Let’s Talk About Adverse Childhood Experiences

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Let’s Talk About Adverse Childhood Experiences

Steering Committee

December 05, 2022

In thinking about this month’s topic, I realized that last month I mentioned ACEs and assumed that you would know what ACEs are and the body of research that has sprouted after the initial ACE study. So, let me back up a little bit, and let’s talk about ACEs. ACEs are Adverse Childhood Experiences (ACEs), they are defined by the Centers for Disease Control (CDC) as “potentially traumatic events that occur in childhood.” Interest in ACEs first started when a study conducted by the CDC and Kaiser Permanente, from 1995-1997, by Drs. Vincent J. Fellitti and Robert F. Anda found that individuals who experienced more, of what came to be known as adverse childhood experiences, or ACEs, had higher incidences of negative health outcomes as adults. The study looked at the health outcomes of more than 17,000 individuals who were mostly white, college educated, had high socio-economic status, and had good jobs with health insurance. Drs. Anda and Fellitti asked questions regarding childhood experiences focused on:

  • Physical, sexual, and verbal abuse
  • Physical and emotional neglect
  • If a family member was:
    • depressed or diagnosed with other mental illness
    • addicted to alcohol or another substance
    • in prison
  • If the person had witnessed their mother being abused
  • If the person had lost a parent to separation, divorce, or other reason

The researchers developed a questionnaire consisting of ten questions which rendered a score between zero and ten. Each type of trauma counts as one, regardless of how many times it occurs. What they found was that the higher number of ACEs a person experienced the more likely they were to develop significant negative health outcomes as adults. The original study showed that nearly 64% of adults had at least one ACE in their lifetime, subsequent studies in the United States (US) and worldwide, have found that that 60+% stays consistent.

The original ACE Study revealed several additional discoveries, including that ACEs don’t occur alone, if you have one, there’s an 87% chance that you have two or more. The more ACEs you have, the greater the risk for chronic disease, mental illness, violence, and being a victim of violence. You can think of an ACE score as a cholesterol score for childhood trauma. For example, people with an ACE score of four are twice as likely to be smokers and seven times more likely to be alcoholics. Having an ACE score of four also increases the risk of emphysema or chronic bronchitis by nearly 400 percent, and attempted suicide by 1200 percent. People with high ACEcores are more likely to be violent, to have more marriages, more broken bones, more drug prescriptions, more depression, and more autoimmune diseases. People with an ACE score of six or higher are at risk of their lifespan being shortened by 20 years. ACEs are responsible for a big chunk of workplace absenteeism, and for high costs in health care, emergency response, mental health, and criminal justice. The original ACE study exposed childhood adversity as a contributor to most of the major chronic health, mental health, economic health, and social health issues in the US. On a population level, it does not matter which four ACEs a person has; the harmful consequences are the same. The brain cannot distinguish one type of toxic stress from another: it’s all toxic stress, with the same impact.

As interest in the impact of ACEs has grown – many researchers and communities have begun to study additional adverse experiences outside of the initial ten studied by Drs. Anda and Fellitti. The study of ACEs has begun to take into consideration that social context matters; therefore, the field has expanded to study adverse community environments and adverse climate experiences. Adverse community environments include things like poverty, poor housing quality and availability, racism, discrimination, lack of access to healthy foods, and safe outdoor experiences. Adverse climate experiences include things like natural disasters, record heat, drought, severe storms, wildfires, and smoke. Social context matters because we do not live our lives in a vacuum.

ACEs science has also furthered the study of:

  • The epidemiology of childhood adversity, or how many people experience different types of childhood trauma, to what degree, and what happens as a result.
  • How toxic stress from these childhood experiences damages children’s developing brains, and shapes adult brains.
  • How toxic stress from ACEs affects our short- and long-term health.
  • Epigenetics – sometimes referred to as the study of historical trauma or generational trauma – or how we pass this toxic stress and thus, ACEs from generation to generation in our genes and from mother to fetus. Toxic stress can turn genes on and off and these changes can be transferred from parent to child.
  • How resilience research is showing that our brains are plastic, and our bodies can heal through implementing trauma-informed and resilience-building practices based on ACEs science.

