Growing up in Philadelphia can be a traumatizing experience. Poverty, hunger, gun violence, evictions, and mass incarceration are just some of the difficult experiences that bear down on children here. Over the last couple of decades, public health researchers and policymakers have increasingly recognized that the body "remembers” childhood trauma, and these experiences at a young age can predict illness, risky behavior, and criminal involvement well into adulthood.

To mitigate the impact of childhood trauma, we need to know which kids are most likely to be traumatized. If we identify them early enough, maybe we can even prevent the trauma from occurring altogether.

Last week, Dr. Christine Forke, a violence prevention initiative fellow at Children’s Hospital of Philadelphia, presented at the American Public Health Association’s annual meeting in Philadelphia with new data exploring the relationship between the levels of childhood trauma experienced by parents and their kids. Her findings can help develop a road map to address the transfer of trauma across generations.

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Much of the early work on childhood trauma and health originated in California’s Kaiser Permanente health system in the 1990s. Researchers developed a list of “adverse childhood experiences” -- ACEs -- and asked patients to tally how many ACEs they have experienced before age 18. ACEs include physical and sexual abuse, neglect, and parental incarceration. The number of ACEs a person experienced is their “ACE score.” The researchers found that having a higher ACE score was associated with a slew of illnesses -- asthma, cancer, depression, diabetes -- and risky behaviors in adulthood. The Kaiser ACE study has been replicated many times. The results are consistent -- childhood trauma is linked to adulthood illness, criminal activity, and drug use.

In 2013, a group of researchers published the Philadelphia ACE study, an evaluation of the ACE scores of Philadelphia residents. They found that 7 in 10 Philadelphians had experienced at least one ACE.

What do all these adverse experiences mean for the city’s children? “It is unknown if ACE burden carries across generations,” Forke says.

To study that potential inheritance, Dr. Forke and her colleagues added questions for parents and children about their childhood trauma to the Southern Pennsylvania Household Health Survey -- a phone survey of households in Philadelphia and the four surrounding Pennsylvania counties. ACEs for parents were traditional -- living with a household member with mental illness, addiction, or incarceration; physical, verbal, or sexual abuse; witnessing domestic violence; neglect -- while ACEs for children were more about their community: parental incarceration, death of a parent, witnessing domestic violence, feeling unsafe in neighborhood or school, having moved homes more than once a year.

The questions that researchers asked more than 1,000 parents and children to study the intergenerational transfer of trauma. From Dr. Christine Forke's presentation at the American Public Health Association annual meeting in Philadelphia. November, 2019.
The questions that researchers asked more than 1,000 parents and children to study the intergenerational transfer of trauma. From Dr. Christine Forke's presentation at the American Public Health Association annual meeting in Philadelphia. November, 2019.

The researchers conducted more than 1,000 interviews. Parents were the ones reporting on both their experience and their child’s experience.

The results showed that just under half of parents experienced some kind of childhood trauma. In comparison, only a quarter of children did -- possibly because they are young and still haven’t had time to experience trauma (the average child respondent’s age was 9), or because parents under-reported (for example, if they are the ones engaging in domestic violence).

The researchers then statistically estimated the relationship between the child’s and parent’s ACE scores. They found that parental childhood trauma increased the likelihood of trauma in their kids. “For parents that have three ACEs," Forke says, “the child’s odds of having an increased ACE burden increased by 2.5-fold.” When parents had four or five ACEs, she added, it increased that child’s odds of a higher ACE burden by 3.5-fold.

Dr. Christine Forke is a violence prevention initiative fellow at Children’s Hospital of Philadelphia and a member of the Philadelphia ACE task force.
Dr. Christine Forke is a violence prevention initiative fellow at Children’s Hospital of Philadelphia and a member of the Philadelphia ACE task force.

It’s not necessarily surprising that parents’ trauma passes down to their children. But having numbers on the impact is valuable -- putting into perspective, for example, that an intervention addressing parental trauma could reduce a child’s likelihood of experiencing their own trauma by half or a third.

It provides concrete evidence that treating parents’ trauma might help not just them, but also their kids.

And it suggests we should rethink how institutions respond to behavior by adults that stems from their own childhood trauma. A higher ACE score is associated with a higher likelihood of criminal activity. When a parent engages in criminal activity, they are more likely to be locked up -- doling out another point for their kid’s ACE score. From this perspective, more humane charging or sentencing becomes another opportunity to prevent ACEs from being passed down every time a parent is incarcerated. Similarly, knowing that frequent moves are an ACE -- and high ACE scores are associated with homelessness -- reducing evictions becomes another way to prevent intergenerational transfer of trauma.

But even trauma we can’t prevent doesn’t have to destine a child to bad health. “There’s definitely research that shows the more ACEs you have, the higher your risk for negative health outcomes,” Forke explains, “but that doesn’t happen to everybody.” Forke wants to flip the narrative around childhood trauma from a negative one to be more positive: Go beyond exploring the negative impact of childhood trauma to focus on protective factors and what we can learn about traumatized kids who grow up to be healthy adults.

Brain Trust is a biweekly column that looks at how new research affects Philly. Ideas? Suggestions? Email Abraham Gutman at agutman@inquirer.com.