The Adverse Childhood Experiences (ACE) Study: A Hidden Public Health Crisis
By Janie Crecco, MA, MSEd, Training and Support Specialist, RTSC
It has been almost 20 years since Vincent J. Felitti, MD and Robert Anda, MD published the results of their Adverse Childhood Experiences (ACE) study in the American Journal of Preventive Medicine. The research began as an obesity study, but has toppled our long-held ideas about long-term health outcomes and the root of challenging behaviors in children and adults. The ACE Study was conducted at Kaiser Permanente from 1995 to 1997, with two waves of data collection. Over 17,000 Health Maintenance Organization members from Southern California receiving physical exams completed confidential surveys regarding their childhood experiences and current health status and behaviors.
The results of the study shed a new light not only on entrenched issues regarding obesity, but around many other health outcomes as well. In a nutshell, the HMO members were asked 10 questions about their adverse experiences as young children, including three types of abuse (sexual, verbal and physical), and five types of family dysfunction (a parent who’s mentally ill or struggles with alcoholism, a mother who’s a domestic violence victim, a family member who’s been incarcerated, or the loss of a parent through divorce or abandonment). Dr. Felitti later added emotional and physical neglect, for a total of 10 types of adverse childhood experiences, or ACEs.
The most jaw-dropping finding of the study was how common ACEs are: almost two-thirds of study participants reported at least one ACE, and more than one in five reported three or more ACEs. The “ACE score”, the total number of ACEs on an individual’s questionnaire, is used to assess cumulative childhood stress. Study findings repeatedly reveal a “graded dose-response relationship between ACEs and negative health and well-being outcomes across the life course”. Essentially, this means that as the “dose” of stressors increases, so does the intensity of negative outcomes.
Here are some potential risks that increase with a higher ACE score:
- Alcoholism and alcohol abuse
- Chronic obstructive pulmonary disease
- Fetal death
- Health-related quality of life
- Illicit drug use
- Ischemic heart disease
- Liver disease
- Poor work performance
- Financial stress
- Risk for intimate partner violence
- Multiple sexual partners
- Sexually transmitted diseases
- Suicide attempts
- Unintended pregnancies
- Early initiation of smoking
- Early initiation of sexual activity
- Adolescent pregnancy
- Risk for sexual violence
- Poor academic achievement
This list is not exhaustive. As research continues on the subject of developmental trauma, including advances that enable us to measure changes to developing neurology, we will be able to better understand the enormity of this public health crisis. The newest ACE Study questions include exposure to such events as: witnessing violence other than a mother being abused; experiencing discrimination based on race or ethnicity; feeling unsafe in your neighborhood or not trusting your neighbors, and bullying.
The ages-old theories about challenging behaviors being willful, deliberate, manipulative are being tossed to the wind. Developing neurology, it seems, is extremely vulnerable to adverse experiences and not easily reparable. Hence, the new education laws are beginning to focus on social-emotional learning, school climate, trauma sensitive schools, safe and supportive environments, and skill-building rather than relyling on punitive negative consequences. In essence, this is a major paradigm shift.
Do you know your own ACE Score? Answer the original 10 questions — each “yes” equals 1 ACE.
Research has shown that the best way to support a student with a high ACE score is through Trauma-Centered Care. The Recruitment and Training Support Center for Special Education Surrogate Parents offers resources on Trauma-Centered Care. Visit fcsn.org/rtsc to find publications on:
- Trauma Sensitivity During the IEP Process
- Helping Traumatized Children Learn
- SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach
You may also wish to view our YouTube page, where we recently shared a webinar on the ACE Study and its implications for long-term health.