Like most healthcare professionals, I was never made aware of the Adverse Childhood Experience (ACE) study while in my graduate programs in acupuncture, or in psychology. I was introduced to the ACE study five years ago while learning one of the trauma modalities I use in my practice, the Trauma Resiliency Model (TRM). This was a pivotal moment which reinforced my therapeutic orientation to treatment. When we heal traumas we address the source of most ailments we suffer from. Thanks to TED, more than two million people now know about the long-term effects of childhood trauma.
The ACE study originated in 1985 when the chief of Kaiser Permanente’s Department of Preventive Medicine in San Diego, Dr. Vincent Felitti, couldn’t figure out why each year for the last five years, more than half of the people in his obesity clinic were dropping out. These patients were successful in their treatment. Many of them lost between 100-600 pounds. Determined to find out the underlying causes, Dr. Felitti joined effort with Dr. Robert Anda at the CDC. Together, they gave birth to what is now known as the ACE study; which was first published in 1998.
Because all of the 17,421 adults participants in the ACE study were Kaiser patients in San Diego, their medical records were compared with their individual interview answers. The average age participant was 57 years old. The population was 75% Caucasians, 11% Latinos, 7.5% Asians or Pacific Islanders, and 5% African Americans. Males and females were, for all intended purposes, divided equally. 74% had been to college and 46% had college degrees or higher. All had jobs, and of course, health insurance—they were all Kaiser patients. In other words, this was an average San Diego population of the mid-nineties. The study examined the emotional, mental and physical impact of adverse childhood experiences over a lifespan, from early childhood to death.
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The ten questions posed during the interview measured the most common adverse experiences participants had suffered as children. Five questions related to personal experiences, while five related to other family members. For every yes, one point was given. Each person was asked if, before the age of 18, he or she had experienced any of these toxic stressors over months or years:
Physical abuse?
Sexual abuse?
Emotional abuse?
Physical neglect?
Emotional neglect?
Mother treated violently?
Household substance abuse?
Household mental illness?
Parental separation or divorce?
Incarcerated household member?
Making sense of the numbers:
The results revealed that 67% of the participants had at least one ACE score. Of these two-thirds, 87% had experienced two or more types of adverse experiences; 12.5% had a score of 4 or more. Since the medical history of each participant was compared to their scores, the study revealed the higher the score, the worse one’s health outcome and chronic illnesses was. For those of us who wonder if the results of a study conducted in the mid-nineties are still valid in 2016, it may help to know that by 2013, eighteen States had done their own ACE surveys. The results are similar.
Those with an ACE score of 4:
- Had significant higher rates of heart disease and diabetes than those with a zero ACE score.
- More likely to be smoker, 2 times higher than those with a zero ACE score.
- Hepatitis and sexually transmitted disease, 2.5 times higher.
- Chronic pulmonary lung disease (emphysema or chronic bronchitis), 2.5 times higher risk.
- Learning or behavioral problems, 3.2 times higher.
- Depression, 4.5 times higher risk.
- Alcoholic, 7 times higher risk.
- Drug street IV user, 10 times higher risk.
- Suicide attempts, 12 times higher risk.
Those with an ACE score of 5 or more:
- Unwanted pregnancies leading to abortion, 2.9 times higher risk than those with a 0 ACE score
- 3 or more marriages, 3.8 times higher risk.
- Victim or perpetrator of domestic violence, 5.1 times higher risk.
- Multiple sexual partners, 5.8 times higher risk.
- Alcohol abuse, 8 times higher risk.
- Having been raped, 8.9 times higher risk.
- Intravenous drug use, 9.2 times higher risk.
- Suicide attempt, 17 times higher risk.
- A 46 times higher increased likelihood of becoming an IV drug user.
Those with an ACE score of 6 or more died nearly 20 years earlier on average than those with an ACE score of 0—60.6 years versus 79.1 years.
