Using arts-based interventions to address adverse childhood experience

In a recent conversation with a professor of arts and health in the UK, I shared my thoughts on how mental health awareness is gradually growing in Pakistan, yet the concept of Adverse Childhood Experiences (ACEs) remains largely unfamiliar and may even be challenging for many to accept. In Pakistan, childhood adversity is often a quiet, yet pervasive reality. For too long, our society has held onto the belief that time alone heals, that silence and patience help develop resilience, and that children simply “move on” from what they endure. But as we look closer into the experiences of young people, it becomes clear that these assumptions fall short.

As a researcher and media producer working on the ATTUNE project—a UK Research and Innovation (UKRI)-funded initiative led by University of Oxford and Falmouth University — our team is investigating the potential of arts-based interventions to mitigate impact of ACEs. Being part of this UK-based project constantly brings to mind the lack of such discussions in Pakistani society. Question isn’t whether trauma exists in Pakistan but how we can help children face it meaningfully. Art, with its profound potential for expression, may be one of the most effective tools for addressing trauma and adversity.

The prevalence of ACEs in low- and middle-income countries (LMICs) like Pakistan is alarming, with studies estimating that between 50% and 70% of children experience at least one ACE in their lifetime. In Pakistan, these ACEs go beyond common adversities like domestic violence and neglect, extending to food insecurity, poor family support, and the broader challenges of limited healthcare and educational access, especially in rural communities. For example, certain practices such as female genital mutilation (FGM) persist in specific regions. While the practice may be done in the name of religion or culture, its impact on young girls is highly under researched due to the sensitivity of the topic. Globally, an estimated 230 million girls and women have undergone FGM, with rates highest in parts of Africa, the Middle East, and some areas of South Asia, including pockets within Pakistan. The research highlights that FGM inflicts physical harm and long-lasting psychological trauma, increasing the risk of post-traumatic stress disorder (PTSD), anxiety, and depression.

But growing up in Pakistan, many of us learned that adverse experiences are best kept private, and one must learn to live with them throughout their life. Expressing pain, sorrow, or fear openly is rarely encouraged, and silence is the default response to hardship. However, as we begin to see the real impact of this silence on children, with rising rates of depression, anxiety, and self-worth issues, it’s clear that “getting over it” is not enough. Trauma does not simply disappear in silence; it grows, and when left unaddressed and on Attune Project, we found that it becomes worst if the feelings and emotions of young people are ‘invalidated’.

Young people on Attune Project shared that they often face persistent invalidation from adults and professionals in their lives. The psychologists on the project that it can dismiss their feelings, experiences, needs, identities, and personal histories and such treatment makes them feel immature, overly dramatic, attention-seeking, insignificant, or irrational. This ongoing invalidation perpetuates emotional pain and allows adverse childhood experiences (ACEs) to continue shaping their teenage years.

Invalidation frequently occurs during small, everyday interactions. We would often sometimes even get this invalidation from our parents. These "micro-moments" of conversation, where adults unintentionally dismiss or undermine young people, leave a lasting impression. Researchers on Attune believe that young people are highly perceptive of this subtle invalidation and feel its impact deeply.

Furthermore, when invalidated, young people internalize the message that there is something wrong or confused about their emotions, needs, or coping mechanisms. This often reinforces unhealthy self-perceptions and negative beliefs about themselves, making it even harder for them to navigate their challenges.

This is where creative expression becomes essential. For example, in Pakistan, art in school was just another subject, a means to earn “marks.” But for children who have endured trauma, creating—whether it’s drawing, painting, sculpting, singing, or storytelling—could serve as an open, safe space of expression, if its free from judgment or grades. Arts-based interventions provide an outlet for emotions that words alone may fail to convey, offering children a voice for complex feelings like fear, anger, confusion, or loss in a way that feels meaningful and secure. Preliminary findings from ATTUNE reveal that arts-based activities in schools are helping children feel more comfortable expressing emotions, relieving stress, and reducing feelings of isolation. These activities include digital art like animation, participatory filmmaking, music/dance, photography, and even co-designing research.

Art in Pakistan has the potential to serve as more than personal therapy; it’s a communal lens through which we can start to understand trauma in ways that resonate with our heritage. Storytelling, or dastangoi, is a tradition deeply rooted in South Asian culture, passed down through generations. Storytelling—whether through spoken words, visual arts, heartfelt songs, or evocative poetry—has long been a way of sharing wisdom, conveying emotions, and making sense of life’s challenges. Research suggests that storytelling and arts-led community spaces effectively build resilience in the face of social and environmental challenges.

In Pakistan, resilience is often framed as a quality forged by hardship, as though struggle alone builds strength. However, true resilience is not simply about enduring pain; it’s about learning to heal, grow, and find meaning through it. Through various arts-based interventions and practices, it has been found in the research that children don’t just confront their trauma; they transform it, giving it form and texture, something they can observe, understand, and reshape. Creating something deeply personal helps children to see themselves not as passive victims but as active participants in their own stories. Art-based interventions turn healing into an empowering, active process, and for children in Pakistan dealing with trauma, this shift—from silence to creation—could be transformative.

As a society, we are still learning to openly discuss mental health, especially childhood trauma. Working on ATTUNE has shown that arts-based approaches do more than support individuals; they start a broader conversation. When children create—expressing themselves through participatory activities, creating and storytelling — they make visible what is often invisible.

There is an urgent need for schools and communities to include art not just as an academic subject but as a powerful tool for expression, where children are encouraged to share and create in ways that feel natural and safe. By giving children, a space to express their trauma, we, as a community, can move beyond silence and invalidation of their feelings.

The writer is a PhD candidate in the UK, researching media representation of minorities in Pakistan. They also work as a researcher and media producer on the Attune Project, a nationally funded initiative supported by UKRI.