What Are Adverse Childhood Experiences?
A pivotal study conducted at Kaiser Permanente between 1995 and 1997 first described the term Adverse Childhood Experiences. More than 17,000 people answered questions about their childhood experiences. Researchers collected and analyzed data in consideration of participants’ current health and life situations. The study found a tight association between Adverse Childhood Experiences (ACEs) and the presence of a host of adverse outcomes in adulthood.
The Adverse Childhood Experiences Study
The original Adverse Childhood Experiences study used a questionnaire that asked about 10 kinds of adverse experiences. There were three categories of adverse experiences: abuse, household challenges, and neglect. The Adverse Childhood Experiences scale used to measure an individual experience of:
The ACE scale is readily available for public use. You can take a version of the test here, and the actual questionnaire used in the study is available here.
How Many People Are Affected By ACEs?
The original study found that around two-thirds of the people who took the questionnaire had experienced one or more ACE. About one-fifth of the respondents had experienced three or more ACEs.
The results of the Adverse Childhood Experiences study were clear and sobering.
1. Adults With High ACE Scores Are Less Physically Healthy
Heart disease, liver disease, diabetes, cancer, and strokes are all more common in adults with high ACE scores. Also, high scores often predict autoimmune diseases in women. This correlation may be partly due to the effect of chronic stress on developing brains.
Childhood is a time of incredible physical growth and cognitive development. Leaving behind the old nature versus nurture debate, we now know that the genes that we are born with respond to the environment in which we develop. That environment, in turn, responds to us. And when our environment is chronically stressful, it inhibits the development of genes that manage stress. Chronic stress can change a child's development at the genetic level, setting their stress response in permanent overdrive.
Life is full of regular stressors; long lines, frustrating coworkers, new jobs, and bad traffic, to name a few. These are generally dealt with easily by healthy adults. But adults with a high ACE score, who may have their stress responses stuck in overdrive, are unable to regulate their stress response in the same way, for which their response to stress may seem rather disproportionate.
Being in a constant high-stress response mode can promote chronic inflammation, dampen a person's immune system, and impair their bodies' regular maintenance and rebuilding. Stress hormones themselves can be disruptive to physical function in the long term. In addition, high-stress responses exhaust a great deal of energy, which, in turn, compromise other physiological functioning and routine processes.
The physical health consequences of ACEs are not all caused by unmanaged adult stress, however. There is some evidence that constant, unregulated childhood stresses trigger changes within the genes that are directly related to the development of many of the adult diseases to which this population is prone. Hence, a high ACE score doesn't just set the bomb of chronic adult stress, but it sneaks into the very genes responsible for physical health and alters them.
2. Adults With High ACE Scores Are Less Mentally Healthy
The effects of ACEs on adult mental health are perhaps less surprising than the effects on physical health. Many of us are familiar with the idea that our early experiences play a part in our adult mental health. However, what may be surprising is that ACEs affect mental health in much of the same way they affect physical health—that is, by triggering actual physiological changes in our bodies.
When a child experiences chronic, unsupported stress, it affects their genes, as we previously discussed. It also changes the shape of their brain. Excessive and ongoing exposure to stress hormones can trigger several changes at the cognitive level, including shrinkage of the parts of the brain that are responsible for learning and memory, under-development of the part of the brain that processes fear, and deficits in decision making and impulse control centers.
The biggest mental health risk for adults with high ACE scores is depression. People with high ACE scores experience more depressive episodes, and it takes them longer to recover from these episodes. They are also more likely to commit suicide than the general population. The physical challenges of chronic stress in childhood and adulthood that we looked at earlier help to explain some of the prevalence of depression.
In addition to depression, people with high ACE scores are also more likely to experience generalized mental distress than the general population. ACEs can contribute to the development of Post-traumatic stress disorder.
3. Adults With High ACE Scores Are Less Socially Stable And Likely To Engage In Risky Behavior
Partly due to disrupted brain development, people with high ACE scores are more likely to engage in personally and socially risky behaviors. High ACE scores are associated with earlier and riskier sexual activities and higher rates of unintended pregnancies, and smoking, alcoholism, and illegal drug use.
As discussed in the physical and mental health sections, the chronic, unsupported stress among ACEs can cause physical changes to our brains. Chronic stress can inhibit the development of decision-making and impulse control centers. This leaves adults with high ACE scores more susceptible to potentially unsafe activities, such as excessive drug and/or alcohol use.
In addition to these risky behaviors, adults with high ACE scores are more likely to report poor work performance or unemployment. They are more likely to have multiple sexual partners and are at higher risk of sexual violence and intimate partner violence.
It's not always clear how ACEs are related to these results. Some of the social issues may stem from the impacts of stress on decision making and impulse control. Also, research on childhood trauma shows that early relationships and attachment style carries over into adulthood. If the ACEs indicate unhealthy patterns in relating to authority figures or family members, these are often very difficult to break later on.
Brain development and learned behavioral patterns seem to play a part in the social instability of adults with high ACE scores. In addition to these, high sensitivity to stress can make challenges in the workplace or in intimate relationships difficult. As we saw earlier, chronic, unsupported childhood stress can cause excessive stress reaction to trigger, later on as adults.
4. Adults With High ACE Scores Die Earlier
All of the challenges detailed above add up to one bald fact: adults with high ACE scores have a life expectancy that is 20 years shorter than that of the average adult when compared to the general population.
Adults with high ACE scores often die of the diseases to which they are prone; suicide, alcoholism, and drug use, to name a few. ACEs lay the foundation for impaired brain development, which essentially contributes to certain mental health disorders, risky behaviors, and social instability. Often, this unfortunately ultimately results in an increased risk of early death.
What if you took the test and scored above a three, four, six, or eight? Does that mean that you are doomed to a lifetime of low-achievement, sickness, and instability followed by early death? The short answer is no.
While the ACE scale measures particularly difficult childhood circumstances that can stack the deck against us in adulthood, it doesn't measure everything. There are positive childhood circumstances that can mitigate a lot of the damage of a high ACE score. Loving, supportive relationships with adults like teachers, grandparents, or friends can go a long way toward helping children cope with trauma. And as an adult, self-knowledge, like your ACE score, is only a tool. It can help you to identify and name detrimental actions. It can help you find help.
Many people with high ACE scores live long and productive lives. But if you are concerned that your ACEs may interfere with the life you want to live, consider consulting a caring, trained professional. Therapists and counselors can help you identify and overcome problematic behaviors. They may be able to help you heal the wounds of your childhood experiences or identify ways that patterns built in childhood are inhibiting your ability to function as an adult.
Research shows that online therapy is a powerful tool in improving mental health and can result in similar success in treating anxiety and depression. For instance, this study found that online therapy was even more effective than traditional in-person sessions, with 100 percent of participants in the online group showing continued symptom reduction three months after treatment. On the other hand, individuals in the face-to-face group showed “significantly worsened depressive symptoms” over the same period.
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