In many people’s lives or careers there is one event that stops them in their tracks, forever changing their view of a critical issue. For me, it was several years ago when I first happened upon a research article, “The Relationship of Adverse Childhood Experiences to Adult Health: Turning Gold into Lead.” I was struck by the articles’ comparison of a newborn baby full of promise, to that of a homeless, seriously mentally ill person nearing the end of life. The article asked “How does this happen, this reverse alchemy, turning the gold of a newborn infant into the lead of a depressed, diseased adult?” As a social worker coordinating child abuse prevention efforts in a children’s hospital, I was certainly aware of the negative and often lasting effects of child abuse and neglect, but as I read and re-read the article, I was astounded to learn that the top causes of death and disease in adults very often have their basis in exposure to adverse experiences in childhood. I remember thinking, “Why haven’t I heard of this before?” and “If we know this, why aren’t we using this knowledge to help us intervene and prevent these future health consequences in the children we’re caring for today?” If we can immunize our kids against illnesses like measles and chicken pox, why can’t we find a way to immunize them to what, statistically, is a much larger threat to their future health?”
The Adverse Childhood Experiences (ACE Study) is perhaps the largest study ever conducted looking at multiple forms of abuse and dysfunction in childhood. It examined the effects of growing up prior to age 18 in a household with:
• Recurrent physical abuse
• Recurrent emotional abuse
• Sexual abuse
• An alcohol or drug abuser
• An incarcerated household member
• Someone who is chronically depressed, suicidal, institutionalized or mentally ill
• Mother being treated violently
• One or no parents
• Emotional or physical neglect
The Study was prompted by the observations of Vincent Felliti, M.D. in the 1980’s, as he was conducting a weight loss program at Kaiser Permanente in San Diego, CA. Dr. Felitti noticed that some of his patients most successful at losing weight were dropping out of the program. In follow-up interviews with more than 200 of these patients, he made a series of startling discoveries:
• Child sexual abuse was very common among these patients, and always preceded the onset of their battle with obesity.
• Many patients indicated their conscious awareness of an association between their childhood abuse and their current obesity.
• Finally, and perhaps most counterintuitive, Dr. Felitti reported that for many of these patients, obesity was not their problem – it was their protective solution, a way to deal with problems they could not talk about.
The study collected detailed evaluations of more than 17,000 middle-aged, middle-class Kaiser patients and assessed childhood exposure to multiple types of serious household dysfunction. A scoring system was used to analyze the findings: a person exposed to none of the 10 factors had an ACE score of 0; a person exposed to any four factors had an ACE score of 4, and so on. The scores were then compared with the health status of these individuals. Results were startling:
• Adverse childhood experiences are vastly more common than generally recognized.
• Almost three-quarters of the study participants reported having at lease one ACE.
• More than 1 in 5 reported a score of three or more, indicating that risk behaviors rarely occur in isolation.
The ACE Study provides remarkable insight into how our experiences as children evolve into risky behaviors, which, in turn, evolve into disease and death. Child abuse and household trauma leave a child vulnerable, and actually disrupt the normal development of the brain. The study suggests that children and adolescents adopt risky behaviors such as smoking and alcohol, as a means of coping or covering their pain. The more trauma they experience (the higher their ACE score), the greater the likelihood of adopting multiple risk behaviors such as smoking, overeating and alcohol and substance abuse. The data showed a powerful and compelling correlation between harmful experiences in childhood and adult health status decades later.
As I talked with other professionals about the ACE research, many committed to think seriously about what the research means for the work we do with kids and families. These conversations with a small group turned into the “ACE Think Tank,” which evolved into the ACE Consortium. Our group continues to grow and is determined to spread the word about the research around the state through a new initiative: Strong Communities Raise Strong Kids.
As a social worker, I know that it’s often much easier to talk “around” issues and avoid talking about the real problem because it’s too painful. But I also know that until we can begin to acknowledge the extent of the problem, we won’t get very far in our attempts to “fix” it. Particularly now, when our nation is embroiled in an impassioned and divisive debate on health care, the knowledge gleaned from the ACE research seems relevant to the discussion.
The ACE Study clearly reveals that “time does not heal the wounds of childhood” and that many adverse childhood experiences go undetected because of shame and social taboo, preventing young victims from revealing their trauma. Yet without intervention and treatment, the study projects a predictable path toward disease and disability. The findings from this study make it imperative that our communities invest in young children and families and provide appropriate interventions.
If we can mobilize our nation to react to or prevent the threat of H1N1, why can’t we mobilize medical and public health to begin a realistic assessment of the impact of childhood trauma on the health of our nation?
Interested in finding out your ACE Score? www.acestudy.org
For more details: www.cdc.gov/NCCDPHP/ACE/
To learn about Strong Communities Raise Strong Kids statewide initiative: www.azpbs.org/strongkids/
Thoughts about how we as a nation, can mobilize to better address the issue?
Marcia Stanton, MSW's Bio
Marcia Stanton, MSW coordinates the Child Abuse Prevention Program at Phoenix Children’s Hospital.