Why should you care? Because ACEs disrupt attachment, and we know that relationships are developed through the emotional bond between a child and their primary caregiver. It is through this relationship that a child learns to:

  • Struggle with receptive and expressive language
  • Have decreased attention and executive function levels
  • Avoid challenging tasks in school
  • Have increased antisocial behavior and aggression
  • Exhibit more withdrawal and defiance
  • Utilize increased special education services
  • Require increased disciplinary referrals and suspensions
  • Have lower grades – they are four times more likely to get Fs than students without ACEs
  • Have lower standardized test scores
  • Are more likely to repeat a grade and drop out

This body of knowledge is fueling an ACEs movement, which now has pediatricians, schools, and juvenile detention centers integrating ACEs science into their practices. There are more than a dozen states whose legislatures have passed everything from resolutions acknowledging the importance of ACEs science and trauma-informed practices to legislation integrating trauma-informed practices in schools. There are hundreds of cities, counties, and regions launching local ACEs initiatives, and one state, Wisconsin, whose governor directed the seven largest state agencies to engage in a two-year trauma-informed learning collaborative. In California, we have a statewide initiative launched by our first ever state surgeon general, ACES Aware, that trains health care providers to screen, recognize, and respond to ACEs and toxic stress. In San Bernardino County, we are collecting ACE data to inform the programs and services made available to children and families most at risk for ACEs.

Conversely, the study of ACEs has also sparked a body of research around positive childhood experiences and what resiliency factors are needed to counter ACEs. It is important to acknowledge that the relationship between ACEs and negative health outcomes in adults is correlational, not causational. In other words, ACEs do not cause those negative outcomes, as many other factors play a role too, including genetics, relationships, access to care, etc. Risk does not define destiny, there is always hope for a positive outcome. We know that protective factors, conditions or attributes in individuals, families, and communities that promote the well-being of children and families, mitigate the effects of ACEs. By ensuring that we help build these protective factors in our clients/students and their families we can assist them in overcoming ACEs and any other factors that put them at risk of not leading healthy, productive lives. One of those protective factors we can help build in our clients/students is resiliency. Resiliency is the ability to thrive, adapt, and cope despite tough and stressful times. Resiliency generally describes the bounce-back ability of individuals who return to the similar shape, form, and condition after misfortune, harm, or injury. Resilience is a natural counterweight to ACEs. The more resilient a child is, the more likely they are to deal with negative situations in a healthy way that will not have prolonged and unfavorable outcomes. Resilience is not an innate characteristic, but rather is a skill that can be taught, learned, and practiced. Everybody can become resilient when surrounded by the right environments and people. Research tells us that just one caring, safe relationship early in life gives any child a much better shot at growing up healthy. It is our responsibility to ensure that the children and families we serve have access to the supports they need to become resilient and help them thrive, despite the challenges they may face

References:

  1. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 1998:14(4): 245–58.
  2. “A Hidden Crisis: Findings on Adverse Childhood Experiences in California.” Center for Youth Wellness Data Report in partnership with Public Health Institute, November 6, 2014.
  3. Rodriguez, D., et al. (2016). Prevalence of adverse childhood experiences by county, California Behavioral Risk Factor Surveillance System 2008, 2009, 2011, and 2013. Public Health Institute, Survey Research Group.
  4. Child and Adolescent Health Measurement Initiative (2013). “Overview of Adverse Child and Family Experiences among US Children.” Data Resource Center, supported by Cooperative Agreement 1‐U59‐MC06980‐01 from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB).
  5. Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Agosti, J., MPP, Connors, K., MSW, LCSW-C, Hisle, B., MSW, Kiser, L., PhD, Streider, F., PhD, Thompson, E., PhD. Baltimore: A Trauma and Resilience Informed City for Children and Families – Breakthrough Series Collaborative Final Report. The Baltimore Partnership for Family and Trauma-Informed Care (2016).

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