By the end of this module you will be able to:
• Identify the vulnerability factors in childhood
• Describe the concept of Adverse Childhood Experiences (ACEs) and the impact of those experiences in adulthood

Vulnerable children can be described as the ones that, due to different factors (both individual and environmental), are more at risk to be exposed to adverse life experiences, discrimination and damages.

There are different elements contributing to this:

The younger the child is, the most dependent from the adult and in need of caregiving is. As a consequence, babies and toddlers are more likely to find themselves in danger and more sensitive and affected by what happens in their families such as: financial issues, caregivers’ mental health diseases, deprivation etc.

Children can have different types of impairments: physical, intellectual, sensory, communication. These disabilities lead to a reduced autonomy, with a consequent higher need of care (physical, emotional, mental, medical) and dependence by the caregivers. Also, these children can have additional health, educational and therapeutical needs and they can encounter several physical, economical and social barriers, which can directly impact their wellbeing and their opportunities to participate in school and social life. Also, they are more likely to experience neglect and bullying as well as violence, while they usually have less educational success. Parents of children with special needs can also experience more stress and pressure, both for the greater needs of the child and for the financial and time resources they allocate for the care of their child, which can affect their parenting skills as well as the relationship they have with the child.

 Children who grow up in poverty often cannot meet their basic needs and rights such as housing, health care, nutrition and education. The risks for these children are really severe, including deprivation, malnutrition, diseases, death. There can be also long-term outcomes, like cognitive and physical impairments and damages in the psychological, social and emotional development. Poor children also have less or no opportunities in terms of education, which can lead to child labour.

Boys and girls face inequal gender norms and expectations and access to resources, with lifelong outcomes. In many countries, girls have less opportunities and rights in relation to boys, they are subject to more and greater discriminations, they are more likely to be victims of violence, to be forced to marriage, to be denied an education. Gender-based vulnerability involves also sexual exploitation and trafficking, domestic unrecognised work, early pregnancy. Even if discrimination against girls is far more common, boys are likely to be exploited too in child labour and as child soldiers.

Children with migrant background are at higher risk of poverty. They may also face disadvantages in the educational field, especially if there are other risk factors, such as caregivers with a poor education and a low socio-economic status. Finally, migrant families can be more mobile, which leads to many changes of the educational and social life of the children and, in some cases, to school drop-out.

Poor mental health in children is associated with other vulnerabilities and risk factors, such as low socio-economic background, material deprivation, caregivers with mental health problems, substance addictions or a low educational level, exposure to stressful situations, abuses or neglect. Children with mental health issues are more likely to have lifelong difficulties, for example in school and in relating with other people. They are also at risk of homelessness, incarceration, substance abuses and suicide. It is important to address these problems as soon as possible, in order to prevent more severe mental health issues and social and behavioural problems.

Adverse childhood experiences are negative and possible events which can occur during childhood, and may lead to serious consequences, such as:
• Domestic violence and witnessing violence
• Parental abandonment (even through the separation or the divorce of the parents)
• Caregivers with a mental health disorder/suicide within the family
• Being the victim of abuse (physical, sexual and/or emotional)
• Being the victim of neglect (physical and emotional)
• A member of the household being in prison
• Growing up in a household in which there are adults with pathological addictions

ACEs’ causes

ACEs’ causes are multiple and can be found in the personal traits and experiences, in the family environment and in the community. It is however possible to identify some elements that can increase (risk factors) or decrease (protective factors) the likelihood that ACEs occur. They are identified in two distinct categories: 1. individual and family factors and 2. community factors.
The individual and family factors include, from the risk side: presence of few friends or friends with delinquent behaviours, early sexual activities, challenges related to the presence of children with special needs in the family, feeling of the children of not being allowed to share their emotions, lack of understanding of children’s needs, caregivers who have experienced abuses, corporal punishment for discipline, lack of parental supervision etc.
On the other hand, protective factors for the children include: good performance in school, presence of adult role models outside the family and positive friendship relationships with their peers. While for the caregivers protective factors include: the ability to create a safe and nurturing environment within the family, a stable job, etc.
As for the community, risk factors include inter alia: high rates of poverty, unemployment, violence and crimes, easy access to drugs and alcohol, lack of support among the neighbours and food insecurity.
Protective factors are amongst others: easy access to financial help, medical and mental health care services, childcare, preschool and after school activities, involvement and commitment to the neighbourhood, etc.

ACEs’ consequences

The consequences of ACEs can be invasive and long-term. In fact, they represent a factor of risk for the onset of chronic diseases (both physical and psychiatric) and behavioural issues. Examples of consequences include:
• Obesity
• Depression
• Alcoholism
• Poor performance in school
• Unemployment
• Smoking
• Drug addiction
• Respiratory and heart diseases
• Cancer
• Suicide
As it can be observed, the possible outcomes are really different from each other and can affect a person in various areas -psychological, social, physical, behavioural. The reason is to be found in how ACEs affect people’s existence. These experiences indeed cause a prolonged/extreme activation of the stress response system, that leads to the development of toxic stress, which, especially in children, can damage both body and brain. Exposure to ACEs for a long time, especially in absence of support and help from adults, can even affect the nerves, endocrine and immune systems, with long-term and pervasive consequences on attention, behaviour, decision-making skills and the ability to respond to stress.

ACEs’ prevention

Prevention plays a key-role: identifying risk factors and work on them is fundamental in order to avoid ACEs and their negative long-term effects. Useful strategies can include, for example, strengthening families’ economic stability, providing care and education to children, enhancing parenting skills and building their resilience, working on reducing parents’ stress. An important tool that can be used is home visiting programs during which professionals (social workers, nurses, childhood educators, etc) visit families in their houses during potentially critical periods like pregnancy and children’s first years of life, in order to support the caregivers, teach them parenting skills and ways to cope with stress and to connect them to support services in their community.
Early detection of issues and difficulties that could be related to the presence of ACEs is fundamental in order to assess possible diseases and provide the children with support as soon as possible. Early interventions can indeed mitigate more severe outcomes and increase people’s quality of life and health.