Adverse Childhood Experiences
The Adverse Childhood Experiences movement is an initiative to revolutionize national awareness, and understanding of the health impacts of adverse childhood experiences (ACEs), and toxic stress, and to implement programs and protocols to prevent, recognize, and address them when they have occurred. Adverse childhood experiences are defined as potentially traumatic experiences that can occur between the ages of 0 and 17. The movement is being driven by pediatric clinicians, educators, parents, policymakers and other child-serving professionals and advocates who are working to implement universal screening for adverse childhood experiences.
Adverse childhood experiences can involve sexual, psychological, or physical abuse. ACEs have been linked to premature death as well as to various health conditions, including those of mental disorders. Resulting toxic stress has also been linked to childhood maltreatment, which is related to a number of neurological changes in the structure of the brain and its function. The Adverse Childhood Experiences Study was the first large scale study to look at the relationship between ten categories of adversity in childhood and health outcomes in adulthood.
Psychologists, politicians, therapists, educators, and countless other professionals interested in advocating for universal screening for ACEs while creating awareness of ACEs and possible treatments for their residual effects has resulted in the launching of a public health campaign Stress Health Public Education Campaign to bring greater attention to the problems implicated by stress and toxic stress in childhood.
Start of the ACE-aware movement
The ACE aware movement arose out of the need for a bidirectional effort to create a public health change, with both individuals and institutions/ government systems. Change on the individual level is essential, because individual change is self-directed. The institutions and government systems engagement is essential, because without the structure surrounding individuals changing, the very systems that are intended to help, can perpetuate the cycle of trauma.
International adoption of the ACEs model
The U.S. ACEs list was created in 1997 when a study was conducted to examine different childhood traumas. From 1995-1997, the CDC Kaiser ACE study involved more than 17,000 people sharing their stories about their unforgettable childhood trauma experiences. They used this study to make a list of ACEs to determine and examine how these traumatizing experiences can lead to health issues and stunt developmental growth. ACEs are divided into three categories: abuse, household challenges, and neglect. Examples of ACEs include being exposed to abuse and neglect, violence in the family, mental illness, parental divorce or substance abuse. It is said to disrupt a child’s development, leading to poor health outcomes and low life expectancy.
In the UK in 2017 a study was made based on the original US study and presented together with recommendations for early intervention to the UK parliament.
The World Health Organization has designed a far more extensive screening questionnaire than the original US version, designed to be used internationally in order to relate adverse conditions to future developments in the hope of possible preventive interventions. In addition to the ACEs identified in the US questionnaire it includes questions related to such adverse experiences as warfare. The questionnaire is titled the Adverse Childhood Experiences International Questionnaire (ACE-IQ).
ACEs score
To determine someone’s ACEs score, they answer the 10 Adverse Childhood Experiences questions relating to events prior to their eighteenth birthday. The questions are:
- 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?
- Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?
- Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?
- 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?
- 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?
- Were your parents ever separated or divorced?
- 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 over at least a few minutes or threatened with a gun or knife?
- Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
- Was a household member depressed or mentally ill, or did a household member attempt suicide?
- Did a household member go to prison?
Long term effects of ACEs
According to the Center for Youth Wellness website, “Exposure without a positive buffer, such as a nurturing parent or caregiver, can lead to a Toxic Stress Response in children, which can, in turn, lead to health problems like asthma, poor growth and frequent infections, as well as learning difficulties and behavioral issues. In the long term, exposure to ACEs can also lead to serious health conditions like heart disease, stroke, and cancer later in life.”
Adverse child experiences are equal to various stresses, and a serious adversity is defined as a trauma. The World Health Organization (WHO) recognises that prolonged stress in childhood can have life-long implications for the development of many diseases. Moreover ACEs can disrupt early brain development leading to the possible development of several disorders. WHO has designed a screening questionnaire to be used internationally in order to list adverse effects, and relate them to future developments in the hope of possible preventive interventions. The questionnaire is titled the Adverse Childhood Experiences International Questionnaire (ACE-IQ).
Additional Information
Sandra Bloom and Brian Farragher’s book Destroying Sanctuary states in its introduction that 17th century philosophers like Descartes took apart the person and “turned over the body to physicians and the mind to philosophers and clergy,” and in the ACEs movement society is now trying to bring them back together.
ACE Nashville has repurposed the acronym, ACE to stand for All Children Excel and is trying to raise awareness about adverse childhood experiences in Nashville, Tennessee.
