Economic hardship, neighborhood violence, split-up parents and substance abuse. Any one of those conditions can make for problems that follow a kid through childhood and beyond.
And the risk of lifetime struggle rises dramatically for children who accumulate multiple adversities, as too many of Ohio's kids do.
A new report based on data from the 2016 National Survey of Children's Health found that Ohio is among five states with the highest share of children — as many as one in seven — who had faced three or more of the potential trauma measures known to researchers as adverse childhood experiences.
"Some of what puts Ohio in the higher levels is that almost a third of children have experienced economic hardship in their lives," said study co-author Vanessa Sacks of Child Trends, a nonpartisan research organization in Bethesda, Maryland.
But even that "doesn't fully explain why so many have had these multiple experiences," Sacks said. "It's particularly concerning."
The original study on adverse childhood experiences completed in the 1990s asked thousands of people whether they had experienced any of 10 categories of childhood trauma. Researchers found a pronounced connection between high scores of youth adversities and adult outcomes, including substance abuse, poor health and suicide attempts.
Since then, Sacks and others say, a growing body of research has supported the view that adverse childhood experiences are a major public-health issue.
"These are difficult things to move the needle on; they're hard to prevent," she said. "I think what is changing is our ability to recognize that these experiences are happening and to address them."
In Ohio, high rates of child poverty and an unrelenting crisis of drug addiction undoubtedly are taking a toll on child development, said Ashon McKenzie of the Children's Defense Fund Ohio. The other four states where at least 15 percent of children had experienced three or more adverse childhood experiences are Arizona, Arkansas, Montana and New Mexico.
Nationally, about 55 percent of children had not experienced any adverse experiences.
The Child Trends report included eight measures that asked whether a child had ever: lived with a parent or guardian who became separated or divorced; lived with a parent or guardian who died; lived with a parent or guardian who was incarcerated; lived with someone who was mentally ill or suicidal; lived with someone who has a problem with alcohol or drugs; witnessed a parent or guardian behaving violently; witnessed or been the victim of neighborhood violence; experienced economic hardship that made it hard to cover food and housing.
"These things impair your brain functioning at really critical junctures," ratcheting up stress levels and pushing kids into a "fight or flight" mode that makes it difficult for them to acquire appropriate behavioral skills and succeed in school, McKenzie said.
"Your brain isn't designed to learn when you're in a fearful state," he said.
Children aren't often the focus of the state's epidemic of opioid addiction, but untold numbers of them will bear the effects, McKenzie said. "When you're talking about 4,050 overdose deaths in 2016, each of those individuals represents someone who is connected with a family."
At the Boys and Girls Clubs of Columbus, staff members are working on new ways to help mitigate the stress of trauma and to help build resilience. Many of the kids face fear and danger just walking through their neighborhoods to school.
"The core of what we do is provide a safe place for kids to come and be kids," said Doug Wolf, the clubs' chief strategy officer. "That in itself provides some comfort and healing. But the reality is, just giving them some safe space is not the only solution. It's a very small piece."
In some cases, behavioral health specialists "actually come to our clubs during operating hours and just sit with kids," Wolf said.
Sacks, the report co-author, said the good news is that communities are embracing "trauma-informed" approaches in schools, child-welfare agencies, hospitals and other places where childhood adversities are recognized.
"There are things that can be done to head some of these things off," Sacks said. "Just having a caring, trusting adult in a child's life is one of the biggest buffers."