A 17-Item Checklist Geared to Neutralize Early Life Distress

As a science reporter and the father of an 11-year-old, I keep my antennae up for any new research that will help me become a better parent and optimize my daughter's odds of growing up to be happy and healthy in adulthood.

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Last week, I reported on a study (Bethell et al., 2019) published on September 9 in JAMA Pediatrics. The takeaway of this study by Christina Bethell and colleagues at Johns Hopkins is that adults who self-reported having more positive childhood experiences (PCE) before the age of 18 tended to have a lower likelihood of clinical depression or poor adult mental health along with a higher probability of healthier interpersonal relationships in adulthood.

These are the 10 adverse childhood experiences (ACEs). Each of these items counts for one point as part of an individual's 1-10 ACE score.

Source: Centers for Disease Control and Prevention/Robert Wood Johnson Foundation

Of note, the Johns Hopkins researchers found that adults who took the 10-item adverse childhood experiences (ACE) test and had relatively high ACE scores but also had a relatively high PCE score were less vulnerable to the psychological toll of early life adversity.

The seven items on this PCE test include answering "yes" or "no" to a prompt, "Before the age of 18, I..."

1. Was able to talk with the family about my feelings
2. Felt that my family stood by me during difficult times
3. Enjoyed participating in community traditions
4. Felt a sense of belonging in high school
5. Felt supported by friends
6. Had at least two non-parent adults who took a genuine interest in me
7. Felt safe and protected by an adult in my home

On September 9, I encouraged readers to look at PCEs and ACEs as two sides of the same coin and to take a two-pronged approach of striving to decrease adverse childhood experiences for today's children under age 18 and to increase their positive experiences.

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A few days later, on September 14, fellow Psychology Today blogger Grant Hilary Brenner published a post, "How Adverse Childhood Experiences Cost $1.33 Trillion a Year." This post reports on the staggering statistics from a systematic review and meta-analysis (2019) of the life course health consequences and associated annual costs of ACEs in Europe and North America that was published on September 3 in The Lancet, Public Health.

In his conclusion, Brenner writes, "Preventing ACEs is of urgent importance, as is mitigating the negative impact of ACEs currently, in terms of substance and alcohol abuse, mental illness, physical health outcomes, and the cost to society." I agree.

Identifying practical strategies for adding fuel to the positive upward spiral created by PCEs and lessening the downward spiral of ACEs has been on my mind a lot lately. (See "8 Research-Based Reasons I Choose to Rose-Tint Some Childhood Memories.")

Serendipitously, yesterday afternoon my phone dinged with a press release headline that jumped off the screen: "For kids who face trauma, good neighbors or teachers can save their long-term health." The subtitle reads, "Previous studies found having adverse childhood experiences can lead to poor health outcomes later in life. New Brigham Young University research finds the anecdote is to counter those with enough positive experiences."

This study (2019) on how positive and negative childhood experiences influence adult health appears in the October issue of the journal Child Abuse & Neglect. The findings of this study are based on a cohort of 246 participants (ages 19-57) who filled out online surveys to acquire ACE scores and also rate what the researchers call "counter-ACE" factors.

Ali Crandall and co-authors from BYU found that even if someone had an ACE score of 4 or more adverse childhood experiences, that if the same person also had a high number of positive childhood experiences (referred to as "counter-ACEs" by Crandall et al.) that these positive early life factors lessened the negative effect of ACEs on health and wellness in adulthood.

As the authors explain, "Overall, the findings suggest that counter-ACEs protect against poor adult health and lead to better adult wellness. Ultimately, the results demonstrate that a public health approach to promoting positive childhood experiences may promote better lifelong health."

Immediately after reading about Ali Crandall's new study (2019) and learning the term "counter-ACEs" for the first time, I was eager to find out more directly from the first author of this study.

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In an email to Crandall yesterday, I introduced myself and said, "I'm planning to write a follow-up post tomorrow that presents your research in a side-by-side comparison with Bethell et al. (2019) in an attempt to drive home the importance of the two-pronged wellness message: 1) reduce ACEs and 2) boost PCEs and counter-ACEs."

Then, I asked Crandall, "Are counter-ACEs and Positive Childhood Experiences (PCEs) two different terms for the same type of early life experiences?" She responded, "They are the same idea, though some of the specific items differ. We used a 10-item scale called Benevolent Childhood Experiences (BCEs) that was developed by Angela Narayan et al. for a 2018 pilot study."

In our email exchange, I also asked Ali Crandall, "What is the most important take-home message from your latest research findings on ACEs and counter-ACEs that you'd like to share with general readers at Psychology Today?" Crandall emailed me a two-part response:

1. As much as we don’t want kids to experience ACEs, the absence of positive things (i.e., the absence of counter-ACEs) may be more harmful than the presence of the negative (ACEs). So whether one is a public health professional, clinician, other professional working with families/children, or a parent or adult who associates with children in some way, we need to focus more on ensuring that children have counter-ACEs. Everybody goes through hard things in life, and those counter-ACEs help us to weather the ups and downs of life.
2. Everybody can make a difference and can contribute to the well-being of children—even if you’re not a parent. Certainly, parents are in the best place to help children receive the positive things. But parents and families need support. Neighbors, teachers, aunts/uncles, grandparents, community and church/religious leaders who work with children, volunteers, and other adults can (and I hope will) intentionally try to build positive relationships with children—and when they do, it can be really meaningful and have a lifelong impact on physical, emotional, social, and cognitive health. Even when a child has experienced ACEs, providing them with the positive can neutralize the negative impact.

7 PCEs + 10 BCEs = 17 Counter-ACEs

Blogger's note: I apologize for the acronym overload in this post. That said, in an attempt to consolidate all of this information, I created an equation (7 PCEs + 10 BCEs = 17 Counter-ACEs) in an attempt to streamline all of this information and make it more user-friendly.

Below are the 10 items from the Benevolent Childhood Experiences (BCEs) psychometric assessment in the form of a simple checklist that you can combine with the 7 items from the Positive Childhood Experiences (PCEs) listed above.

To get a BCE score, the survey-taker is asked how many of these ten items he or she experienced before the age of 18. Would you respond "yes" or "no" to the prompt, "Growing up, I had..."

1. At least one caregiver with whom you felt safe
2. At least one good friend
3. Beliefs that gave you comfort
4. Enjoyment at school
5. At least one teacher that cared
6. Good neighbors
7. An adult (not a parent/caregiver or person from #1) who could provide you with support or advice
8. Opportunities to have a good time
9. Ability to like yourself or feel comfortable with yourself
10. Predictable home routine, such as regular meals and a regular bedtime

Although there's some overlap between the 10 BCEs and 7 PCEs, taken together, these 17 counter-ACEs make a comprehensive checklist that "covers all the bases" and may have the potential to neutralize some of the harmful ripple effects of early-life adversity and ACEs for future generations.

Note: Big thanks to Ali Crandall for your quick response and for helping all of us understand the lifelong importance of ensuring that children have bountiful positive experiences and multiple counter-ACEs.

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