A trusted adult refers to a grown-up in a child’s life who they can go to for support and guidance to discuss personal problems and issues they are facing openly.
This adult is someone with whom the child feels a strong bond, who they believe will listen without judgment, and who will provide caring advice to help them.
Specifically, the concept was assessed with the survey question:
“While you were growing up, before the age of 18, was there an adult in your life who you could trust and talk to about any personal problems.”
Bellis, M. A., Hardcastle, K., Ford, K., Hughes, K., Ashton, K., Quigg, Z., & Butler, N. (2017). Does continuous trusted adult support in childhood impart life-course resilience against adverse childhood experiences-a retrospective study on adult health-harming behaviours and mental well-being. BMC psychiatry, 17(1), 1-12.
Key Points
- Exposure to adverse childhood experiences (ACEs) like abuse, neglect, and household dysfunction is associated with an increased risk of mental health issues and adoption of health-harming behaviors (HHBs) like smoking, heavy drinking, and poor diet in adulthood.
- Access to trusted, caring adults in childhood may build resilience and mitigate the impacts of ACEs on HHBs and mental well-being across the lifespan.
- This study found that trusted adult support in childhood reduced risks of mental health issues and health-harming behaviors in adulthood by over 50% – even with high adversity.
- Combined health-harming behaviors and poor mental well-being showed a dramatic 30-fold increase in likelihood for those with ≥4 ACEs lacking trusted adult support compared to the 0 ACE, with support group.
- Impacts were seen across socioeconomic groups, but risks were higher in deprived populations.
Rationale
Prior research has clearly demonstrated strong links between adverse childhood experiences (ACEs) like abuse, household dysfunction and later mental health issues, chronic diseases, and early death (Felitti et al., 1998; Hughes et al., 2016).
Other studies also confirm relationships between ACEs and adopting health-harming behaviors (HHBs) like smoking, heavy drinking, and overeating that mediate these poor health outcomes (Campbell et al., 2016).
However, fewer studies have quantified resilience factors that may mitigate these long-term impacts from childhood adversity.
There is increasing recognition that building trusted relationships between children and caring adults promotes resilience and the capacity to overcome early trauma (Masten, 2014).
Yet little empirical investigation has examined how this buffers specifically against mental illness and HHBs known to be impacted by ACEs.
This study aimed to address that gap by quantifying how access to trusted adult support in childhood reduces the likelihood of poor mental well-being and adoption of HHBs in adulthood associated with exposure to adversity early in life.
Establishing such evidence can inform policy and programmatic efforts to both prevent ACEs and foster greater resilience through strengthening supportive child-adult relationships.
Method
- Cross-sectional surveys of 7,047 adults in Wales and England
- Measured retrospectively: exposure to 9 ACE types before age 18; access to trusted adult mentor; current diet, smoking, drinking; mental wellbeing
- The participants were grouped into four categories based on their total number of adverse childhood experiences: 0 ACEs, 1 ACE, 2-3 ACEs, 4 or more ACEs (≥4 ACEs)
- This grouping allowed the researchers to analyze the differential impacts on health and well-being outcomes between those with no ACEs, those with some ACEs, and those with higher levels of adversity (2-3 or 4+ ACEs).
- Controlling for demographics (age, sex, ethnicity) and socioeconomic factors (neighborhood deprivation) allows for isolating the impact of ACEs and trusted support on the outcomes, separate from factors like age, gender, ethnicity, and relative economic disadvantage. Controlling for region aims to account for any geographic differences as well.
Measures
1) Adverse Childhood Experiences (ACEs):
- 11 questions from the Centers for Disease Control and Prevention (CDC) short ACE tool assessing childhood exposure before age 18 to abuse, neglect, and household dysfunction like domestic violence, substance abuse, and incarceration. These were categorized into 9 ACE types.
2) Always Available Adult (AAA) Support:
- Single question on whether respondents had access to adult support as a child: “While you were growing up, before the age of 18, was there an adult in your life who you could trust and talk to about any personal problems.”
3) Health-harming behaviors:
- Daily smoking
- Poor diet (typically consuming ≤1 portion of fruits/vegetables per day)
- Heavy weekly drinking (having ≥6 standard alcoholic drinks in one occasion weekly)
4) Mental Well-being:
- Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) – 7 items on recent feelings of optimism, usefulness, relaxation, problem-solving ability, clarity of thought, interpersonal closeness, and autonomy.
Sample
- 54% female, 85% white ethnicity
- Wide age range, with most 18-29 years
- The sample was drawn from households across 4 regions: Wales, Hertfordshire, Luton, and Northamptonshire.
- The study utilized random probability sampling stratified by region and neighborhood deprivation level.
Analysis
- Bivariate then binary/multinomial logistic regression models
- Tested relationships of ACE count and trusted adult access with outcomes
- Calculated adjusted odds ratios relative to reference group (0 ACEs with support)
Results
Summary
- Prevalence of poor diet, daily smoking, and heavier weekly alcohol consumption increased with higher ACE count
- Access to trusted adult support lowered the risks of poor outcomes within each ACE count group.
