Adverse Childhood Experiences: What They Are and What To Do

 

Take the Adverse Childhood Experiences Questionnaire:

1. Did a parent or other adult in the household often … Swear at you, insult you, put you down, or humiliate you? OR Act in a way that made you afraid that you might be physically hurt?
2. Did a parent or other adult in the household often … Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?

3. Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Try to or actually have oral, anal, or vaginal sex with you?
4. Did you often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?
5. Did you often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
6. Were your parents ever separated or divorced?
7. Was your mother or stepmother: Often pushed, grabbed, slapped, or had something thrown at her? or Sometimes or often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
9. Was a household member depressed or mentally ill or did a household member attempt suicide?
10. Did a household member go to prison?

Add up your Yes answers. This is your ACE score.

Remember, plenty of people with high ACE scores do very well in life. Resilience builds from close relationships and is important in overcoming adverse childhood experiences. Trauma informed therapy is key, and there is always help available.

Adverse childhood experiences can affect children for the rest of their lives.

Adverse childhood experiences can affect children for the rest of their lives.

Childhood is when we develop our personalities, our fears, beliefs, and thoughts about the world. While most of us are lucky enough to have a happy, nurturing childhood, unfortunately for some, their childhood doesn’t hold such enjoyable memories. Adverse Childhood Experiences (ACEs) are what experts and pediatricians have called any kind of abuse, neglect, or other kinds of traumatic experiences that happen before the age of 18. ACEs have been linked to risky health behaviors, such as drug or alcohol abuse, chronic health conditions, a lowered life potential, and even an early death. The more often or the longer that ACEs occur during childhood, the greater the risk for those negative outcomes.

What are Adverse Childhood Experiences?

ACEs can involve any number of experiences, which are organized into three categories: abuse, household challenges, or neglect. Childhood abuse could involve emotional, physical, or sexual abuse. Household challenges are when a family member has a mental illness, there is substance abuse in the home, a family member is being abused, there is a separation or divorce, or a family member goes to prison for a long period of time. Neglect could be physical or emotional.

Effects of divorce on children and families

All childhood experiences have a lifelong impact on all aspects of our lives, so it’s no surprise that negative experiences in childhood negatively impacts our lives. The Centers for Disease Control and Prevention (CDC) began the original study on adverse childhood experiences in 1995 with a huge sample of over 17,000 participants, and it is still ongoing. There, researchers found that ACEs are common. Two-thirds of respondents reported that they have had at least one ACE in their childhood. Almost forty percent of total respondents have had two or more. Participants were given an ACE scored based on how many of the 10 types of adverse childhood experiences they were exposed to.

There are three types of ACEs

 

adverse childhood experiences

Source: Centers for Disease Control and Prevention Credit: Robert Wood Johnson Foundation

There are three levels of stress, all of which affect the body in some way. While a certain amount of stress is important, and even necessary, for development and productivity, some stress is too overwhelming for children and adults alike.

Positive stress is normal and healthy. At this level, the body has a brief increase in heart rate levels and mild elevations of cortisol – the stress hormone.

Tolerable stress is more serious. The body will react with a more severe response, due to longer lasting, more serious issues. If the response is limited (doesn’t last too long), and there is a positive, supportive relationship with the child, the body can learn to adapt and the brain and organs can recover before any long term effects take place.

Toxic stress is severe, and is caused by a prolonged or excessive activation of the body’s stress response systems without any buffer (like a positive, stable adult relationship) to help counteract the negative effects of excessive stress. The body’s stress response will increase the heart rate, raise blood pressure, and release cortisol.This extreme response can weaken and damage the response system, brain architecture, and regulatory systems, causing lifelong effects. However, this is not to say that adversity always predicts poor health outcomes. It seems to be that the greatest identifier would be the lack of a protective parental role that helps the child manage stress and learn to problem solve on their own.

Pediatricians have been working with the CDC on researching and advocating on the effects of toxic stress on children as they develop. Researchers have found that there are several links between ACEs and psychological issues, risky behaviors, illnesses, and the leading causes of death such as heart disease, obesity, and depression. This includes the strong association between ACEs and substance use disorders. Adverse childhood experiences have been shown to lead to early initiations of alcohol use, as well as a higher risk of alcohol abuse as an adult, especially abuse, parental alcoholism, and family dysfunction. Tobacco use prevalence increased as ACE scores increased. The same relationship exists with prescription drugs, as well as illicit drug use over the lifetime, drug dependencies, and addictions.

