Adverse childhood experiences have lasting consequences on mental health

Some children endure deeply distressing experiences within their home, including abuse, domestic violence, poverty, parental illness or absence, and divorce. For children who cannot remain with their caregivers, there is a system of foster care, through which society assumes responsibility for their upbringing. “However, separating a child from their caregiver does not mark the end of casework. What matters most comes afterward,” says Ishida, who conducts research on recovery support for children with adverse childhood experiences (ACEs).

In a 2022 study, Ishida conducted a survey of 834 young people who had lived in children’s homes, revealing the high prevalence of ACEs among them. Using the Japanese version of the 10-item ACEs scale developed by Tsuboi, she assessed how many adverse experiences each respondent had previously encountered, and the results showed that 55.3% had an ACE score of 4 or higher. While scores of this level are estimated to occur in only about 1% of the general population, her work revealed that more than half of those who have lived in children’s homes had multiple adverse experiences during early childhood. The study also found that ACE scores tended to be higher among females and among those who entered care in children’s homes at an older age.

“ACEs can have profound consequences on mental health even into adulthood. Previous research has shown strong correlations between ACEs and multiple major causes of death in adults. There is also evidence that a mother’s ACEs may influence behavioral problems and depressive symptoms in her children during adolescence. This makes it critically important to concentrate resources on support during childhood in order to promote recovery later in life,” Ishida emphasizes.

Reading aloud in homes for infants: Examining verbal interaction and emotional development

In terms of supporting children’s recovery, one area of particular interest in Ishida’s work is listening to children’s voices—in other words, advocacy.

Until now, it has been taken for granted in child welfare that adult professionals make decisions regarding children’s care. One reason is the difficulty of fully understanding the intentions of children who are still developing. However, there is now increasing emphasis on reflecting the voices of children themselves in various decision-making processes. “Listening to the voices of children who have experienced trauma and helping them accumulate experiences of feeling ‘understood’ is extremely important for their recovery,” Ishida explains.

As part of this research, in 2023, she collaborated with NTT Communication Science Laboratories to conduct a nationwide survey of homes for infants, focusing on picture-book reading and verbal interaction with infants and toddlers.

Preliminary findings had already suggested that children in homes for infants tend to show slight delays in the development of their emotional vocabulary— that is, the words used to express feelings. “Previous research has shown that reading picture books aloud has positive effects on both academic ability and emotional development. By closely examining current practices in reading aloud and verbal interaction with infants and toddlers, we hope to identify ways to support the development of emotional vocabulary in these children,” she says, discussing the goal of her research.

The survey revealed that many homes for infants carry out reading activities diligently and with strong motivation, despite their busy schedules. It also showed that the staff, who are trained childcare professionals, select books appropriately according to children’s developmental stages. “While we must wait for full analysis before drawing conclusions, I hope the findings from this research can be applied in clinical practice,” Ishida notes.

Supporting children’s expression of emotion: The importance of positive early experiences

Frameworks for listening to children’s voices are now beginning to take shape. Following revisions to the Child Welfare Act in 2022, a new advocacy program was launched on April 1, 2024, which led to the introduction of a new role: advocates. Advocates are workers who listen to children in foster care regarding their treatment and other matters and then convey those opinions to government agencies or other relevant organizations.

However, the program is still in its early stages, and many challenges remain, including improving and establishing techniques for accurately understanding children’s actual voices. Ishida is actively working to provide knowledge and share information to address these issues. “One key to helping children express their views lies in the positive childhood experiences (PCEs) among children with ACEs,” she explains. Previous research has shown that PCEs, independently of ACEs, are associated with better mental health and interpersonal relationships in adulthood. “In my own interviews with those who had multiple ACEs, many cited encounters with two or more trusted adults as important PCEs,” Ishida says.

In psychological support, the importance of building a one-on-one trusting relationship (rapport) between therapist and client has long been emphasized. However, Ishida proposes a broader approach: “In supporting children with ACEs, including advocacy, it is important not only to rely on professionals or specific individuals, but also to increase opportunities for children to engage with a diverse array of adults.”

Going forward, Ishida aims to expand this body of knowledge through ongoing research while promoting cross-disciplinary collaboration among professionals working with children and sharing her insights with the public to build a society that fosters children.