Growing up isn’t easy for anyone. All of us had experiences that were embarrassing, heartbreaking, or challenging.As adults, we have an opportunity to look back and reflect on how these experiences changed us. Take a moment to think about one challenging experience from childhood and how it changed your life….. Now imagine if you were also coming home each day to an abusive parent, or no dinner on the table when you got home, or were raped by a family friend without knowing what was going on. What if you experience a school shooting in elementary school? What if you spent your early childhood separated from your parents in a cage on the border? How would these adverse experiences change your life? How would the experience affect your ability to participate in school? Make friends? Or trust adults? How would these adverse experieinces affect your health? Your ability to participate and engage in everyday life would change.

All types of abuse and neglect of a child under the age of 18 by a caregiver or person of authority that results in harm, potential harm, or threat of harm, is considered child maltreatment, and results in adverse childhood experiences (ACEs) (CDC, 2019). In 2015, 37.3% of youth experienced a physical assault, 2% of female youth experienced a sexual assault, and 15.2% of youth experienced maltreatment (Finkelhor, Turner, Shattuck, & Hamby, 2015). This is the prevalence of ACEs in just one year. Think about if you included the entire span of a child. That is an alarming rate and ACEs have the potential to produce long lasting effects. These include increased risk of mental health conditions, injuries, sexually transmitted infections, cancer, cardiac conditions, unintended pregnancy, drug and alcohol abuse, and dropping out of school. ACEs have also been linked to risky health behaviors, chronic health conditions, lower life potential, and early death (CDC, 2019).

As occupational therapists, we have been given the opportunity and responsibility to reduce these numbers. We can help individuals who have experienced a traumatic life disruption through occupational adaptation and the recovery process. Furthermore, occupational therapy practitioners are mandatory reporters, meaning this is not just a recommendation but a responsibility. Occupational therapy practitioners can have a meaningful impact on children and families, affected by adverse childhood experience. We are able to aid in the recovery process by supporting the four dimensions of recovery; health, home, purpose, and community (Recovery Is Possible, 2019). Occupational therapists can help by using interventions that promote healthy choices and lower stress levels, enable individuals to engage in purposeful and meaningful activities, provide resources to ensure stability in the home, and teach social skills that help individuals create healthy social networks.Occupational therapy interventions have been proven to increase the quality of life specifically in children with mental health conditions and children who have experienced physical abuse (Howard, 1986; Read, Roush, & Downing, 2018). This is backed up by replicable research, which continues to show childhood maltreatment is directly linked to decreased, health-related, quality of life, in adulthood (Corso, Edwards, Fang, & Mercy, 2008).

Holistic, client centered treatment including prevention, adaptation, maintenance, restoration, and health promotion through occupational therapy services will increase participation and engagement in meaningful and purposeful activities for children and their families affected by ACEs. An occupational therapy focus on participation in children and youth populations, has been shown to improve social inclusion and emotional resilience (Berg, Medrano, Acharya, Lynch, & Msall, 2018). Along with one-on-one occupational therapy interventions with the child, the Center for Disease Control (2019) recommends supporting the family unit by encouraging positive parenting, teaching positive parenting skills, providing resources for access to preschool and economic support systems for families, intervening when physical and/or mental harm are present, and preventing future risk through identification of warning signs associated with the three main types of ACEs, followed by appropriate intervention.

1. Abuse:
   1. Sign of physical, emotional, or sexual abuse.
2. Neglect:
   1. Signs of physical or emotional
3. Specific household disruptors:
   1. An adult with a mental illness living at home
   2. An incarcerated relative
   3. Violence towards a parent
   4. An adult with a substance abuse disorder living at home
   5. Parental divorce, separation, or conflict

As occupational therapists, we have the opportunity to spend a significant amount of time with our clients and their families. We have a unique opportunity to recognize signs of abuse and can intervene early. You can impact a child’s whole life just by double checking, trusting your instincts, and intervening early. You may even save a life.