Adverse Childhood Experience (ACE)
Trauma can have a lasting impact and can affect many different aspects of a person's life and wellbeing. The table below identifies some of the areas that can be affected by adverse childhood experiences.
The population risk as a result of adverse childhood experiences:
Behaviour
- Lack of physical activity.
- Smoking (times 2).
- Alcoholism (times 7).
- Drug use (times 10).
- Missed work (times 10).
Physical and mental health
- Severe obesity.
- Diabetes (times 10).
- Depression (times 5).
- Suicide attempts (times 12).
- Sexually transmitted diseases.
- Heart disease (times 2).
- Cancer.
- Stroke.
- Congestive obstructive pulmonary disease (COPD).
- Broken bones.
The ACE study
The Adverse Childhood Experiences Study (ACE Study) is a research study conducted by the American health maintenance organization Kaiser Permanente and the Centre for Disease Control and Prevention. Participants were recruited to the study between 1995 and 1997 and have been in long-term follow up for health outcomes. The study has demonstrated an association of adverse childhood experiences (ACE’s) with health and social problems across the lifespan (Felliti et al, 1998).
The ACE Pyramid represents the conceptual framework for the ACE Study, which has uncovered how adverse childhood experiences are strongly related to various risk factors for disease throughout the lifespan, according to the Centers for Disease Control and Prevention.
Although this diagram may be of concern to individuals who have had adverse childhood experiences it is worth noting that it is a correlation not a cause and effect relationship. This means that the statistics suggest an increased risk of various factors for disease rather than a certainty that these diseases will occur. Additionally, there are things that can be done to reduce this risk including healthy lifestyle choices and maintaining good wellbeing.
About the study
The study asked participants about 10 types of childhood trauma that had been identified in earlier research literature:
- Physical abuse.
- Sexual abuse.
- Emotional abuse.
- Physical or emotional neglect.
- Exposure to domestic violence.
- Household substance abuse.
- Household mental illness.
- Parental separation or divorce.
- Imprisoned household member.
According to the United States’ Substance Abuse and Mental Health Services Administration, the ACE study found that:
- Adverse childhood experiences are common. For example, 28% of study participants reported physical abuse and 21% reported sexual abuse. Many also reported experiencing a divorce or parental separation, or having a parent with a mental and, or substance use disorder.
- Adverse childhood experiences often occur together. Almost 40% of the original sample reported two or more ACE’s and 12.5% experienced four or more.
- A person’s cumulative ACE’s score has a strong, graded relationship to numerous health, social, and behavioural problems throughout their lifespan, including substance use disorders.
The ACE study’s results
The ACE study’s results suggest that neglect and abuse in childhood can contribute to health problems decades later. These include chronic diseases, such as heart disease, cancer, stroke, and diabetes, that are the most common causes of death and disability in the United States. The study’s findings, while relating to a specific population within the United States, might reasonably be assumed to reflect similar trends in other parts of the world, according to the World Health Organisation.
Although this study has it’s limitations (it did not examine resilience factors like supportive relationships, quality health care, exercise, and nutrition, for instance) the results leave little question that early childhood experiences of trauma impact long-term health outcomes in a significant way. While inferring causation may seem like a stretch to some, it does not require a huge leap of imagination to see how trauma and adverse childhood experiences may indeed be at the root of many major public health issues like cancer, heart disease, stroke, addiction, and suicide.
By developing knowledge and awareness individuals with high ACE scores can be supported to take action to mitigate the ongoing effects of trauma, and to avoid the tendency of exposure to ACE’s to be repeated through generations. The idea is that predictable patterns, once known about, can be altered and prevented.
Building resilience is important because it enables people to find hope in their traumatic past. It gives people the opportunity to be proactive instead of reactive when it comes to addressing the traumas in their past.
Video
For more information on the impact of trauma watch this informative TED talk ‘How childhood trauma affects health across a lifetime’.