Childhood and Trauma and ACEs (oh, my!)
We are finally in a place where it is recognized that childhood experiences have a major impact on the rest of a person’s life. It’s more common knowledge then ever that when someone experiences trauma or chronic stress growing up, they are more likely to struggle with their mental health, miss use substances, struggle with relationships, parenting, career goals and even experience more difficulties with their physical health. One of the major catalysts for this increased understanding is the landmark ACEs study. Today we’re going to dive into ACEs research and help you think about what it all means for you and your family. Please be aware this post contains mention of childhood sexual abuse.
The ACEs Study
The ACE (Adverse Childhood Experiences) study was a large study of 17,000 people conducted by by Dr. Vincent Felitti with Kaiser Permanente and the Centers for Disease Control in 1998. Dr. Felitti conducted this study not because he was interested in understanding childhood trauma, but because he was trying learn why so many of his patients were dropping out of a weight loss program even though they were loosing weight.
He started asking program participants a set of standard medical questions to try to learn more about why they dropped out, but he wasn’t learning anything useful. The story goes that one day he accidentally asked a patient “How much did you weigh when you were first sexually active” instead of his standard “How old were you when you became sexually active” His patient answered “40 pounds” In interviews Dr. Felitti has stated that he believed that his patient miss heard him so he repeated his mistakenly asked question, but got the same answer; then his patient shared with him that her father began molesting her when she was 4 years old. Dr. Felitti has described being shocked by her answer, and believed that this report of incest was an outlier. But he decided to keep asking the question and was surprised that just 10 days later he learned about another patient who was a survivor of incest. As he kept asking Dr. Felitti found that 50% of the patients who dropped out of the weight loss program were survivors of sexual abuse. From here the ACE study was born. Were it not for Dr. Felitti’s mistaken question and the bravery of his patient’s honesty about her trauma experiences the revolution of trauma informed care may have never happened.
Dr. Felitti and a team of researchers developed a questionnaire asking about 10 potentially traumatic and difficult childhood events covering areas such as abuse, neglect, abandonment, humiliation, and hunger then sent it out to Kaiser insurance members. The investigators correlated the responses with outcomes related to the respondent’s mental health, substance use and physical health.
The Results
On receiving the results of the ACEs survey the CDC shared with Dr. Felitti that these were “once in a lifetime results.” It’s rare for a study of this nature to have such a large sample size, for the demographics to be so reflective of the general population at the time and to have such clear correlations as was found in the ACEs study. In spite of this when Dr. Felitti started presenting his results many of his colleagues simply didn’t believe him. They thought the study participants were lying about their traumatic experiences or that the data was conflated. Today, after multiple repeated studies across many different demographics these results are much more well accepted in the medical community. Here’s what was learned:
The prevalence of childhood trauma:
It was found that the majority the population, 64% have a positive ACE score, 26% have an ACE score of 1, 12.5% have an ACE score of 4 or higher. This means that only 36% of the population studied had an ACE score of 0. So if you’re in a room with 10 people only 3 of them would not have experienced an ACE. And keep in mind this is only of those 10 questions asked. There are a multitude of adverse experiences a person could have that were not included. For today’s children, a global pandemic is certainly something that isn’t on that form that was very difficult for so many of our kids. The data gathered from this survey also showed that females and members of certain minority groups are at greater risk of an ACE score of 4 or higher, you’ll see why this is important in the section below. To put it in a nut shell, what we learned from this study is that childhood trauma is nearly universal.
Outcomes for those with an ACE score:
It was also learned that ACE scores are correlated with increased risk for a mental health diagnoses of all types as well as substance use disorders. It is likely not surprising to you that a difficult childhood is related to difficulties with mental health and substances. What might be more surprising and is still not common knowledge in the medical community is that poor physical health outcomes are also associated with a high ACE score. For more on that check out this TED talk from the brilliant Nadine Burke Harris, pediatrician and surgeon general for the state of California.
The higher a person’s ACE score the more at-risk that person is for poor health outcomes, with people who have an ACE score of 4 or higher being particularly vulnerable. For example a person with an ACE score of 4 is 1350% more likely to become an injection drug user then someone with an ACE score of 0. That number is already staggering, but once you get up to an ACE score of 6 a person is 4600% more likely to use injection drugs. In addition, the CDC reports that if ACEs were prevented Americans would experiences 44% less depressive disorders, 27% less COPD and 24% less asthma. In fact the five leading causes of death are associated with ACEs.
What Can We Do?
This is depressing news indeed, and ACEs truly are a public health crisis- one that deserves as much attention as nicotine use, cancer or gun violence. That being said the most important thing to know is that having a high ACE score is not a death sentence, people with high ACEs are not doomed to a life of misery. Our body and brain change after experiencing a trauma, AND they have an amazing capacity to change back. There is recovery, there is resiliency. With support the damage done by ACEs can be undone. Getting support, especially for parents, can also stop ACEs in future generations. So if you or someone you love is ready to start recovering from ACEs experiences reach out here for more on how to get help.
While its good news that the damage done by ACEs doesn’t have to be permanent, prevention is even better. More recent studies have found that there are seven key resiliency factors that can help children bounce back from adverse experiences and avoid the poor outcomes found in the ACE study. They are:
Be able to talk with family about feelings
Have a sense that family is supportive during difficult times
Participation in community traditions
Feeling a sense of belonging in high school
Feeling supported by friends
Having at least two non-parent adults who genuinely care
Feeling safe and protected by an adult in the home
The more of these protective factors a child has in place, the more resilient they can be. This is great news because we can’t always control what happens in a child’s life, but we can be empowered to ensure that as many of these protective factors are in place as possible. Though these resilience factors were looking specifically at how to protect kids from ACEs, its likely that they will also protect children in the face of other difficulties such as bullying, academic stress, and the impacts of a changing climate. So take some time to think about the kids in your life and how you can show up for them. You might be the one who can provide the next generation a bright future, no matter what hardships they face.