Introduction to Adverse Childhood Experiences (ACEs)

Amanda Luzzader

New understanding of trauma also includes the concept of Adverse Childhood Experiences (also known as ACEs)

As recently as thirty years ago, if you heard the word "trauma" it was likely in reference to a severe physical injury resulting from a car accident, gunshot, or some other serious accident.

Today, we think of trauma much more comprehensively.

For example, we now understand that trauma can take numerous forms, not all of which are physical or tangible. We also have a much better awareness of the lasting psychological effects of trauma, including the causes, effects, and treatment of Post-Traumatic Stress Disorder.

This relatively new understanding of trauma also includes the concept of Adverse Childhood Experiences (also known as ACEs).

The concept of ACEs was developed during the CDC-Kaiser Adverse Childhood Experiences Study, which was launched in the mid-1990s and was one of the largest investigations into childhood trauma, abuse, and neglect ever conducted in the United States. The ACEs are a set of ten events and conditions that are potentially traumatic and life-affecting if they occur during a person's childhood (age 17 or younger). The following list comprises the events or conditions that are generally considered ACEs:

1. Physical abuse

2. Sexual abuse

3. Verbal abuse

4. Physical neglect

5. Emotional neglect

6. Having a family member who is depressed or diagnosed with other mental illness

7. Having a family member with substance-abuse problems

8. Having a family member who is incarcerated

9. Witnessing a mother being abused

10. Losing a parent to separation, divorce or death

The study has found that individuals who experience these events or conditions during childhood are more likely to develop a wide variety of negative health conditions and early death.

What is perhaps most surprising (and dismaying) about ACEs and the CDC-Kaiser research is how widespread and numerous the effects of ACEs can be. ACEs are not just traumatic to children at the time they occur. The effects are lasting and significant. For example, the stress and trauma resulting from exposure to ACEs can alter the way the brain develops, which in turn can negatively affect cognitive functions such as learning, paying attention, making decisions, and the way a person will respond to trauma in the future. These problems, obviously, can lead to any number of follow-on problems and degraded quality of life.

More specifically, the CDC-Kaiser research shows exposure to ACEs can increase a person's risk for life-long physical ailments (e.g., heart disease and cancer), mental illness (e.g., depression and anxiety), and social disadvantages (e.g., early pregnancy, familial instability, low income, and poor performance in school and the workplace).

Not surprisingly, the greater the number of ACEs experienced by an individual, the more problems that individual is at risk for. The CDC-Kaiser research has shown that experiencing four or more ACEs is generally associated with significantly increased risk for seven out of ten leading causes of death during adulthood. These include heart disease, cancer, stroke, diabetes, Alzheimers disease, and suicide.

Sadly, ACEs are common. The CDC-Kaiser research reported that: "About 61% of adults surveyed across 25 states reported that they had experienced at least one type of ACE, and nearly 1 in 6 reported they had experienced four or more types of ACEs." The CDC also states that ACEs are a severe economic burden on society, resulting in health-care costs and social costs that amount to billions annually.

Not all groups are affected by ACEs at the same frequency, however. The CDC-Kaiser study has identified a wide range of individual and community risk factors that increase an individual's likelihood of experiencing ACEs.

The individual risk factors include (but are not limited to) the following:

  • Youth who start dating early or engaging in sexual activity early
  • Families with caregivers who have a limited understanding of children's needs or development
  • Families with caregivers who were abused or neglected as children
  • Families with young caregivers or single parents
  • Families with low income
  • Families with adults with low levels of education
  • Families experiencing high levels of parenting stress or economic stress
  • Families with caregivers who use spanking and other forms of corporal punishment for discipline
  • Families with inconsistent discipline and/or low levels of parental monitoring and supervision
  • Families with high conflict and negative communication styles
  • Families with attitudes accepting of or justifying violence or aggression

Community risk factors include (but are not limited to) the following:

  • Communities with high rates of violence and crime
  • Communities with high rates of poverty
  • Communities with high unemployment rates
  • Communities with easy access to drugs and alcohol
  • Communities with few community activities for young people
  • Communities with unstable housing and where residents move frequently
  • Communities where families frequently experience food insecurity

If there is good news about ACEs, it is this: now that they have been identified and are becoming increasingly understood, they can be prevented and mitigated. While efforts to prevent ACEs and their effects is and will be a monumental task, knowing the behaviors, risk factors, and ways to prevent them is incredibly important. The CDC suggests that prevention should first involve removing families and individuals from high-risk situations, conditions, and groups. Families and individuals must be educated about how to create stable, nurturing, and less-risky conditions at home.

Those who have been exposed to ACEs, and even those who have experienced long-term effects from exposure to ACEs can also be assisted with trauma-aware therapy and other treatments.

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