Factors that help children thrive in the face of adversity

For the study, "The Relative Contributions of Adverse Childhood Experiences and Healthy Environments to Child Flourishing," researchers analyzed data from the 2011-2012 National Survey of Children's Health, conducted by the National Center for Health Statistics, to gauge children's health and well-being, physical, emotional and behavioral health indicators, family context and neighborhood environment.

"We focused on questions about ACEs exposure, but also family, social and community assets that could serve to moderate that risk or enhance resilience," said lead author Iman Sharif, MD, MPH, chief of the division of general pediatrics at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and co-director of the Nemours Primary Care Research Collaborative. Her research team found that even when children were exposed to adverse childhood experiences, certain family and community strengths appeared to have a protective effect on health, social and behavioral outcomes. Among the most influential of these were having access to patient-centered, coordinated medical care, mothers who were in excellent mental health, and community supports. The latter was gauged by responses to statements such as, "I have adults I can trust, people to count on."

Additional protective factors identified in the study included fathers in excellent mental health, mothers and fathers who had completed at least some college, living in a neighborhood with amenities such as sidewalks, a library, a park and a recreation center, and mothers in good physical health.

"The research for the past 20 years has clearly demonstrated the relationship between ACEs exposure and adult physical and mental health outcomes. This study adds to the emerging literature on the impact of ACEs on child health outcomes, and goes further to identify the factors that can help children thrive even when exposed to ACEs," Dr. Sharif said.

The findings support earlier research showing that ACEs exposure does not render health systems and communities "helpless," she said. "This shows there are things we can do," she said. "With appropriate screening to identify children at risk we can support children and families through the patient-centered medical home, linking parents to mental health services, and building community social supports to help children succeed."