In the District, 47 percent of children and teens have experienced a traumatic event, such as the death or incarceration of a parent, witnessing or being a victim of violence, or living with someone who has been suicidal or who has a drug or alcohol problem, according to new federal data. In Maryland and in Virginia, the rate was 41 percent.
The findings come from state-by-state survey data released Thursday from the 2016 National Survey of Children's Health, which aims to take a first-ever real-time look at the rate of children affected by adverse childhood experiences, or ACEs. Such experiences can have serious long-term impacts on a child's health and well-being, studies show, including increased risk for smoking, alcoholism, depression and heart disease.
Public health advocates hope this data, which is expected to be collected annually, will undergird a wide range of policy changes to prevent such adversity and to help children heal.
"These numbers tell a story about what is happening nationally to children. They have implications for schools and families and communities and health care," said Martha Davis, senior program officer for the Robert Wood Johnson Foundation, which is promoting policies that can counteract childhood adversity, such as paid family leave and home visiting programs that give parents time and resources to support their children.
Nationally, more than 46 percent of youth in the United States have had at least one adverse experience. The survey showed Minnesota had the lowest rate at 38 percent, and Arkansas had the highest rate at 56 percent.
The 10 states with the highest rates of childhood adversity were all in the South or Western part of the United States. The federal government first included questions about ACEs in the 2011/2012 survey. Since then, the sample size changed, and the numbers released Wednesday will become a baseline.
About 1 in 5 — 22 percent — of children nationwide have had two or more adverse experiences, compared with 15 percent in Maryland, 19 percent in Virginia and 22 percent in the District. Across the country, the prevalence of adversity is higher for children who are African American or Hispanic. Roughly 40 percent of white children have had at least one adverse experience, compared with 51 percent of Hispanic children and nearly 64 percent of black children.
The disparity is particularly stark in the District, where just 16 percent of white children had at least one, compared with 55 percent of nonwhite children.
The term "adverse childhood experiences" — or ACEs — was popularized following a landmark 1998 study by Kaiser Permanente and the Centers for Disease Control and Prevention that showed the prevalence of childhood adversity and its overwhelming correlation with poor health outcomes.
In the past two decades, major advances in brain science and biology have helped explain the connection: Excessive and prolonged stress changes the hormonal balance in the developing brain and body, causing long-term damage.
A parallel body of research now shows the brain is plastic, and certain interventions can buffer stress and help reverse the deleterious affects of heavy doses of stress in childhood.
This body of "ACE science" is already influencing policies and practices in a wide range of professions and government agencies, with a push for more professionals and organizations that work with children and teens to be "trauma-informed" or "trauma-sensitive."
In pediatrics, a growing number of doctors are collecting children's social histories along with their medical histories, and they are seeking to treat root problems, not just symptoms, by offering referrals to social services.
In public education, more teachers are viewing academic or behavioral issues through a trauma lens, to see if there is a root problem that is causing children to withdraw or to act out.
Similarly, juvenile courts are also looking at ways to divert more youths from probation and incarceration.
In Fairfax County, the juvenile court screens all new children and teens who are placed on probation and has found about 85 percent have at least one ACE, said Chrissy Cunningham, a prevention coordination specialist for the county.
The county has also trained more than 1,000 people through a 90-minute "trauma Awareness 101" training.
It has an active "trauma informed community network" that includes government and non-government professionals who want to promote trauma-informed care for children.
Statewide there are nine such networks, meeting for the first time in Richmond this year.
Next month in Maryland, a nonprofit is sponsoring a two-day "master training" with Robert Anda, the doctor who was the co-principal investigator for the original childhood ACE study.
It is inviting leaders from state agencies that work with children and families, and other professionals who work with or advocate for children.
In the District, the public schools are increasingly promoting trauma sensitive principles in training and approaches to school discipline, and research about ACEs is informing reforms being developed for the juvenile court system, said Wendy Ellis, project director for a Building Community Resilience initiative at George Washington University who said she has consulted with the attorney general's office.
In addition to information about ACEs, the new federal survey includes information about protective factors that research shows can help children.
Children whose parents report "always" having positive communication with their children's health-care provider were more than 1.5 times more likely to have family routines and habits that can protect against ACEs, such as eating family meals together, reading to children, limiting screen time and not using tobacco at home.
Christina Bethell, director of the Child and Adolescent Health Measurement Initiative at Johns Hopkins University that is analyzing the data, said she hopes the new survey will spark conversations in communities across the country about how to reverse the impacts of childhood stress.
"Children are incredibly resilient. We can buffer their stress, and we can help them," she said. "We are the medicine."
The complete list of ACE questions that were asked to parents in the survey include: whether it is often/very often hard to get by on income; whether a parent/guardian is divorced or separated; whether a parent/guardian has died; whether a parent/guardian served time in jail; whether the child saw or heard violence in the home; whether the child was a victim of violence or witnessed violence in the neighborhood; whether the child lived with anyone mentally ill, suicidal, or depressed; whether the child lived with anyone with an alcohol or drug problem; and whether the child was often treated or judged unfairly due to race or ethnicity.