# Motivation and emotion/Book/2024/Adverse childhood experiences and risk-taking motivation

* Multimedia presentation (3 min)

## Overview

* Figure 1. Cognac Danger on a set of two shot glasses
* Scenario
* A U.S. study involving 515 children aged between 9 and 11 years who were placed in foster care due to maltreatment were interviewed about their risk-taking behaviours such as substance use, engagement in violence and delinquent behaviour. It was found throughout this study that there was a direct association between the number of ACEs experienced and engagement in health-risk behaviours. For each additional ACE, there was an increased 24% of engagement in violence and 50% increase in the likelihood of substance abuse (Garrido et al., 2017).
Adverse childhood experiences (ACEs) are often defined as neglect, abuse, and domestic adversities experienced throughout childhood. Adverse childhood experiences have been shown throughout research to lead to less than ideal circumstances throughout the lifespan. Risk-taking behaviours, such as excessive drug and alcohol intake (see Figure 1), and engagement in criminal activities, can also lead to adverse effects on the body such as organ failure and the increase in the prevalence of mental disorders. Adverse childhood experiences similarly have shown to affect mental health. Poorer mental health has been linked to risk-taking behaviours in adolescence which can escalate normal adolescent risk-taking due to the heightened activity in the brain as a result of ACEs and the increased need for rewarding cues. The combination of predispositions to poor mental health outcomes and increasing the affects on the body, people who experience traumas in childhood and partake in risk-taking behaviours may be more susceptible to further aversive experiences. There are also some individuals who experience ACEs and avoid risk-taking behaviours as they tend to be fearful of the negative consequences of behaviours, although this is not as heavily researched as risk-taking. People affected by ACEs, at some point in their lives, will likely rely on strategies to reduce their risk-taking. Some effective strategies found in research is marketing around risk-taking behaviours that informs individuals on prevention strategies and promoting resiliency and and self-regulation skills in children at an education level. This chapter investigates all of these factors and delves into how ACEs impact individuals and how best society can reduce the impact adverse experiences have on individuals' throughout the lifespan.
* Focus questions
* What are adverse childhood experiences and risk-taking behaviours?
* How do adverse childhood experiences increase risk-taking motivations?
* How can adverse childhood experiences make someone risk averse?
* What are some strategies to reduce risk-taking behaviours in people affected by adverse childhood experiences?

## Background to ACEs and risk-taking

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### Key Points

* Adverse childhood experiences are typically categorised by abuse, neglect and household adversities.
* ACEs can affect mental health, physical conditions and interpersonal and social skills.
* Different types of risk-taking behaviours exist, such as: financial, recreational, social, health and sensation seeking behaviours.
* Consequences of risk-taking behaviours range from increased alcohol and drug intake, which can lead to long-term health effects. Additionally, if violent or criminal behaviours are present, youth incarceration can also become a consequence.

### What constitutes an adverse childhood experience?

Adverse childhood experiences are characterised by many different experiences. The term was introduced following the 1988 CDC-Kaiser Permanente adverse childhood experiences (ACE) study, where between 1995 and 1997 over 17,000 participants reported their childhood experiences and current health status and behaviours (Felitti et al., 1998). The most recognised and researched ACEs relate to neglect, abuse and household adversities (Felitti et al., 1998; Gupta & Tariq, 2023; Ramiro et al., 2010). Some of these included:
* childhood physical, sexual and emotional abuse
* physical and emotional neglect
* exposure to family violence
* parental substance abuse
* parental mental illness
* parental separation or divorce
* parental incarceration (Felitti et al., 1998).

### Consequences of adverse childhood experiences

ACEs can have many lifelong effects on individuals. Briefly, ACEs can have an impact on a youth's mental health, propensity for risk taking behaviours and life potential, as seen in Figure 2. Additionally, studies found that participants who had self-reported ACEs had experienced physical and psychological conditions, risk behaviours, and developmental disruption to name a few (Kalmakis & Chandler, 2015). Interpersonal and social skills are also affected by the number of ACEs experienced at an early age, with one study finding that the more ACEs experienced, the larger decrease in social skills and higher prediction of interpersonal difficulties (Pierce et al., 2022; Poole et al., 2018).

