The Impact of Adverse Childhood Experiences
The Study That Started It All
In 1995 the Centers for Disease Control and Prevention and Kaiser Permanente conducted an extensive study to understand the impact of adverse childhood experiences (ACEs) on health outcomes. In this study 54% identified as female and 46% as male. 74.8% identified as white, 11.2% Hispanic, 7.2% Asian/Pacific Islander, 4.5% black, and 2.3% other. Over half of the participants were over the age of 50 and 70% of participants were college educated. What they discovered was that 67% of participants reported experiencing at least 1 ACE score and 1 in 8 participants reported experiencing 4 or more ACEs. Further studies have shown that people who identify as members of specific groups, such as non-Hispanic American Indian or Alaska Native people, multiracial, and LGBTQIA+ experience significantly more ACEs.
Researchers discovered a “dose-response relationship” between ACEs and health outcomes. The higher your ACE score, the worse your health outcomes. Those who indicated 4 or more ACEs risk of chronic obstructive pulmonary disease and Hepatitis increased by 2.5 times. Their risk for depression was 4.5 times and suicidality, 12 times higher than those who reported no ACEs. For participants who reported 7 or more ACEs their lifetime risk of lung cancer tripled and their risk of ischemic heart disease (the #1 killer in the United States) was 3.5 times higher. This study continues to impact the way we understand and treat those who have experienced adverse childhood experiences, and it is the recognition and understanding of how adverse childhood experiences impact us that is the first step towards healing.
Something worth noting is the ACEs asks about a person’s history in 10 categories including physical, emotional, or sexual abuse, physical or emotional neglect, and growing up in a household where parents/caregivers experienced mental illness, substance dependence, incarceration, where there was parental separation or divorce, or intimate partner violence Further studies have also shown that chronic poverty, community violence, and racism can also impact a child’s physical and mental health development.
The Impact
According to the CDC the ACEs study showed that those who experienced adversity early in life had lasting impacts throughout their life. These included:
- Injury: Traumatic Brain Injury, Fractures, Burns
- Mental Health: Depression, Anxiety, Suicide, PTSD
- Maternal Health: Unintended pregnancy, Pregnancy complications, Fetal Death
- Infectious Disease: HIV, STDs
- Chronic Disease: Cancer, Diabetes, Heart Disease, Strokes, Asthma, Kidney Disease
- Risky Behaviors: Alcohol & Drug Abuse, Unsafe Sex
- Opportunities: Education, Occupation, Income
A critical part of the ACEs study was the role our toxic stress response played in the impact adverse childhood experiences has on an individual. According to Dr. Nadine Burke Harris, children are vulnerable to repeated activations of their toxic stress response since their brains are still developing.
What is the toxic stress response and what impact does it have on an individual? The toxic stress response is the prolonged activation of our bodies stress response and the long-term changes that occur as a result. When children experience chronic or toxic levels of stress, their brain can get stuck in “fight-or-flight mode.” When this occurs, there is a release of stress hormones such as adrenaline or cortisol. When there is danger, this can be an adaptive tool or lifesaving for us. Yet, when this is activated repeatedly, it can become maladaptive or health damaging. What we see are problems with self-regulation, learning, social interactions, and long-term consequences of difficulty forming and maintaining healthy attachments later in life.
Additionally, we now know that the negative effects of adverse experiences can even alter a child’s genes and be passed along to the next generation. It is not uncommon to see ACEs repeated in families, passing from generation to generation to generation. Dr. Nadine Burke Harris reflects that it is this understanding of how that might be impacting you and being able to recognize this as being the key to being able to do things differently. She states “ACEs are not destiny. Even if someone has experienced significant ACEs it doesn’t mean they are absolutely going to have these negative outcomes. Recognizing our ACEs requires us to recognize our vulnerabilities and that can be really scary, but it is also the place where we can have a chance to ask for what we need.”
When researchers utilized neuropsychological testing, they discovered that individuals who had experienced significant childhood trauma or had high scores on the ACE Questionnaire had difficulty with emotional awareness and emotional bias. They were more likely to respond slower to happy faces and more quickly to disgusted faces. Additionally, they were able to identify fewer neutral faces correctly while recognizing more angry faces correctly. As a result, they were more likely to have a negative view of the world. This demonstrates how an adaptive behavior (keeping themselves safe when recognizing an angry face) can shift into maladaptive impact on other relationships or beliefs about the world.
ACEs Are Preventable
ACEs only measures negative experiences, and this is an important tool for medical and mental health professionals to use. If we identify these negative experiences at an early age, we are able to be more proactive versus reactive. Just as important is identifying ways we can create positive, healthy experiences in childhood. In the past 30 years, we have focused on changing norms, environments, and behaviors that can prevent ACEs from happening in the first place. The CDC has identified 6 core areas where we can create positive childhood experiences. Many of these include both individual and community level changes.
Strengthen families’ financial stability
We can achieve this through family-friendly work policies such as paid time off, flexible and consistent work schedules, livable wages, as well as though state policies such as state option for managing federal nutrition assistance programs (SNAP) and assisted housing mobility programs.
Promote social norms that protect against violence
This includes educational opportunities that help parents learn and implement positive parenting practices (such as Family Advocates Family Strengthening Education Program), prevention efforts involving men and boys, and public education campaigns.
Help kids have a good start
Early learning programs, affordable preschool and childcare programs, preschool programs that include parental/caregiver involvement, and improved quality of childcare through licensing and accreditation are a few of the ways we can achieve this.
Teach healthy relationships
Family discussions and educational opportunities that teach conflict resolution, emotion regulation skills, how to cope with pressure from peers, and understanding healthy non-violent relationships are important in creating positive childhood experiences. These skills while focused on youth, are also important for parents to learn.
Connect youth with activities and caring adults
Creating and having ongoing school or community mentor programs or after-school activities supports youth who may not have nurturing relationships in their home.
Intervene to lessen immediate and long-term harms
ACEs education, therapy, family-centered treatment for substance abuse are just a few examples on how we can support youth and increase positive experiences. It is also important to educate parents and caregivers on the impact of ACEs and toxic stress so that they are equipped to support their child(ren).
Individually we can also find healing through our individual choices and actions. When we gain awareness of what happens in our body with toxic stress response and understand the impact of continued activation we can take the first steps towards healing. A critical step includes identifying things that help us regulate our stress response. This includes tools and skills such as mindfulness, meditation, spending time outdoors, regular exercise, healthy eating, having healthy relationships, and mental health interventions. All of these, according to Dr. Nadine Burke Harris, decrease the harm that happened as a result of our past experiences AND all of these are scientifically demonstrated to help regulate the biological stress response and improve outcomes for those who have experienced ACEs.
Nadine Burke Harris also identifies how nurturing relationships are a key part of healing from ACEs. She states that these types of relationships literally change our biology – when we have safe, stable, and nurturing relationships we see improvement in neurological functioning, hormone regulation, immune functioning and these social supports are a vital part of healing.
A quote worth repeating “ACEs are not destiny.” We will not ignore or minimize the impact adverse childhood experiences have on an individual, on a family, on multiple generations, but this impact is not without hope and healing.
References
- Centers for Disease Control and Prevention: https://www.cdc.gov/violenceprevention/aces/about.html
- Amen Clinics: https://www.amenclinics.com/blog/the-long-term-impact-of-adverse-childhood-experiences-aces/
- Nadine Burke Harris Ted Talk: https://youtu.be/95ovIJ3dsNk?si=1tZFYX3X1tamv7a3
