What are ACEs?

Adverse Childhood Experiences: How childhood trauma affects a lifetime 

In 1998, the Center for Disease Control (CDC) and Kaiser Permanente co-authored a groundbreaking research paper that studied how childhood trauma impacts the life of a child as they grow into adulthood. 9508 adult Kaiser patients responded to a questionnaire about their experiences they had as children. Specifically, the questionnaire asked about 10 different adverse childhood experiences, or ACEs:

Psychological, physical, or sexual abuse; violence against the child’s mother; or living with adults who abused substances, adults who were mentally ill or suicidal, or adults with a history of time in prison.

Then the questionnaire asked the adult participants about their physical and mental well-being. The study found that adults who had experienced more ACEs were more likely to have a wide range of physical and mental illnesses as adults. The categories of illness included: alcoholism and other forms of substance use; obesity; mental illness diagnoses including depression and suicidality; and many sexual partners, with a history of sexually transmitted infections.

These results were expected. The researchers found other results that were not expected. Adults with high ACE scores were more likely to be diagnosed with life-​threatening medical illnesses including heart disease, chronic lung and liver disease, and cancer.

The results of the 1998 ACEs study have changed the way physicians, mental health professionals, social workers and others care for young people who have experienced childhood trauma. Unless we understand what kids have been through, we cannot protect their physical and emotional well-being, and their future health. 

Our goal at the SPARK Clinic is to address the effects of ACEs and improve long term outcomes—by providing trauma-informed medical care and connecting our patients to excellent behavioral health services.


If you would like to know more about ACEs, here are a few tools you may find interesting. 

First, here is a link to a TED talk about ACE’s by Nadine Burke Harris, MD, the first and current Surgeon General of California. Dr. Harris’ TED talk is excellent! 

Dr. Harris stand by window

How Childhood Trauma Affects Health Across a Lifetime

The following graphic about ACEs was reproduced with the permission of the Robert Wood Johnson Foundation. 

Infographics about the truth about ACEs

If you are interested in reading more about ACEs research, here is a copy of the ACEs Study Abstract, from the article published in the American Journal of Preventative Medicine in May, 1998.

The Adverse Childhood Experiences (ACE) Study: The relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults.

Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Am J Prev Med. 1998 May; 14(4):245-58.

BACKGROUND

The relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during childhood has not previously been described.

METHODS

A questionnaire about adverse childhood experiences was mailed to 13,494 adults who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. Logistic regression was used to adjust for effects of demographic factors on the association between the cumulative number of categories of childhood exposures (range: 0-7) and risk factors for the leading causes of death in adult life.

RESULTS

More than half of respondents reported at least one, and one-fourth reported > or = 2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P < .001). Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, > or = 50 sexual intercourse partners, and sexually transmitted disease; and 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.

CONCLUSIONS

We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.