### Types of risk-taking behaviours

The propensity to engage in risk-taking behaviours has been found throughout research to increase with the more ACEs experienced by individuals (Kalmakis & Chandler, 2015). General and domain-specific risk-taking behaviours are assessed by the domain-specific risk-taking (DOSPERT) scale, which investigates different domains of risk taking such as financial decisions, health, safety, recreational, ethical and, social decisions (Blais & Weber, 2006). Some individuals also engage in sensation seeking behaviours which can also involves components of risk taking. These are typically measured by the behavioral inhibition system (BIS)/behavioral approach system (BAS) scales (Babad et al., 2019).

### Consequences of risk-taking behaviour

Risk-taking behaviours, such as excessive alcohol and drug consumption, can have long-lasting effects on the body. In regards to drinking and smoking behaviours, individuals have rated their overall health as worse due to their behaviours (Akasaki et al., 2019). Alcohol consumption can lead to several physiological and psychological, such as speech and walking difficulties, nausea, confusion, exhaustion and sadness (Peacock et al., 2012). In a study where participants mixed alcohol and energy drinks, researchers discovered increased odds of enduring physiological and psychological conditions such as heart palpitations, sleep difficulties, agitation, tremors, irritability and tension (Nadeem et al., 2021; Peacock et al., 2012). These results show that mixing substances, which have shown throughout research to sometimes have harmful effects, can be detrimental to a person's health, sometimes even leading to psychological distress (Akasaki et al., 2019; Peacock et al., 2012).
In more extreme circumstances, youth detention centres will hold juveniles when they have committed violent or dangerous crimes (Gupta & Tariq, 2023). Most cases where juveniles commit offences, they can be sentenced to bail and have conditions about how they live in the community as opposed to being in youth detention centres.

## How do adverse childhood experiences motivate risk-taking behaviours?

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### The brain, adolescents, and risk-taking behaviours

Adolescents are known for being more susceptible to risk-taking and sensation seeking behaviours, and across a variety of species this has been proven (Doremus-Fitzwater et al., 2010; Parsons et al., 1997). Functional magnetic resonance imaging (fMRI) has been used throughout research to locate the areas in the brain that respond to reward values, which can be caused by risk taking behaviours (Galvan et al., 2006). The study by Galvan et al (2006) found that adolescents' accumbens activity was similar to that of adults however, the magnitude of the activity was exaggerated. As well as this, adolescents' orbitofrontal cortex (OFC) activity was more similar to that of a child than an adult, maintaining less patterns of activity (Galvan et al., 2006). With the lack of patterns in the OFC and the responses in the accumbens upon the introduction of rewarding stimuli, adolescents' behaviour was found to be biased towards immediate over long-term gains (Galvan et al., 2006). Enhanced sensitivity towards reward seeking behaviours may find individuals, specifically adolescents, who are seeking escapes from their adverse experiences engaging in behaviours such as drug use (Doremus-Fitzwater et al., 2009). The exaggerated activity in the brain upon using a drug and experiencing 'positive' effects may stimulate the desire to repeat the activity until the presence of an aversive effect arises (Doremus-Fitzwater et al., 2009; Feltus, 2022). As with the continued misuse of any substance, a vulnerable individual may become sensitive to the experience a substance gives during or after use and abusive patterns of behaviour and "cravings" may arise (Doremus-Fitzwater et al., 2009). The brain is impacted by many experiences individuals have throughout the lifespan, sometimes increasing the propensity for risk-taking when initially an individual had no desire to partake in those behaviours.

