Adversity in childhood and gendered responses

Adversity in childhood is a key driver of health inequality, with strong evidence linking early life stress, trauma and disrupted attachment to poorer mental health, educational outcomes and increased risk of substance use and suicide in adulthood. Ten of these have been defined, referred to as adverse childhood experiences (ACEs), though these do not capture all adversities, such as living in a community experiencing poverty, poor employment, bereavement and isolation (Figure 19). The ACE pyramid (Figure 20) is a conceptual framework, demonstrating how adverse childhood experiences influence health and wellbeing.

Evidence suggests that girls are more likely than boys to report ACEs overall, and that ACEs experienced differ by sex, with boys more likely to experience physical abuse and girls more likely to experience sexual abuse(Jones et al., 2022). Boys and girls respond to adversity in different ways: boys are more likely to exhibit externalising responses, such as anger, behavioural disruption or withdrawal, while girls are more likely to exhibit internalising responses, such as anxiety or low mood. Gendered responses to behaviours are learned through and beyond childhood, including in schools. Both biological and social factors influence the emergence of gendered behaviours, with theoretical models of development summarised from Chaplin in Table 7.

Table 7: Theoretical models of emergence of gendered behaviour, extracted from Chaplin (Chaplin, 2015).

In practice, externalising responses are more likely to be interpreted as behavioural or disciplinary problems, particularly within school settings. This increases the likelihood that boys experiencing adversity are sanctioned or excluded. Over time, this contributes to disengagement from education, increased contact with the care and youth justice systems, and reduced access to protective factors.

The 2018 Annual Public Health Report for Cumbria highlighted the importance of recognising and responding to adverse childhood experiences through whole-system, trauma-informed approaches. Understanding how adversity is experienced, expressed and responded to differently in boys is critical to preventing the escalation of risk across the life course.

Boys growing up in deprived and coastal communities are more likely to experience multiple, overlapping stressors, including economic insecurity, bereavement, parental ill-health or substance use, and limited access to services. These experiences often accumulate rather than occur in isolation. Where adversity coincides with care experience, placement instability or school exclusion, its impact on emotional development and wellbeing is amplified.

The care system

When considering ACEs, it is important to consider the care system as by definition, children in the care system will have been exposed to ACEs. Cumberland has higher rates of children in need, on a protection plan and children cared for (94.4 vs 71.3 per 10,000) compared to the national average and statistical neighbours. Over half (51.5%) of children cared for are placed outside the Cumberland boundary, but are less likely to be moved through multiple placements. However, Cumberland has shorter adoption waiting times, and higher rates on onwards employment and care experienced adults in higher education that the England average (source: Cumberland HDRC).

National data from 2011-2015 shows that across England, boys were less likely to be placed into foster care than girls, and more like to be placed into children’s homes, secure children’s home or young offender institutes (Figure 21).

Identity formation is a central developmental task of adolescence and early adulthood. Through family relationships, school experiences, peer interactions and community context, boys learn who they are, what is expected of them and how they are valued. Identity is not a fixed personal characteristic, but a socially shaped process that reflects opportunity, context and lived experience.

Erikson’s psychosocial model conceptualises identity development as a lifelong process, structured around a series of developmental stages, each involving a central psychosocial challenge. Figure 22 presents Erikson’s eight stages of psychosocial development, the associated core challenges and the psychological strengths, or “virtues”, that emerge when these challenges are successfully navigated.

Figure 22: Erik Erikson’s stages of psychosocial development, image taken from psychology today

Early childhood and school-age experiences are key periods in shaping sense of competence and self-worth. Repeated experiences of difficulty, sanction or low expectation can undermine the development of competence and purpose. Boys in Cumberland are disproportionately exposed to cumulative stressors, including poverty, bereavement, substance use and involvement with the care system. Where such experiences coincide with limited opportunities to express vulnerability or access trusted adult support, identity may become organised around emotional self-reliance, withdrawal or risk-taking. These patterns reflect adaptation to context and are reinforced by social expectations around masculinity.

As boys move into adolescence and early adulthood, these identity pathways influence how they relate to work, relationships and support. For those whose early experiences have disrupted the development of competence, belonging or role identity, transitions into employment or training may be particularly challenging, especially in areas with limited local labour market opportunities. This helps explain why early disadvantage in Cumberland is closely linked to later patterns of insecure work, social isolation and poor mental health among men. Where a sense of future role, belonging or purpose is weakened, feelings of hopelessness may emerge, a factor consistently associated with suicide risk. Consistent relationships, access to meaningful work or training, community connection and responsive services can support the re-development of identity, even where early experiences have been adverse.