Unnoticed Adverse Childhood Experiences in COVID-19

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Unnoticed Adverse Childhood Experiences in COVID-19

2021-05-21T12:50:33-07:00 May 21st, 2021|Health and Medicine, Science and Society|

By Vishwanath Prathikanti, Political Science ‘23

Author’s Note: While doing research for a paper on the mental decline in adults during the pandemic, I discovered something alarming occurring in younger people. While young adults are still the most susceptible to acquire depression in the pandemic, an unprecedented number of K-12 students were as well. Furthermore, K-12 students facing parental abuse were not being recognized as often as before due to the new virtual learning environment they are in. In this paper, I identify what this can lead to, and why we should be doing a better job protecting our younger students.

As college students, we often take for granted the fact that, if we do not have a positive relationship with our parents, many of us can live on campus during the pandemic. Children do not have this luxury, and in fact, the pandemic has made the threat of child abuse arguably even more dangerous.


Part 1: Adverse Childhood Experiences and their effect on the biological development of adolescents.

An Adverse Childhood Experience (ACE) can be any traumatic experience in a child’s life from the ages of 0-17, ranging from the death of a family member to abuse or neglect [1]. ACE’s are relatively common in the US, with around 61% of adults reporting to have experienced some form of an ACE in their lifetime [1]. Apart from the psychological damage, chronic stress caused by ACE’s has a number of harmful effects on a biological level, including a weakened immune system, which can result in premature death [2]. 

First and foremost, ACE’s cause a fear response in multiple parts of the brain; the amygdala mediates the response, the prefrontal cortex is involved with the cognitive response, and the hypothalamic-pituitary-adrenal (HPA) axis is critical in the stress response [3]. In a developing brain, extra stressors can cause dysregulation of the HPA system, which inhibits hippocampal neurogenesis, or the growth of new neurons [3]. These stressors have been found to cause cognitive defects in children resulting in lower attention span, lower scores in problem-solving, and lower scores on the California Verbal Learning Test long delay-free recall, which tests learning and memory [4]. Children who suffer from these stressors are often diagnosed with PTSD as a result of the ACE.

Part 2: How COVID-19 makes these situations more difficult to notice and likely more frequent

An important fact to note is that child abuse is more likely to occur in households with parentswho are chronically stressed or have mental illnesses such as depression [1]. COVID-19 has seen a general rise in mental illnesses and general stress across the world, with one study reporting a rise in depression from 14.6 percent to 48.3 percent and stress increasing from 8.1 percent to 81.9 percent [5]. Unsurprisingly, experts are concerned that this has resulted in a surge in domestic abuse. It is important to note is that while reports of child abuse have gone down by 20-70 percent (depending on the area), it is very likely that this is because the primary reporters were teachers, doctors, and social workers who had higher access to children before the pandemic [6, 7]. Furthermore, while the visits themselves have decreased, visits that result in hospitalization increased from 2.1 to 3.2 percent, suggesting that injury severity is getting worse [6].

Normally, teachers are one of the most important ways of identifying and reporting child abuse. Rashes and bruises are easily identifiable by teachers when a child is at school for the majority of the day. On the less physical side of things, when a student is distressed or is showing signs of poor mental health, such as inattentiveness or stress, teachers will address it with a personal conversation with the student. However, it is much more difficult to observe these signs of abuse over online platforms, such as Zoom. Rashes and bruises are much harder to detect due to limited to no visibility of a child’s body, and when students mute themselves or turn off their camera, it is extremely difficult to gauge attention and recognize when there is a problem. The zoom format of group meetings is also naturally less conducive to one-on-one meetings with teachers and students that would normally be very flexible and easy to conduct in person. 

Dr. Kevin Gee from the UC Davis School of Education spoke about K-12 education and dealing with the challenges COVID has posed for this age group during a UC Davis live event. According to Gee, the more support schools can provide to kids the better. “I know of schools that did one-on-one home visits; socially distanced with masks just to check in on how kids are doing,” Gee said [8]. Gee went on to further explain how schools often have many strategies for recovering “academic learning losses, but we still don’t know a lot about how one goes about recovering socio-emotional losses that have been incurred over the past year and a half” [8].

Part 3: Implications for adults

In abuse-related PTSD specifically, adults have been shown to have smaller hippocampal volumes after experiencing an ACE followed by chronic stressors [3, 9]. This smaller volume results in a myriad of memory-related effects. The most significant were deficits in verbal short-term memory, or the ability to remember words that were just spoken, and a failure to activate the hippocampus during memory tasks, leading to poor memory or the inability to make new memories [3]. This reduction in volume can be seen in the other aspects of the brain that contribute to a fear response, including the prefrontal and frontal cortices, cerebellum, and corpus callosum [3]. Neuronal survival and synaptic connectivity generally decreased, resulting in abnormalities in brain structure, possibly leading to psychotic disorders such as schizophrenia and bipolar disorder [10, 11].

