These days, there is greater public awareness about the impacts of traumatic events. Books such as The Body Keeps the Score by Bessel van der Kolk and Trauma and Recovery by Judith Lewis Herman, among many others, have played an essential role in educating us about the effects interpersonal trauma can have across a lifetime. Even those who have not read about the topic are likely aware that traumatic and terrifying childhood events can have long-lasting consequences.
This article offers an outline of the Adverse Childhood Experiences Study (ACE Study), with its key findings. It also illustrates how and why a higher ACE Score is associated with a greater likelihood of developing mental and physical health conditions in adulthood.
The Original ACE Study
The original CDC-Kaiser Permanente ACE Study involved two separate waves of data collection between 1995 and 1997. Although other psychotherapists and sociologists had published on the consequences of childhood trauma, there was, at the time, limited empirical data addressing the relevance of these adversities to medical outcomes in adulthood.
Overall, the purpose of the ACE Study was to discover “the relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during childhood.”
The researchers received survey results from over 17,000 participants. Each question began with the phrase: “While you were growing up during your first 18 years of life…” and was clustered under one of seven categories. The study questions are summarized below.
- Psychological Abuse: Had an adult frequently insulted, sworn at, or put down the person as a child or made them feel that they would be physically hurt?
- Physical Abuse: Had they often been slapped, pushed, shoved, or hit hard enough to leave marks or injuries?
- Sexual Abuse: Had an adult (or person at least five years older) ever sexually touched them, asked to be touched sexually, or attempted or actually had intercourse with them?
- Household Substance Abuse: Had a household member been an alcoholic, problem drinker, or used recreational drugs?
- Household Mental Illness: Had a household adult been depressed or mentally ill or ever attempted suicide?
- Mother Treated Violently: Had their mother (or stepmother) frequently been slapped, hit, pushed, etc., or had something thrown at her? Had she ever been repeatedly hit for a prolonged time or threatened with or hurt by a knife or gun?
- Criminal Behavior in Household: Had a household member ever gone to prison?
It’s worth noting that the second wave of the ACE Study also included emotional and physical neglect, and more recent adaptations of the ACEs incorporate parental divorce or separation.
Findings from the ACE Study and Related Research
The results from the original study drew much-needed attention to a major public health issue. Due to stigma and shame, people do not often divulge traumas suffered in their youth. Thus, the widespread nature of ACEs may have come as a surprise to the original researchers. Over 60% of respondents reported at least one ACE, and over 30% had two or more. More than 12% had experienced four or greater adversities.
An individual’s ACE Score is the total of how many ACEs they experienced during childhood. The prevalence for both waves combined was:
- 0 ACEs: 36.1%
- 1 ACE: 26%
- 2 ACEs: 15.9%
- 3 ACEs: 9.5%
- 4 or more ACEs: 12.5%
The results indicated that ACEs were present across all socio-economic, educational, and cultural groups and tended to cluster together. If individuals were exposed to one, they were likely to have experienced others.
Higher ACE Scores are associated with worse health outcomes in adulthood. As the score increases, so does the adult risk for a wide range of adverse conditions. Studies indicate that there is “a graded dose-response relationship between ACEs and negative health and well-being outcomes.” According to Dr. Nadine Burke Harris, compared to a person with zero ACEs, someone with four or more is:
- Two and a half times more likely to develop chronic obstructive pulmonary disease (COPD)
- Two and a half times more likely to have hepatitis
- Four times more likely to develop depression
- 12 times more likely to be suicidal
And a person with seven ACEs is:
- Three times more likely to develop lung cancer
- Three and a half times more at risk for ischemic heart disease (the number one killer in the United States)
The lasting consequences of early adversity can impact a broad range of areas in one’s life. With increased exposure to ACEs, the traumatized child is more likely to become an adult who engages in risky behaviors, such as drinking alcohol excessively, using illicit drugs, and having unsafe sex with multiple partners. According to the Centers for Disease Control, those with higher scores are more at risk for:
- Depression, anxiety, PTSD, and suicide
- Traumatic brain injury, fractures, and burns
- Diabetes and cancer
- Unsafe sex and alcohol abuse
- Unintended pregnancy, pregnancy complications, and fetal death
- STDs and HIV
- Limited educational, occupational, and income outcomes
Why is this the case? The ACE Study researchers hypothesized that partaking in potentially damaging behaviors helps survivors regulate their nervous systems. Engaging in drinking, smoking, recreational drug use, excessive eating, and risky sexual behavior could have “immediate pharmacological or psychological benefit as coping devices in the face of the stress of abuse, domestic violence,” or other household dysfunction witnessed as a child. The neurobiological impacts of early trauma have been well documented.
In her TED talk, Dr. Harris reassures us that this is not “just bad behavior” by adults with difficult upbringings. Rather, exposure to early adversity can impact children’s developing minds and nervous systems. It has been shown to affect brain regions such as the nucleus accumbens (associated with reward dependence), prefrontal cortex (related to impulse control), and amygdala (involved in fear processing). Additionally, the fight-or-flight response is often overactivated in those raised in trauma-inducing homes.
Thus, traumatized children often become adults with neurological reasons for engaging in high-risk behaviors to regulate and soothe their nervous systems. Unfortunately, these actions can have repercussions for many aspects of their health and well-being. The ACE Study and subsequent research shed light on how this plays out across a lifetime.
Hope for the Future
What if you have a high ACE Score? While it can be the case that “In my beginning is my end,” it certainly doesn’t have to be that way. Thanks to tremendous and continuous advancements in trauma-informed care, we now have the insights and resources to recognize, integrate, and heal from even the worst childhood experiences. With patience and self-compassion, survivors can integrate their mind’s fragmented parts and traumas to become wholly and richly human, mindful, and fully alive and aware in the present.
If you or someone you know experiences mental health issues, it is important to seek help from a qualified professional. Our Resource Specialist can help you find expert mental health resources to recover in your community. Contact us now for more information on this free service to our users.
About the Author: Monique Moate is a professional writer and editor living in Sydney, Australia. She holds a postgraduate degree in editing and digital publishing and has lived experience of mental health struggles.
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