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When Prevention is Better than Cure

It has long been understood that adverse childhood experiences, an umbrella term for ‘severe negative environmental events that require significant emotional, cognitive, or neurobiological adaptation by an average child have long term deleterious physical and emotional consequences. These experiences include parental incarceration, domestic violence, household mental illness/suicide, household alcohol and substance misuse, exposure to physical and sexual abuse, neighbourhood violence, bullying, discrimination, and parental death. Reviews show that high ACE exposure is strongly linked to sexual risk-taking, mental ill health, and problematic alcohol use and strongest for problematic drug use and interpersonal and self-directed violence. It is self-evident that this is highly costly both for services and in terms of individual, family, and community suffering.

Authors Wolfgang Linden, and Joelle LeMoult (2022) argue that resources should be deployed as early as possible, during pregnancy and the first two years of life, to take advantage of the proliferation of neurones and synapses which, once solidified become more difficult to rewire. A two-year-old child who learns that adults cannot be trusted, and the world is a dangerous place already has a nervous system that retains connections that reflect fear and distrust. As these pathways are reinforced by experience, the child will develop exaggerated stress responses which interfere with adaptation to life’s demands. Prevention programmes need to promote secure attachment for the child and skills to regulate emotions. We need to be creative in how we conceptualise and deliver these programmes using all forms of delivery and ensuring they reach both the geographically and socially isolated. The initial cost would be high, but the alternative is much more expensive for those who are wounded and the wide circle who suffer at their hands.


Linden, W.  and LeMoult, J. Editorial Perspective: Adverse childhood events causally contribute to mental illness – we must act now and intervene early Journal of Child Psychology and Psychiatry 63:6 (2022), pp 715–719


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