10 Things You Need to Know About Adverse Childhood Experiences

1. There are 10 categories of experience that are considered to have adverse consequences on the later development of children

These include:

• Abuse:
• Emotional
• Physical
• Sexual
• Neglect:
• Emotional
• Physical
• Household Dysfunction:
• Domestic Violence
• Substance Abuse
• Mental Illness
• Parental Separation/Divorce
• Crime

2. It is possible to determine your own Adverse Childhood Experience (ACE) score

The ACE score is a measure that has been designed to measure the cumulative nature of childhood distress.

If you are interested in finding out your ACE score, please answer the following questionnaire from acestudy.org:

While you were growing up, during your first 18 years of life:

1. Did a parent or other adult in the household often or very often…

• Swear at you, insult you, put you down, or humiliate you? or
• Act in a way that made you afraid that you might be physically hurt?

Yes? No? If yes, enter 1 _____________

2. Did a parent or other adult in the household often or very often…

• Push, grab, slap, or throw something at you? or
• Ever strike you that you had marks or were injured?

Yes? No? If yes, enter 1 _____________

3. Did an adult or person at least 5 years older than you ever…

• Touch or fondle you, or have you sexually touch their body? or
• Attempt or actually have oral, anal, or vaginal intercourse with you?

Yes? No? If yes, enter 1 ____________

4. Did you often or very often feel that…

• No one in your family loved you or thought you were important or special? or
• Your family didn’t look out for each other, feel close to each other, or support each other?

Yes? No? If yes, enter 1 ___________

5. Did you often or very often feel that…

• You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or
• Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

Yes? No? If yes, enter 1 ___________

6. Were your parents ever separated or divorced?

Yes? No? If yes, enter 1 ___________

7. Was your mother or stepmother:

• Often or very often pushed, grabbed, slapped, or had something thrown at her? or
• Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or
• Ever repeatedly hit at least a few minutes or threatened with a gun or knife

Yes? No? If yes, enter 1 ___________

8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?

Yes? No? If yes, enter 1 ___________

9. Was a household member depressed or mentally ill, or did a household member attempt suicide?

Yes? No? If yes enter 1 ___________

10. Did a household member go to prison?

Yes? No? If yes enter 1 __________

Now add up your “Yes” answers: __________ This is your ACE Score.

3. Adverse childhood experiences are common

Of the 17,337 individuals surveyed, here is the prevalence of each possible adverse experience, from most to least, represented as a percentage:

• Physical abuse towards the child — 28.3%
• Substance abuse in the household — 26.9%
• Parental separation/divorce — 23.3%
• Sexual abuse toward the child — 20.7%
• Mental Illness in the household — 19.4%
• Emotional neglect towards the child — 14.8%
• Domestic violence in the household — 12.7%
• Emotional abuse towards the child — 10.6%
• Physical neglect towards the child — 9.9%
• Imprisoned household member — 4.7%

This graph from acestoohigh.com presents these percentages visually:

4. It is more common to have an adverse childhood experience than not to have any

As shown in the graph from cdc.gov, 64% of the population surveyed experienced at least one adverse childhood experience(ACE), with the majority of those reporting at least one ACE reporting multiple ACEs.

Beyond the ACEs study, at least one in four children will suffer from physical, emotional or sexual abuse at some point during their childhoods, with one-in-seven children experiencing abuse or neglect in the past 12 months (Finklehor, Turner, Shattuck & Hamby, 2015).

