Changing the Outcome of Adverse Childhood Experiences: How Interpersonal Relationships, Play, and the Arts Support Posttraumatic Growth

Background and Purpose: The annual cost of early exposure to childhood trauma and adversity in 2015 was estimated at $428 billion (Peterson et al., 2015). Schaefer and colleagues (2018) reported that childhood adversity is projected to create an economic burden exceeding $585 billion over the next decade. Yet, research on mechanisms for mitigating these long term effects, and reducing their associating costs, is largely absent. Further, traditional measures of childhood adversity (e.g.: physical abuse, sexual abuse, domestic violence) fail to account for social determinants of health. This presentation explores the narratives of adults who experienced complex and prolonged childhood adversity, yet who mitigated negative outcomes to wellbeing in order to identify avenues for intervention towards symptom and cost reduction. Specifically, the researcher examined the combination of supportive interpersonal relationships and expressive arts (drama, music, dance/movement, art) as mechanisms to achieve positive outcomes despite significant exposure to adversity and trauma in childhood.

Methods: The researchers expanded the traditional ACE inventory to include social determinants of health and lived experiences (e.g.: child welfare involvement, unsafe neighborhoods, school violence). Using purposive and snowball sampling methods, the researcher recruited 10 adult participants (N=10) between the ages of 25-65 years, who reported four or more ACEs but who did not report significant negative behavioral, physical or chronic health conditions. Participants completed two 45-minute qualitative retrospective interviews including a structured family history and a semi-structured interview regarding important relationships and participation in the arts. Data analysis used the constant comparative method to complete both iterative and theoretical coding. Researchers examined interpretations of trauma, the meaning of participation in arts-oriented communities, and learning in the context of important relationships.

Findings: Participants perceived nurturing relationships, nested in expressive arts activities and communities, attenuated the long-term impact of adverse childhood experiences. These relationships counteracted earlier understandings of self and other developed in abusive spaces by providing a context for identity formation and emotional and cognitive processing of early trauma. Expressive arts, including music, drama, visual arts, and dance, enabled and encouraged new forms of self-expression, emotional catharsis, stress management, indirect teaching (learning through metaphor), improved self-esteem, and creative problem solving, which participants believed combined to diminish the effects of ACE exposure. Participants reported engaging in self-care across the lifespan through continued play and art expression.

Conclusions and Implications: The findings reveal how relationships in combination with the expressive arts, provide a context for self-expression, self-care, and healing. This potent combination promoted the development of posttraumatic growth following childhood trauma. The systemic health consequences of childhood trauma merit building protective factors into societal frameworks to enhance child health and development. Thus, the implications of this work extend to public health policy and education as institutions evaluate the necessity of public funding for arts programs in communities and schools. Schools utilizing approaches to learning that incorporate the arts in addition to science, technology, engineering, and mathematics (STEAM), may contribute to lessening the impact of trauma.