The implications of this data are grim, indicating that COVID-19 may produce a generation suffering from mental illness brought on by ACE’s on a scale never before seen. With no way of knowing exactly how many children are affected, it is crucial to focus on preventing abuse rather than intervening when signs appear. This shift can be seen in the passing of the Family First Prevention Services Act of 2018, which is still being updated and improved today. The act focuses on giving states the option to spend money on “prevention services that would allow ‘candidates for foster care’ to stay with their parents or relatives” given the candidates create a “written, trauma-informed prevention plan” that is evidence-based [12]. So far the process for actually implementing these changes has been slow, and not all states have approved the reimbursement of medical charges for families [13]. It’s a relatively small step, and many more must be made to prevent a rise in ACE’s and the health detriments that accompany them in COVID-19.



  1. “Adverse Childhood Experiences” CDC. https://www.cdc.gov/violenceprevention/aces/fastfact.html#:~:text=Adverse%20 childhood%20experiences%2C%20or%20ACEs,in%20the%20home%20or%20community 
  2. Bellis et al. “Adverse childhood experiences and sources of childhood resilience: a retrospective study of their combined relationships with child health and educational attendance.” BMC Public Health. 2018; 18: 792. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020215/#CR2 
  3. Anda, et al. “The enduring effects of abuse and related adverse experiences in childhood” Eur Arch Psychiatry Clin Neurosci. 2006 Apr; 256(3): 174–186. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3232061/ 
  4. Beers, Sue R. and De Bellis, Michael D. “Neuropsychological Function in Children With Maltreatment-Related Posttraumatic Stress Disorder.” The American Journal of Psychiatry. March 2002. 159(3): 483-486. https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.159.3.483 
  5. Xiong, J. et al. “Impact of COVID-19 pandemic on mental health in the general population: A systematic review.” Journal of Affective Disorders. December 2020. 277(1): 55-64. https://www.sciencedirect.com/science/article/pii/S0165032720325891 
  6. “Trends in U.S. Emergency Department Visits Related to Suspected or Confirmed Child Abuse and Neglect Among Children and Adolescents Aged <18 Years Before and During the COVID-19 Pandemic — United States, January 2019–September 2020” CDC. https://www.cdc.gov/mmwr/volumes/69/wr/mm6949a1.htm#:~:text=During%20the% 20COVID%2D19%20pandemic%2C%20the%20total%20number%20of%20emergency, hospitalization%20increased%2C%20compared%20with%202019
  7. Eberman, Sarah. “Identifying and Addressing Child Abuse During the Coronavirus Pandemic.” Hackensack Meridian Health. April 23, 2020. https://www.hackensackmeridianhealth.org/HealthU/2020/04/23/identifying-and-addressing-child-abuse-during-the-coronavirus-pandemic/ 
  8. “UC Davis LIVE: Covid’s Impact on Education” https://m.facebook.com/events/2815426028773876
  9. Bremner, J.Douglas. “Long-term effects of childhood abuse on brain and neurobiology.” Child and Adolescent Psychiatric Clinics of North America. April 2003. 12(2): 271-292. https://www.sciencedirect.com/science/article/abs/pii/S1056499302000986?via%3Dihub 
  10. Read, J. et al. “The contribution of early traumatic events to schizophrenia in some patients: a traumagenic neurodevelopmental model.” Psychiatry. Winter 2001;64(4):319-45. https://pubmed.ncbi.nlm.nih.gov/11822210/ 
  11. Aas, et al. “The role of childhood trauma in bipolar disorders.” Int J Bipolar Disord. 2016; 4: 2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712184/#:~:text=Childhood%20 traumatic%20events%20are%20risk,suicide%20attempt%20and%20substance%20misuse). 
  12. National Conference of State Legislatures. “Family First Prevention Services Act.” Accessed 4/12/2021. https://www.ncsl.org/research/human-services/family-first-prevention-services-act-ffpsa.aspx 
  13. National Conference of State Legislatures. “Family First Legislation.” Accessed 4/12/2021. https://www.ncsl.org/research/human-services/family-first-updates-and-new-legislation.aspx
  14. Centers for Disease Control and Prevention. “Data Visualizations: Adverse Childhood Experiences (ACEs).” Accessed 5/18/21. https://www.cdc.gov/vitalsigns/aces/data-visualization.html#info2