### ACEs and associations to health-risk behaviours

Taking into consideration the impact ACEs can have on the brain, individuals' desire for reward and positive sensations, and how problematic behaviours such as drug and alcohol misuse can become easier to partake in when seeking positive sensations, an association between health-risk behaviours and ACEs becomes easier to understand. In an online questionnaire about drinking motives, behaviours and ACEs, 98% of the undergraduate students recorded at least one ACE (Feltus, 2022). Additionally, Feltus (2022) found in a separate model that the relationship between ACEs and heavy drinking was statistically significant and mediated by the motivation to cope (R$^2$ = 0.10, F(2, 540) = 23.31, p < .001). Without motives to cope mediating the association between ACEs and heaviest day drinking, the model was not significant and demonstrated that motives to cope was necessary for this model (Feltus, 2022). Feltus (2022) went on to examine the different motives mediating the association, discovering that coping with negative affect, enhancing positive affect, social reasons, and conformity simultaneously, but partially, mediated the relationship between ACEs and negative consequences. The results of the study found that the motivation to cope with negative affect or enhance positive affect, which was done through heavy drinking, was more common in individuals with ACEs (Feltus, 2022). In a different study, "persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse... a 2- to 4-fold increase in smoking, poor self-rated health" (Felitti et al., 1998). In individuals with larger amounts of ACEs, a graded relationship was discovered in the amount of diseases experienced later in life, such as heart disease, cancer, lung and liver disease (p < .001) (Felitti et al., 1998). This is further supported by Ramiro et al (2010), whereby 75% of respondents recorded exposure to at least one ACE, with 9% experiencing four or more types, and most respondents reporting engaging in health-risk behaviours such as smoking, alcohol use and risky sexual behaviours. Ramiro et al (2010) also found a strongly graded relationship between some ACEs, health-risk behaviours and poor health.

## How can adverse childhood experiences make someone risk averse?

Being aware of the consequences of behaviours can deter people from engaging in them. Individuals with strong motives to avoid failure will prefer easier tasks with little risk and this will influence what behaviours they partake in (Atkinson, 1957). Specific ACEs, such as growing up with a mentally ill family member and emotional neglect, significantly predicted reduced motivation to pursue reward cues (Babad et al., 2021). A reduction in the desire to pursue rewarding stimuli leaves individuals with reduced behaviour and therefore an aversion to risks. Learned helplessness was also reported in individuals who experienced ACEs, which possibly could lead to the avoidance of behaviours as they may fear a negative outcome (Crandall et al., 2024). An analysis of adolescent risk-taking found that involvement in behaviours was significantly correlated to perceived benefit and the perception of risk, although in opposite directions (Lavery et al., 1993). When perceived benefit was higher, involvement was too, and vice versa for perceived risk (Lavery et al., 1993). In a regression analysis of perceived risks and overall risk-taking behaviour, behavioural intentions were significantly varied by perceived risks in regards to five of six types of risk-taking behaviours discovered (Parsons et al., 1997). However, this study by Parsons et al (1997) reported that despite perceived risks impacting behaviour, perceived benefits were better determinants of behaviours and engagement in risk-taking. Despite this, perceived risks is still an important determinant of risk-taking behaviour but when analysing this, taking into consideration the perceived benefits is also necessary (Parsons et al., 1997). Whilst risk aversion is an important behaviour which occurs due to ACEs, risk-taking behaviours are more prevalent in research, which demonstrates an area that needs greater focus in future research.

## What are some strategies to reduce risk-taking behaviours in people affected by adverse childhood experiences?

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### Key points

* Resiliency theory is applied to understand how counter-ACEs can help reduce the impact of ACEs on health.
* Marketing focused towards preventing negative effects from health-risk behaviours will help reduce how much individuals with ACEs engage in that behaviour.
* Trauma-informed supports services will cater to individuals' specific needs and help them navigate the issues that arise with ACEs.

### Resiliency theory and ACEs

In resilience theory, an individual's capacity to adapt within and across systems and processes determines their resilience and it is impacted by multiple systems that interact throughout the lifespan (Masten & Cicchetti, 2016). Counter-ACEs, positive childhood experiences such as parental warmth, residential stability and supportive schooling environments, were correlated to the three main models of resiliency theory, being the compensatory model, protective factors model and the challenge model (Crandall et al., 2019). A regression analysis discovered that counter-ACEs corresponded with improved health outcomes in adults and in some cases neutralised the negative impacts ACEs on adult health outcomes under the compensatory model of resiliency (Crandall et al., 2019). When four or more ACEs existed, counter-ACEs had a reduced positive effect on adult health as per the challenge model of resiliency, compared to individuals' with less than four ACEs (Crandall et al., 2019). Collaborative community efforts to implement programs in school environments which promote resiliency, self-efficacy and self-regulation can enhance the skillset of children experiencing ACEs and act as a protective factor against the negative long-term effects (Di Lemma et al., 2019; Leitch, 2017; Sciaraffa et al., 2017) Given the results of this study and other research on resilience as a protective factor, early intervention and supportive environments around children experiencing ACEs will provide stability that can counter and reduce the likelihood of ongoing negative effects.

