The ghost in the nursery: how adversity can harm children
No Child 2020: Adverse childhood experiences are linked to physical and mental health problems
‘I came to tolerate poor behaviour from anyone who, at least, wasn’t hitting me.’ Photograph: Getty
“My father kept breaking the barring orders,” says Karen. “He’d show up at the house, the Garda would be called and he would be arrested. Mam was always extremely distressed so, instead of us feeling protected, we tried to protect her.”
Karen’s mother, Mary, had a hellish upbringing. Her paternal grandparents were unemployed alcoholics who physically abused their children and each other. Her maternal grandfather abandoned his family, and extreme physical abuse, both at home and in school, was their reality.
Mary and her siblings were all early school leavers. Her father was in and out of prison.
The cycle continued. Mary and her husband had 10 children in 15 years. “We grew up around physical and mental abuse, with a controlling, alcoholic father,” says Karen.
“When Mam was around 35, she started volunteering at the school and built up a network of support, which helped her get the courage to leave our father. We spent about eight months in a refuge which was close to Mam’s brothers and sisters. Then came the barring orders, and the breaches, and the terrifying stories that Mam shared with us about Dad’s behaviour.
“But we had a social worker and a project worker, as well as our aunts and uncles, and these were important positive role models for us.”
Mary turned to alcohol and would often leave the children for days on end, beating the older children when they challenged her. “She got into a relationship with an alcoholic man and moved out, leaving four children aged 12-18 behind. We were left homeless as the council took the house back and we hid, not wanting to be put into care.”
Two of Karen’s sisters entered into abusive relationships and became victims of domestic violence, with their partners in and out of prison. Two of her brothers also spent time in prison for petty crimes.
“When Mam and Dad split, my social worker created space for us to talk, study and have hopes and dreams. He made me think of college and possibly studying social work. So I went, but I felt so intimidated and out of place, and I left. My biggest fear was that I wouldn’t be able to break the cycle.”
Karen, who is now 30, met a man whose mother saw her potential and supported her in going back to college. Her relationship has lasted for 10 years and she has two children. Karen is a full-time youth worker on a programme called Preparing for Life, a prevention and early intervention project based in north Dublin under the auspices of the Northside Partnership, which works to improve children’s lives by supporting parents, early-years practitioners and teachers.
Changes to DNA
Last week, the Preparing for Life project hosted a screening of Resilience: The Biology of Stress and the Science of Hope at a north Dublin hotel. The documentary tells of a seminal study carried out by two American researchers, Dr Vincent Felitti and Dr Robert Anda, in which participants were asked about both their adult health and their childhood experiences.
Their findings suggested a strong link between adverse childhood experiences – including growing up with domestic violence, drug and alcohol addiction, neglect, and physical, sexual or emotional abuse – and later health problems, including heart and lung disease, depression and even changes to DNA.
Adults with a score of three out of 10 on a questionnaire were found to be twice as likely to suffer from heart disease. With a score of four, the study said they were three times as likely to suffer from depression. And with a score of six, life expectancy can be lowered by as much as 20 years.
Experts now believe the State must intervene to help families in distress.
For several years, the Preparing for Life initiative has run a “trauma-informed” approach to its services and, says Sue Cullen, the organisation’s home visiting and infant mental health co-ordinator, it is one that all organisations working with young people should adopt.
“We want to get in at the root, before the baby even comes into the world, and provide evidence-based programmes that give parents the skills and coping mechanisms to do what is best for themselves and their children.
“We need early-years practitioners, doctors, teachers, social workers and all professionals to be educated about the short and long-term effects of trauma on children and put supports and preventative measures in place.”
Children acting out
For Clodagh Carroll, assistant director of services at Barnardo’s, this means working with families “where they are”, recognising that if children are acting out in school, at home or in the community that they may have suffered one or more adverse childhood experiences.
“We might see a child not sitting still in school, but internally that child may be constantly feeling like a truck is coming at them ... Their behaviour may be caused by less immediately obvious factors. Parents may be the strongest buffer for a child with adverse childhood experiences, but what if that parent had the same experience as their child two or three decades ago?”
Julie-Ann Lyons, child and adolescent psychoanalytic psychotherapist and infant mental health co-ordinator at Young Ballymun, says her team has been decimated due to the end of funding support from Atlantic Philanthropies and government funding cuts, which have affected their ability to provide therapeutic home visits for parents.
“The medical model continues to distinguish between the mind and body, but medical and mental health teams need to work closer together – and we need less lip service and much more investment in early intervention. The ‘ghost in the nursery’ means that the same problems will be passed from one generation to the next if they are not brought to consciousness and thought about.”
Dr Michael Drumm, principal clinical psychologist with the Child and Adolescent Mental Health Services, believes that a trauma-informed approach, coupled with increased resources for primary care and community services, could help address youth mental-health problems and reduce the waiting lists for access to services, allowing more focus on those young people who are most in need.
Experts stress that, while adverse childhood experiences may increase the risk of poorer social and health outcomes in later life, it is not deterministic: not all such experiences lead to problems, and the right interventions can get people back on track.
Jessica (17) had severe adverse childhood experiences but, with support, has been helped to deal with them.
“I was four. He was about 11. He dragged me away from the party, undressed me and started touching my genitals. Earlier, he had kicked me and when I told an adult, they said ‘it’s because he likes you.’ So I thought maybe this was normal, but I learned not to trust older or taller men.
“I was around the same age when my alcoholic father started to beat me. He’d also call me names and degrade me. I was bullied throughout primary school because he used to show up drunk at parent-teacher meetings.
“I came to tolerate poor behaviour from anyone who, at least, wasn’t hitting me. My parents were separated, and Mum did her best to protect me, but I learned that telling her what was going on would upset her, so I censored myself. When I was 12 I stopped seeing my father.
“Without the right support, children and young people can’t process experiences like this: it’s too much for a small person to deal with. I developed anxiety and depression but, through my mum, got help from Pieta House.
“I’ve been lucky enough to get that therapy and support – and it has made a big difference to me – but not everyone is. We need more awareness from teachers, and children need to be told that certain behaviours are not okay, and supported in coming forward and speaking out.”
What is resilience?
But not everybody is convinced that the emerging interest in adverse childhood experiences will genuinely tackle the root causes of inequality. Dr Michelle Kelly-Irving is an Irish woman working as a senior researcher at Inserm, a French public research organisation focused on human health and epidemiology.
“Resilience is a fuzzy notion,” she says. “What is it and how do you build it? It can only be fostered if people are not fighting for basic needs. Understanding adverse childhood experiences is very useful as it gives us a different perspective on human suffering beyond deprivation and poverty. But, if that becomes the focus of policy, it can suggest that people can ‘fight’ to become ‘more resilient’.
“Much like the language around ‘fighting’ cancer, it suggests that fighting is all that it takes to win, whereas there are lots of other factors that contribute to whether or not people get well.
“Evidence does show a correlation between poverty, disadvantage and adverse childhood experiences, but looking at intergenerational disadvantage, it can be hard to see what came first: the disadvantage or the adverse childhood experiences.
“If someone is living in poor-quality, noisy, overcrowded housing without access to green spaces, these are material conditions that need to be tackled. Therapy and interventions alone are a patch, but it’s still a lot to ask a child to be resilient if they are going home to a damp and hungry house.