5. Adverse childhood experiences are linked with a higher risk of many things in later life

This includes:

• Alcohol abuse and dependence
• Early smoking initiation and current smoking status
• Illicit drug use
• IV drug abuse
• Obesity
• Suicide attempts
• Depression
• Anxiety
• Hyperactivity
• Sleep Disturbances
• Hallucinations
• Eating disorders
• Suicide attempts
• Post-traumatic stress disorder
• Conduct disorder
• Teen or unintended pregnancies
• Intimate partner violence
• Improper brain development
• Impaired learning ability and general cognitive difficulties
• Attention and memory difficulties
• Visual and/or motor impairment
• Lower language development
• Impaired social and emotional skills
• Poorer quality of life

Another long-term study indicated that approximately 80% of young adults who had previously been abused qualified for at least one psychiatric diagnosis at 21 (Silverman, Reinherz & Gianconia, 1996). Neglected or abused children are also 59% more likely to be arrested during childhood, 28% more likely to engage in criminal behaviour as adults, and 30% more likely to engage in violent crime as an adult (Widom & Maxfield, 2001).

The graph below from vetoviolence.cdc.gov shows the increased risk of many conditions in individuals who have previously had adverse childhood experiences:

As you can see, there is a higher risk of experiencing these difficulties for individuals with ACEs. However, the prevalence rate is NOT 100% for any of the factors. The importance of this should not be understated…

Individuals who have had negative experiences during their childhood can still grow and flourish as adults and can also be more resilient due to learning how to overcome significant challenges when they are younger.

A major longitudinal study even found that what goes right during childhood is often more important than what goes wrong. Having even one safe, stable and nurturing figure in a child’s life can reduce the later risk of psychological and physical health problems (Vaillant, 2015).

6. Adverse childhood experiences are linked with a higher risk of later disease and early mortality

This includes:

• High Blood Pressure
• High Cholesterol
• Obesity
• Chronic Obstructive Pulmonary Disease (COPD)
• Ischemic Heart Disease (IHD)
• Liver Disease
• Sexually Transmitted Infections (STIs)
• Lung Cancer
• Death Before Age 65

As you can see in the table below from acestoohigh.com, individuals with an ACE score of 4 or more are at a significantly higher risk of developing later physical health conditions:

Abuse and neglect during childhood can also negatively impact the ability of individuals to efficiently establish and maintain healthy romantic adult relationships (Colman & Widom, 2004). As relationship warmth and social connection are vital protective factors for long-term health and happiness, many of these more significant risks could at least be partially explained by the higher risk of interpersonal conflict, disconnection and isolation.

7. The more adverse childhood experiences one has, the more significant likelihood they have of experiencing difficulties with their mental and physical health and overall well-being later in life

A “dose-response reaction” exists with most risk factors and following conditions, in that the more adverse childhood experiences one has, the higher their risk is for adverse outcomes later in life, as shown in the above graphic from cdc.gov.

8. It is possible to conceptualise how these adverse childhood experiences lead to an early death

The ACE Pyramid from cdc.gov suggests that adverse childhood experiences contribute to premature death via four intermediate processes that develop in a sequential nature:

9. Reducing adverse experiences of childhood will significantly improve public health and reduce the burden that these issues have on individuals and the society

Childhood abuse and neglect are not just damaging to the individual. They also place a substantial financial strain on society, with an estimated total lifetime economic burden of approximately $124 billion (2010 dollars) in the US in 2008 (Fang, Brown, Florence & Mercy, 2012). This is similar to the financial burden of other public health issues, such as diabetes and stroke.

The main reasons for the increased economic burden are lost productivity, followed by increased medical costs, special education, child welfare and criminal justice costs (Fang, Brown, Florence & Mercy, 2012).

Even though it may be expensive to develop and implement programs that aim to prevent child neglect and abuse, the benefits of these programs, if valid, are very likely to outweigh the costs in the long run.

10. We need to do something to address and lower the prevalence of ACEs in future generations

Creating safe, stable and nurturing environments (SSNREs) is the key to positively impacting reducing ACEs from now on.

The five best practices to do this is shown in the graph below:

The US Centers For Disease Control (CDC) also suggests:

• Greater treatment for mental illness and substance abuse
• More high-quality child care, and
• More financial support for low-income families.

Conclusion

Please help to get this information out there to as many people as possible. Also, if you found something of value in this article, please share it or pass it onto whoever else may benefit too!

Dr Damon Ashworth

Clinical Psychologist