### Health-risk behaviour focus marketing

Throughout the education system and in marketing for products such as alcohol and reproductive health items, individuals are warned of the negative side effects they can cause if used improperly. This extends to behaviours such as unsafe sex practices, drug use, smoking and delinquency. Karatekin et al. (2018) discovered while analysing ACEs, promotion versus prevention focus, patient activation, and health, that participants' with higher self-reported ACEs maintained a stronger association with higher prevention focuses. This higher prevention focus demonstrates that individuals will avoid negative outcomes, and likely will be more receptive to marketing that highlights the gravity of negative outcomes associated with health conditions and promotes that a treatment will be a means of avoiding these negative health outcomes (Karatekin et al., 2018). Applying these strategies in messaging aimed towards people with ACEs will be beneficial to deter them from engaging in unsafe behaviours (Karatekin et al., 2018). Additionally, this research found that interventions for people who have experienced ACEs to increase their patient activation would be beneficial to reduce the likelihood of engaging in health-risk behaviours (Karatekin et al., 2018). Marketing has been used for various products and for a significant amount of time, and catering marketing of products, such as alcohol, towards a prevention of adverse effects may help reduce the likelihood of individuals with ACEs engaging in health-risk behaviours.

### Trauma-informed support services

Implementing trauma-informed practices into places such as health-care and education settings will allow for early intervention for people experiencing ACEs and also give strategies to better manage for people later in life who are struggling. Trauma-specific care, specifically in a therapy environment, will help people learn how to build their relationships, resilience and how best to respond to their traumas and reduce the impact of the triggers they may have (Di Lemma et al., 2019). If this is to be done across individual, family and community levels, the ability to detect ACEs at a young age or early on will increase and reduce the likelihood of lifelong issues that stem from ACEs (Di Lemma et al., 2019). In a study by Goldstein et al (2020), the majority of participants reported a high rate of satisfaction with the intervention, stressing the importance of talking with trained professionals who can listen to them, understand the challenges they face and help facilitate behaviour change plans. In community-based clinics, teaching clinicians high level conversation and listening skills will allow them to more easily identify patients who were exposed to ACEs and help promote and teach healthy coping behaviours (Goldstein et al., 2020). As ACEs have been associated with interpersonal difficulties, specifically emotion dysregulation, implementing easier to access therapies and trauma-informed support services will allow individuals to better manage their emotions and reduce the impact their ACEs have on day-to-day life (Poole et al., 2018). Trauma-specific care is necessary to ensure people's individual needs are met to reduce the impact of things such as ACEs on daily life.

## Conclusion

Adverse childhood experiences, stressful events or circumstances which occur during childhood, can have serious impacts on children as they age. ACEs typically refer to abuse, neglect and household adversities. Some consequences of ACEs are chronic and mental health issues as well as social developmental issues. Risk-taking behaviours are engaged in for various reasons and vary from health related risk-taking, such as drug and alcohol abuse, to physical behaviours like violence. From reward seeking to coping mechanisms, a wide variety of motivations for risk-taking behaviour exist. Risk-taking can be exaggerated throughout adolescence as the adolescent brain has more susceptibility to sensation seeking and the desire for rewarding cues. In contrast, some individuals who experience ACEs avoid anything that may have an aversive consequence, which can limit the life experiences they have throughout their lives. Adverse childhood experiences lead to more susceptibility to mental health conditions, which can in turn increase the susceptibility to peer pressure to partake in risk-taking behaviours. Early intervention in situations of child neglect and abuse can allow for the reduction of detrimental affects from ACEs. If early interventions are unable to occur, increasing the accessibility of medical, counselling and other services such as support groups for sufferers will allow for better mental and physical health outcomes for people affected by ACEs.