- ACE —
- adverse childhood event
- ICE —
- US Immigration and Customs Enforcement
An undocumented immigrant father drops off his 12-year-old daughter at school in Los Angeles. Moments later, 2 black, unmarked vehicles surround his car a few blocks from the school. US Immigration and Customs Enforcement (ICE) agents arrest him while his 13-year-old daughter watches from his car; she can be heard sobbing while she films a cell phone video of the arrest that later goes viral.1 An undocumented Guatemalan mother of 4 children, including 1 with cerebral palsy, faces deportation after 24 years as a Connecticut housecleaner and seeks sanctuary in a church with her 9-year-old daughter by her side.2 One day after his mother’s ICE arrest, an undocumented Ecuadorian high school senior in New York is taken into custody by ICE hours before his senior prom.3 While waiting at his school bus stop, an undocumented Salvadorian high school senior in North Carolina is arrested and handcuffed by armed ICE agents as schoolmates watch from the bus; he is detained for 5 months and misses graduation.4,5 Another undocumented North Carolina high school senior (who crossed the border as an unaccompanied minor to escape Honduran gang violence) is arrested as he leaves home to attend school; the next day, one-third of students in his English as a Second Language class are absent.4,6
One day after ICE raids at a Las Cruces trailer park, the city’s public schools experience a 60% spike in absences (2100 students in total), including a 150% rise in absences in elementary schools.7 Recent presidential executive orders expanding deportations prompted undocumented parents across Wisconsin to complete Power of Attorney forms to protect their children in the event of parental deportation, assigning temporary guardians to care for the children and take them to school and doctors’ appointments.8
Adverse childhood events (ACEs) are associated with deleterious health outcomes in adulthood, including premature death, chronic diseases, psychiatric disorders, high-risk behaviors, and lower quality of life.9 One might reasonably assume that recent episodes described above of parental arrest and/or deportation or witnessing or being the target of arrests or raids would constitute ACEs. In this issue of Pediatrics, however, although Caballero et al10 revealed a high ACE prevalence in Latino children, they also surprisingly found Latino children in immigrant families were less likely than those in US-native families to have high ACEs, at 16% vs 30%, with an adjusted odds ratio of 0.46.
How can one reconcile these seemingly contradictory findings? The Caballero et al10 study was rigorous and used the 9 customary ACE domains,11 including poverty-related hardships, divorced or separated parents, parental death, parental incarceration, witnessing domestic violence, victimization by or witnessing neighborhood violence, household mental illness, household drug or alcohol abuse, and racial or ethnic discrimination. As the authors astutely point out, however, their ostensibly contradictory findings may be due to traditional ACE measures failing to reflect immigrant-specific ACEs.
As the multiple tragic cases above graphically illustrate, traditional ACE measures cannot capture (1) ICE arrests or deportations of parents or guardians, (2) being a victim of or witnessing ICE arrests or raids, (3) parent or guardian separation because of migration, and (4) experiencing anti-immigrant discrimination. For ACE measures to be accurate and truly inclusive of all US children, these 4 domains should be integrated with other traditional ACE measures. Research documents the substantial adverse impact on children of detained or deported parents, including higher risks of depression, emotional problems, negative self-esteem, anxiety, attention disorders, externalizing and internalizing disorders, speech delay, compromised school performance, and disrupted parent-child relationships.12–15 All children in immigrant families, therefore, should be screened for ACEs by using the proposed revised 13-component measures, and referred to appropriate mental health professionals, pediatric subspecialists, legal services, and resources to address social determinants of health.
Challenges for immigrant Latino children are only getting worse. Eighteen million US children live with at least 1 immigrant parent, comprising 26% of all US children, and 12% (2.1 million) were born outside the United States.16 Four million undocumented immigrant adults (38%) reside with their US-born children, so millions of US children are at risk for detainment or deportation of their parents or themselves.17 In the first 6 months of President Trump’s administration, there were 49 983 deportation orders by immigration judges, a 1-year spike of 28%.18 The United States has the world’s largest immigration detention system, detaining up to 442 000 persons per year; many are children. Earlier this year, the US Homeland Security Secretary stated that he is considering separating children from parents caught crossing the border as a “deterrent.”19 A 2017 American Academy of Pediatrics Policy Statement supports (1) comprehensive health care for every US child, including all immigrant children; (2) protecting immigrant children from additional traumatization in the United States; and (3) identification and treatment of trauma in a child’s country of origin, while migrating, and during immigration processing or detention in the United States.20 In our view, regardless of one’s political persuasion, such recommendations could not be more timely, ethical, or essential for the health and well-being of immigrant children.
- Accepted August 22, 2017.
- Address correspondence to Glenn Flores, MD, FAAP, Connecticut Children’s Medical Center, 282 Washington St, Hartford, CT, 06106. E-mail:
Opinions expressed in these commentaries are those of the authors and not necessarily those of the American Academy of Pediatrics or its Committees.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2017-0297.
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- Copyright © 2017 by the American Academy of Pediatrics