Stop smoking tips

According to the Adverse Childhood Experiences study, a higher ACEs score is more likely to lead to difficulties later in life.

adverse childhood experiences

Source: Centers for Disease Control and Prevention Credit: Robert Wood Johnson Foundation

The links between adverse childhood experiences and behavioral problems are also well documented. ACEs increase the risk of suicide attempts 2-5 fold throughout the lifetime. Depressive disorders are also much more prevalent among those who have experienced any form of ACEs. High risk sexual behaviors such as having 30 or more partners, having early intercourse, or believing that they are at risk for HIV/AIDS, are common among women who have experienced ACEs. Adolescent pregnancies and unfortunately fetal mortality are also an area of concern among teens who have been exposed to ACEs. Sleep disorders such as trouble falling and staying asleep, or still feeling tired after a good night’s sleep is also attributed to ACEs.

Adverse childhood experiences have negative effects not just on individuals, but society as a whole. According to the CDC, people who had 6 ACEs or more during their childhood died about 20 years earlier on average than people with no ACEs. The CDC also estimates that the lifetime costs of ACEs and child maltreatment is $134 billion. Researchers found a strong dose-response relationship between ACEs and several health problems.

adverse childhood experiences

Sufferers of adverse childhood experiences should use them as a basis for their issues when seeking treatment

Preventing Adverse Childhood Experiences

There are some strategies that pediatricians and public health practitioners are trying to implement to prevent adverse childhood experiences:

  • Strengthening economic supports to families – This may involve improving family friendly policies at workplaces and increasing financial security.
  • Improving social norms to support parenting and good parenting practices – public engagement and education is necessary to change minds.
  • Provide quality early childhood care and education – Preschools and family engagement are important in improving child care.
  • Improving parenting skills and improving child development – Families are essential in support and care.
  • Interventions to reduce harm and preventing future risks – Parent trainings and treatment should be used if abuse or neglect is suspected.

 

Because ACEs are common and very strongly related to substance abuse and negative behavioral health outcomes, it is important to either prevent ACEs if possible, or identify early those who have suffered ACEs. Pediatricians and community organizers can help prevent or overcome the effects of ACEs by understanding what behavioral or health issues may arise and knowing how to react if the child shows signs. Adverse childhood experiences are a growing public health concern that have several complications and negative health outcomes which affect our entire society. We all need to work together in the community and with families to prevent adverse childhood experiences when we can. Resilience builds from close relationships and is important in overcoming adverse childhood experiences.

 

References:

Anda, Robert F., et al. “Adverse childhood experiences and smoking during adolescence and adulthood.” Jama 282.17 (1999): 1652-1658.

Chapman DP, Wheaton AG, Anda RF, Croft JB, Edwards VJ, Liu Y, Sturgis SL, Perry GS. Adverse childhood experiences and sleep disturbances in adults. Sleep Medicine. 2011;12(8):773-9.

Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, and Section on Developmental and Behavioral Pediatrics, Garner AS, Shonkoff JP, Siegel BS, Dobbins MI, Earls MF, Garner AS, McGuinn L, Pascoe J, Wood DL. Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health. 

Dube SR, Anda RF, Felitti VJ, Edwards VJ, Croft JB. Adverse Childhood Experiences and personal alcohol abuse as an adult . Addictive Behaviors 2002; 27(5):713–725.

Dube, Shanta R., et al. “Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study.” Pediatrics 111.3 (2003): 564-572.

Felitti, Vincent J., 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.” American journal of preventive medicine 14.4 (1998): 245-258.

Foege, William H. “Adverse childhood experiences.” A public health perspective. Am J Prev Med 14.4 (1998): 354-55.

Hillis SD, Anda RF, Dube SR, Felitti VJ, Marchbanks PA, Marks JS. The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial outcomes, and fetal death . Pediatrics 2004; 113(2):320–327.

Hillis SD, Anda RF, Felitti VJ, Marchbanks PA. Adverse childhood experiences and sexual risk behaviors in women: a retrospective cohort study . Family Planning Perspectives 2001;33:206–211.

JPB Research Network on Toxic Stress.

Elsie is a public health professional working in education and research. She is a lifelong learner, and is especially interested in mental and behavioral health. She loves travelling and spending time with her dog.