Author Dr. Robert Saul

Raising Young Citizens in the Age of Columbine

Positive Childhood Experiences

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A great deal of effort has followed a landmark study back in the late 1990s.  Dr. Felitti and colleagues surveyed over 17,000 adults in California.1  They found that individuals who reported exposures to negative events in childhood were more likely to manifest chronic disease in adulthood, such as problems generally related to overeating, smoking, alcohol use, substance use and sex with multiple partners.  Those negative events (abuse [emotional, physical, sexual], household dysfunction [intimate partner violence, substance abuse, mental illness, parental separation or divorce, incarcerated household member], neglect [emotional, physical]) were recorded as adverse childhood experiences (ACEs).  With a potential ACE score of up to 10, it was noticed that the higher the ACE score the greater the likelihood of adult health problems.2 (Chapter 1)

It was therefore noted that issues in childhood (ACEs) did not stay in childhood.2  Put another way, diseases typically described as adult-onset were actually adult-manifest from childhood.  And if we want to improve the lot of adults, we should be concentrating more on our children.  It makes sense morally and ethically, but it also makes sense economically.  There would be less health care expenditures on adults for very costly conditions.  Our inattention to this matter is really discouraging.

I have previously discussed the above and extolled the virtues of diminishing the ACEs that children are subject to.3  It is simplistic to state that just diminishing the exposure to ACEs will occur given the multiple barriers that our children and families face every day.  There are so many factors affecting the ability of families to overcome adversity and avoid the hazards of untoward social determinants of health.  In reality, the ACE score has been over emphasized at times, and its true impact has been underappreciated at times.  By putting emphasis on all of the negative factors present in the lives of our children, we have overlooked the positive things that we can do.  Below I want to highlight a recent study that demonstrated the power of positive things that can impact our children, all of our children.

Sege et al. just published a paper that draws on work from multiple previous studies and recent surveys – Positive childhood experiences and adult health and opportunity outcomes in 4 US states.4  For me, the results are so dramatic that I wanted to highlight some of them and then touch on actions going forward.

  • First, they surveyed close to 21,000 individuals in 4 states (KA, MT, SC, WI). They asked them to self-report any of the following Positive Childhood Experiences (PCEs) that they experienced in childhood.
    • Adult made you feel safe and protected
    • Felt you belonged in high school
    • Felt supported by friends
    • At least 2 adults took an interest in you
    • Felt your family stood by you
    • Enjoyed community traditions
    • Felt able to talk with your family
  • Multiple tables in the paper demonstrate fairly dramatic data based on the number of PCEs present. One must always analyze this type of data carefully and be cautious about conclusions.  Yet, to ignore this type of information is to continue down a path that does nothing to lift up our children and fellow citizens.  So much can be done when we accept our shortcomings, carefully assess the circumstances and willfully move forward with positive steps to change/enhance our ability to improve the lives of others.  A sampling of some of the data –
    • 0 PCEs – 2.5%; 1-2 PCEs – 10%; 3-5 PCEs – 34.5%; 6-7 PCEs – 53%
      • The shocking statistic here for me is that 47% of respondents report ≤ 5 PCEs. Ideally, we should be shooting for 6-7 PCEs for every child.
    • College education or income ≥ $50,000
      • 0 PCEs – 50%
      • 6-7 PCEs – 78%
    • Moderate/heavy drinking or smoking
      • 0 PCEs – 65%
      • 6-7 PCEs – 50%
    • Two or more chronic conditions (arthritis, asthma, cancer, chronic obstructive pulmonary disease, depression, diabetes, heart disease, kidney disease, stroke, overweight)
      • 0 PCEs – 58%
      • 6-7 PCEs – 31%
    • Poor general health (physical or mental)
      • 0 PCEs – 53-57%
      • 6-7 PCEs – 27-30%

Previous evidence by Bethell et al. has revealed that positive childhood experiences lead to a greater likelihood of flourishing (a combination of 3 different factors for children and 6 different factors for families).5 The presence of more PCEs markedly increased the likelihood of flourishing even in the presence of high levels of adversity (a high ACE score).  This might seem paradoxical (that high levels of adversity can be overcome leading to higher levels of child and family flourishing) but it demonstrates the power of relational health.2 (Chapter 3)  To quote Garner and Saul, “relational health (RH) is our primary objective for the next generation because we want them to develop [the] requisite skills for healthy and productive lives, and RH is the way to go about building those skills.”

Let’s finish with mentioning some of the ways that PCEs can have such a positive effect.4

  • Direct effect
    • Healthy environment for exploration, learning and social interaction
    • Support of cognitive development and high quality education
    • Promotion of secure attachments and social supports
  • Prevention of ACEs
    • Early childhood home visitation programs
    • Paid family leave
    • Child income tax credits
    • Early literacy programs
    • Well child care that focuses on relational health and PCEs
  • Enhancement of community resources
    • Support and development of all neighborhoods
  • Building resilience
    • Research dramatically demonstrates the importance of PCEs to build resilience. Indeed, resilience is the key to future flourishing.  Any and all attempts to develop, promote and enhance PCEs for children and families are so important.

To summarize, PCEs are critical to childhood development.  When problems occur such as ACES, PCEs and their associated relational health are the key going forward.  We want all children to develop resilience and flourish.  When children and families encounter struggles, we want them in addition to be restored before they can then develop resilience and flourishing.

Our inattention to the development and nurturing of programs and services that allow for PCEs to flow like water from a spigot can be disheartening.  But I refuse to give up and will continue to advocate for what needs to be done.  The very nature of PCEs means for things to be positive, during childhood and experienced.  Not gently nudged but immersed in positivity, experienced fully while still in childhood.

Childhood adversity should be avoided to the greatest extent possible.  When it occurs, PCEs can be a saving balm that helps all of our children.  That is so exciting!

  1. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 1998;14(4):245-258.
  2. Garner A, Saul R. Thinking Developmentally: Nurturing Wellness in Childhood to Promote Lifelong Health, 2nd American Academy of Pediatrics; 2025. 200 pp.
  3. https://mychildrenschildren.com/the-pediatric-way/
  4. Sege RD, Aslam MV, Peterson C, et al. Positive childhood experiences and adult health and opportunity outcomes in 4 US states. JAMA Network Open 2025;8(7):e2524435. doi:10.1001/jamanetworkopen.2025.24435
  5. Bethell CD, Gombojav N, Whitaker RC. Family resilience and connection promote flourishing among US children, even amid adversity. Health Aff (Millwood). 2019; 38(5):729-737. PMID: 31059374 doi: 10.1377/hlthaff.2018.05425