Adverse Childhood Experiences (ACEs): What can we do to protect our small humans?

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BY: Nadia King

Did you know that toxic stress as a child can lead to cancer as an adult?

Before very recently, I didn’t either.

It makes intuitive sense that health outcomes would be worse for a child who has experienced trauma. They are likely to cope with the experiences by adopting unhealthy habits such as smoking or drinking, and these behavioral coping mechanisms have costly effects on health. Interestingly, the toxic stress itself can have a lasting impact on the brain and body. It disrupts neurodevelopment and the stress response system, creating a hyper vigilant state of being accompanied by skyrocketing, unnecessary levels of stress hormones like cortisol.  

In 1998, the Adverse Childhood Experience (ACEs) study was published. Looking at over 17,000 participants at Kaiser Permanente Hospital in San Diego, the researchers found a very strong correlation between childhood trauma and adult health outcomes. The researchers included 10 highly stressful events for their measure of ACEs including:

  1. Emotional abuse
  2. Physical abuse
  3. Sexual abuse
  4. Emotional neglect
  5. Physical neglect
  6. Absence of a parent through divorce, death, or abandonment
  7. Parent violently treated by other parent
  8. Drug/ alcohol abuse in home
  9. Mental illness in home
  10. Household member incarcerated

A dose-wise relationship was found, meaning that for every ACE a person experienced, the worse their health outcomes were as an adult. This relationship holds true for over 40 different health outcomes from heart disease to depression. Shockingly, ACEs predict the development of 7 out of 10 of the leading causes of death and having an ACE score of 6 results in a 20 year reduction in lifespan compared to a person with 0 ACEs, on average.

Yikes. This study discovered some pretty dreadful information, especially considering over 60% of the population has experienced at least one ACE.

“Adverse Childhood Experiences (ACEs) are the single greatest unaddressed public health threat facing our nation today.”

Robert Block, former President of the American Academy of Pediatrics

I want to reassure you; there is hope and it comes in the form of resilience and prevention.

This summer, I worked on a research project with the OPEC team at the Hallie Ford Center (funded through the SURE Science program at Oregon State University) that assessed how Oregon healthcare systems are incorporating ACEs science and parenting education into practice. Healthcare systems are an excellent avenue to help families develop this important concept of resilience that I mentioned above. By screening all families for ACEs, practitioners can identify those who are at risk and connect them with helpful resources such as parenting education, therapy, support groups, or stress reduction techniques. These connections can help families both cope with trauma that has occurred and prevent additional ACEs from happening.

As a piece of my research, I had the privilege to interview some of the leaders in the area of ACEs. The interviewees included family care practitioners, researchers, and parenting education professionals. Here are a few selected quotes that highlight some of the emerging themes.


Why ACEs? Why trauma informed care?

“CCOs started looking into ACEs because they wanted to provide preventative care and get to the root of illness and then the more they looked into ACEs they realized what a strong correlation— actually causation there is between ACEs and physical and mental health and well being.”

“How do we cut cost and improve health? Well we go upstream and prevent ACEs as much as possible to improve the health of the community.”

“We get the majority of our parenting information from how our parents treated us… if that’s a negative experience, how do we change the trajectory to help prevent that from happening again?”

“Trauma informed care is looking at the underlying cause to the problem, not just treating the physical symptoms.”

What does this look like in practice?

“Our intervention is primarily doing what we already do as pediatricians: giving advice about positive parenting and doing this even more intentionally for families who have trauma histories.”

“Asking, listening, and accepting as a powerful form of doing is a very important idea.”

Addressing the commonly held belief that families will fight the process:

“We have screened over 440,000 people at Kaiser and have had 0 patient complaints.”

“What I’ve found over and over again in parents who have had these experiences is that there’s a worry in the back of their mind that they will pass this on to their kids, and so they’re usually more relieved than anything else when we ask about ACEs…Families often see their pediatrician as a trusted bridge to services so if we have these conversations in a meaningful way with them then they view it as a way they can get the help that they need. They don’t fight the conversation.”

