By Jackie Tolland and Jonathan Sher 

WHEN playing poker, it is incredible luck to have four aces. However, being dealt four aces in the game of life is very unfortunate for a child.

ACEs, in this case, stands for Adverse Childhood Experiences. These indicators of “toxic stress” range from maltreatment to poverty, family violence to substance abuse. Experiencing four (or more) ACEs dramatically increases the likelihood of bad consequences, including life-long mental and physical health problems.

Thousands of people viewed and discussed an ACEs-related documentary, Resilience, during a tour in Scotland last year. Other organisations, including Parent Network Scotland, arranged separate viewings and conversations because parents are crucial to success.

It is indisputably right to assist children who are being harmed. Responding compassionately, early and effectively to reduce ACE-based trauma must become a high priority. However, Scotland’s well-intentioned ACEs movement might go “pear shaped”. We offer three cautions: Avoid an inaccurate, unhelpful “us” and “them” mindset. The original ACEs studies were with adults in America’s Kaiser Permanente’s health plan. Their recollections of adverse childhood experiences (their ACE scores) were analysed alongside their present health. They were middle class and well educated; but many had multiple ACEs. Low-income Americans were not included because they could not afford Kaiser Permanente.

ACEs exist in Scottish society. Why focus solely on the “usual suspects”, the 20-25 per cent classified as “vulnerable”? Scotland has an opportunity, and obligation, to take seriously the adversities experienced by children in relatively “privileged” families too. The ACEs movement could be a unifying force, creating common ground between service providers and the people they serve. Perpetuating the “us” and “them” divide will not build the respectful, empathic relationships needed to reduce “toxic stress”.

Support, rather than “blame and shame”, parents. Helping parents offers a brilliant way to create better lives and life chances for children. That begins with parents acknowledging, and coping with, their own ACEs. This toxic legacy continues to (mis)shape their attitudes and behaviours.

Parent Network Scotland operates its peer groups on the “airplane oxygen mask” model: parents get the “oxygen” they need so they can then better assist children. It takes time and compassion to support parents (and practitioners) properly.

If the tendency to view mothers, fathers and carers as the “problem” continues, we lose the benefits from treating parents as partners in overcoming ACEs.

Give preventing ACEs the same priority as overcoming them. Our “tradition” is to wait for crises before taking meaningful action. We talk a better prevention game than we play. Preventing adverse childhood experiences in the first place is always the least costly and most effective option.

We need to better balance prevention and intervention. That means overcoming the social and economic inequalities that produce ACEs. It also means engaging and empowering families. The combination of collective and individual action can break the toxic cycle. Let’s help each generation deal ever-better hands to the next generation.

Miss Tolland is the Glasgow-based Chief Executive of Parent Network Scotland. Dr Sher is an Edinburgh-based consultant on pre-conception health, education and care.