What the ACE study reveals:
- Those scoring 0 are non-obese, non-smoking, non-alcoholics, non-diabetics, non-hypertensive. While the ten most common causes of death in the United States are directly correlated to one’s ACE score.
- There is a direct link between childhood trauma and adult onset of chronic disease, mental illness, doing time in prison and absenteeism at work.
- Adverse Childhood Experiences usually don’t happen in isolation. For example, people who have an alcoholic parent are likely to also experience physical abuse or verbal abuse.
- More adverse childhood experiences result in a higher risk of medical, mental and social problems as an adult.
- Every doctor probably sees several high ACE score patients every day. Dr Felitti notes: “Typically, those are the most difficult patients, though the underpinnings will rarely be recognized.”
- High level of adversity not only affects the developing brain, but also affects the developing immune system, hormonal system and the way our DNA is read and transcribed.
- The effect of ACE scores affects all of us individually and socially. It is not an issue that affects “those people out there with whom we have nothing in common”.
- ACE scores are directly related to antisocial behaviors, crime rates, domestic violence, learning disabilities and countless health issues.
- It behooves all of us to heal the effect traumas have had on our body, emotions and mind. Doing so will reduce our maladaptive coping mechanisms, and help prevent the trans-generational transmission of the pain inflicted to the most vulnerable in our society: from children to elders.
It is easy to understand why many think the ACE study is probably the most important public health study ever conducted in the United States. Its results drastically changed our understanding of the effect of unattended childhood traumas over a lifetime. Most of us can easily accept that childhood experiences, both positive and negative, have a tremendous impact on how we develop as adults. However, very few of us knew, until the ACE study, how pervasive and long lasting the effects of adverse childhood experiences have on their victims.
– “ACEs are the single, greatest, unaddressed public health threat facing our nation today.” Dr. Robert Block, former president of American Academy of Pediatric Association
Conclusions:
To put it mildly, this information is both quite disturbing and sobering. Writing this Post could easily be perceived as being the bearer of bad news, of doom and gloom. If taken without a greater frame of reference, the ACE study can make us feel that the cumulative effect of our adverse childhood experiences totally predicts our future, from physical health and longevity to the quality of our relationships and our ability to thrive. Thankfully, while the ACE study is as scientific as it comes, it does not represent the entire picture. There is a silver-lining. More than ever before in history, we are not doomed to become another statistic and live from under the effect of our childhood traumas.
The nineties, the period when the ACE study came out, is referred to, in the neuroscientific community, as “the decade of the brain”. Since then, our understanding of how the human brain operates and communicates with itself and other brains has increased more than at any other times in history. fMRI (functional Magnetic Resonance Imaging) measures brain activity by detecting changes in blood flow in the brain. This amazing technology gives us a window on what really happens inside our brains under different circumstances. One of the great outcomes of this brain revolution is that we now know about brain neuroplasticity—the ability of the brain to reorganize itself by forming new neural connections throughout life, and to prune neuronal connections that no longer serve the greater good of the organism. In other words, our brains can—under the proper environment and stimulation—rewire themselves in ways that promote healing and wellbeing, adaptability and resiliency. This is a concept believed to be impossible until the later period of the 20th century.
While we can’t go back in time and change the adverse experiences we suffered in childhood, we can still heal from our traumatic experiences. This being said, there is no single magic cure to heal high ACE scores. However, when the adequate healing modalities are provided–[see the trauma section of my website], or [the modalities I practice that are trauma informed]–the neuroplasticity of our brain can be activated; and the devastating effects of traumas overcome. Far from predicting our future, our ACE scores can be great opportunities for post-traumatic growth; where healed traumatic experiences profoundly transform our lives in a deep, rich and meaningful way.
Lastly, as Dr. Burke states in her TED Talk, we, as a planet and a society, must do all we can to put the ACE study at the forefront of our educational, social, political, law enforcement and economic policies. We must do so because, as Dr. Anda and Dr. Felitti said: “It’s not just ‘them’. It’s us.”