Recognizing a stigma:

“Many of the these things are too uncomfortable to think about or have been taught very successfully to us as small children that “Nice people don’t talk about it, and my God don’t ask questions about it.”


From these insights, it became clear that this ACEs screening and intervention can be transformative for the way pediatric and family healthcare is approached. It enables the important shift from “What’s wrong with you?” to “What happened to you?”.  Despite the benefits of screening for ACEs, I identified some major barriers to implementation including a lack of time, a lack of resources to provide to families, the absence of a universal screening process, and provider discomfort. Those practices who were able to overcome these barriers and implement ACEs screening were met with positive results. They were able to support families with connections and resources and help them to build resilience.

So what does this mean for parents?

Well, resilience can be strengthened in many ways, especially through the secure and consistent attachment of one meaningful adult relationship. By helping families build these positive relationships with their children, parents can become that person who acts as a buffer against hardship and stress. Parents can also benefit from the knowledge of ACEs science because they can recognize the severe impact that ACEs can have on their family and start finding resources to help them.

ACEs are preventable. Let’s not forget this important fact.

If we can create a society that is aware of the lasting health outcomes resulting from ACEs, then we can ignite people to change and work toward preventing ACEs from occurring in the first place. Although the conversation of ACEs is commonly seen as taboo in our society, it is important that we address it. We need a multi-generational approach where resilience is built and toxic stress is reduced.

If organizations and people come together to address ACEs, we can improve the health and well being of families and children for years to come.


There are some excellent resources where you can learn more about the science of ACEs, toxic stress, and resilience:  

If you join the Ford Family Foundation Select Books program, you can be delivered a free copy of the book “The Deepest Well” by Dr. Nadine Burke Harris. Nadine explores the science of ACEs and how she utilizes ACEs knowledge in her practice.

http://www.tfff.org/select-books/book/deepest-well

How childhood trauma affects health across a lifetime”

Ted Talk by Dr. Nadine Burke Harris on ACEs

 

Centers for Disease Control and Prevention- CDC on ACEs

https://www.cdc.gov/violenceprevention/acestudy/index.html

An interesting video on ACEs-

“Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.”

https://www.ncbi.nlm.nih.gov/pubmed/9635069

Building Resiliency: Preventing Adverse Childhood Experiences (ACEs)

https://www.oregon.gov/oha/PH/HEALTHYPEOPLEFAMILIES/DATAREPORTS/Documents/OregonACEsReport.pdf

Trauma Informed Oregon

https://traumainformedoregon.org

Center on the Developing Child- Harvard University: Aces and Toxic Stress Frequently Asked Questions

https://developingchild.harvard.edu/resources/aces-and-toxic-stress-frequently-asked-questions/

Center on the Developing Child- Harvard University: Information about Resilience

https://developingchild.harvard.edu/science/key-concepts/resilience/

Center on the Developing Child- Harvard University: Information about Toxic Stress

https://developingchild.harvard.edu/science/key-concepts/toxic-stress/

This article discusses parent perspective on ACEs screening.

http://psycnet.apa.org/fulltext/2017-54863-001.pdf

This blog post was written by Nadia King, a student at Oregon State University as part of a summer internship funded by Summer Undergraduate Research Experience (SURE) program.

About Nadia: My name is Nadia King. I’m a third year undergraduate student at OSU studying biology with the hopes to attend medical school. I can see myself becoming a pediatrician or family physician, but I’m keeping my options open. As well as my interest for the hard sciences, I love learning about public health. I’ve enjoyed working with the OPEC team and broadening my perspective and understanding of how parenting education benefits families. I think it’s incredible that OPEC offers free education statewide and even more incredible that this education has the potential to prevent ACEs. Thank you for taking the time to read this blog and I hope you enjoy learning a little bit about ACEs!

 

References:

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., . . . Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine,14(4), 245-258.

Photo 1 by Bess Hamiti on Pexels.com

Toxic Stress. (n.d.). Retrieved October 30, 2018, from https://developingchild.harvard.edu/science/key-concepts/toxic-stress/

Violence Prevention. (2016, April 01). Retrieved from https://www.cdc.gov/violenceprevention/acestudy/

 

 

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