breathing in and slowly exhaling to the count of four helps interrupt the stress response. Repeat as necessary.
— Consider a peer-to-peer parenting coach. “We found this really promising,” Schickedanz said. “It helps break down the barriers to trust. When it’s someone from your community or social network, it’s much easier to trust them.” Ask your health provider about parenting coaches in your area.
— Visit a parenting class or workshop. “It’s important to realize that when it comes to parenting, not one size fits all,” says Dr. Barbara Greenberg, a clinical teen psychologist licensed in Connecticut and New York. “If the class doesn’t feel right to you, try a different one.”
— Build in some daily rituals. Research suggests routines and rituals are critical for healthy child development. Cooking and eating together, playing board games, reading to your kids at bedtime, even sorting clothes together while talking — all these “anchoring” rituals can help create closer, more loving relationships with your children, according to Greenberg.
— Take care of yourself. Take a walk with a friend, watch the dancing cockatoo on YouTube, have the neighbors over for a picnic. It’s good for the kids to see you having fun.
— Get more support. If you’re depressed or find you’re continually on the verge of a meltdown, consider seeing a mental health professional for help.
Schickedanz A, Halfon N, Sastry N, et al. Parents’Adverse Childhood Experiences and Their Children’s Behavioral Health Problems. Pediatrics. 2018;142(2)
2014 Childhood Retrospective Circumstances Study (CRCS). Special data set supplement to The Panel Study of Income Dynamics: A national study of socioeconomics and health over lifetimes and across generations. The Institute for Social Research, University of Michigan.
2014 Child Development Supplement (CDS). Special data set supplement to The Panel Study of Income Dynamics: A national study of socioeconomics and health over lifetimes and across generations. The Institute for Social Research, University of Michigan.
Panel Study of Income Dynamics. (n.d.) Institute for Social Research. Survey Research Center. Retrieved from https://psidonline.isr.umich.edu/Guide/FAQ.aspx?Type=2
— Diana Hembree is a science writer with the Center for Youth Wellness and its initiative Stress Health, which supported this research, and has written or edited for Time Inc. Health, Hippocrates, HealthDay, Forbes.com, the Times of London syndicate, and many other outlets.