- For example, with 0 ACEs, lacking support doubled the odds of poor mental well-being.
- But with ≥4 ACEs, lacking support increased the odds of poor mental well-being over 8-fold.
Individual health-harming behaviors (HHBs)
- Having access to trusted adult support in childhood was associated with lower levels of each HHB
- With trusted adult support, only daily smoking rates were significantly higher at 2-3 ACEs and 4+ ACEs compared to 0 ACEs
- Without support, odds of each HHB increased progressively with higher ACE counts
Multiple health-harming behaviours (≥2 HHBs)
- The percentage of participants with ≥2 HHBs increased sharply from 5.6% in those with 0 ACEs to 22.9% in those with ≥4 ACEs
- Rates decreased with the availability of trusted adult support in childhood
- The combined impact of increasing ACEs and lacking trusted adult support substantially heightened the risks of having ≥2 HHBs
Health-harming behaviors with lower mental well-being
- Odds of having ≥2 HHBs along with lower mental well-being rose dramatically from 1 ACE to 4+ ACEs when no trusted adult support was available (AORs from 3.46 to 32.01)
- With trusted support, the increase in odds was far lower (AORs from 1.21 to 4.71)
Lower mental well-being (LMWB)
- LMWB more than tripled with ACE counts of 0 versus ≥4
- LMWB more than doubled without always available trusted adult support
- Higher ACEs increased odds of LMWB even with trusted support, but lacking support combined with high adversity gave highest odds
Insight
This study provides compelling population-level evidence that ACEs negatively impact mental and physical health over the lifespan.
However, always having trusted adult support in childhood could substantially mitigate these effects. For instance, the likelihood of having both poor lifestyle factors and mental health was 32 times higher for those with ≥4 ACEs lacking support compared to those with 0 ACEs who had support.
This highlights that preventing ACEs and building resilience are both critical to reduce the burden of poor mental wellbeing and chronic disease rooted in harmful health behaviors.
Strengths
- Large community sample from multiple regions
- Measured several key outcomes retrospectively
- Controlled for socioeconomic status
- Quantified resilience factors’ risk modification
Limitations
- Self-selected participation may bias results
- Retrospective design limits proving causation
- Single resilience measure may miss other protective factors
- Lacked detail on adults’ roles or supportive actions
Clinical Implications
These robust findings should inform policies and programs to prevent ACEs and strengthen trusted child-adult relationships.
Parenting interventions, screening protocols in healthcare settings, and public health messaging are avenues to achieve this.
In turn, this can alleviate enormous suffering and costs related to mental illness, addiction, obesity, cancer and other chronic diseases stemming from childhood adversity.
Early bonding with caring adults might “convert” childhood toxic stress into more tolerable stress. This protects brain development and supports growth of coping abilities.
References
Primary reference
Bellis, M. A., Hardcastle, K., Ford, K., Hughes, K., Ashton, K., Quigg, Z., & Butler, N. (2017). Does continuous trusted adult support in childhood impart life-course resilience against adverse childhood experiences-a retrospective study on adult health-harming behaviours and mental well-being. BMC psychiatry, 17(1), 1-12.
Other references
Bush, K., Kivlahan, D.R., McDonell, M.B., Fihn, S.D. & Bradley, K.A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Archives of Internal Medicine, 158(16), 1789-1795.
Bynum, L., Griffin, T., Ridings, D.L., Wynkoop, K.S., Anda, R.F., Edwards, V.J., Liu, Y., McKnight-Eily, L.R. & Croft, J.B. (2010). Adverse childhood experiences reported by adults – Five States, 2009. MMWR Morb Mortal Wkly Rep, 59(49), 1609-1613.
Campbell, J. A., Walker, R. J., & Egede, L. E. (2016). Associations between adverse childhood experiences, high-risk behaviors, and morbidity in adulthood. American journal of preventive medicine, 50(3), 344-352.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245-258.
Hughes, K., Lowey, H., Quigg, Z., & Bellis, M. A. (2016). Relationships between adverse childhood experiences and adult mental well-being: results from an English national household survey. BMC public health, 16(1), 1-11.
Masten, A. S. (2014). Global perspectives on resilience in children and youth. Child development, 85(1), 6-20.
Stewart-Brown, S., Tennant, A., Tennant, R., Platt, S., Parkinson, J. & Weich, S. (2009). Internal construct validity of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS): A Rasch analysis using data from the Scottish Health Education Population Survey. Health and Quality of Life Outcomes, 7:15.
Keep Learning
- What specific actions or qualities make certain adults more effective sources of trusted support and resilience-building for children who suffer adversity? How can we cultivate these relationships?
- Would prospective cohort studies following children over decades provide further insight into how trusted adults and other factors mitigate impacts of ACEs as individuals age? What barriers exist to conducting such research?
- How much do cultural norms around family, community and self-sufficiency interact with the effects of ACEs and trusted support? Could focused study of certain cultural groups reveal additional resilience factors?
