All who aim to promote MCH need to know about ACEs. ACEs only sound
like something you would like to have in your hand or up your sleeve.
Actually, ACE stands for Adverse Childhood Experiences. And the impact
of these ACEs on adult health status is strong and cumulative.
ACEs are categorized as abuse (psychological, physical, or sexual) or
household dysfunction (substance abuse, mental illness, mother treated
violently, criminal behavior/incarceration). In a study of over 17,000 patients
in a California HMO, over half of adults reported at least one ACE. Like aces
in a poker game, these ACEs tend to show up in clusters. One-fourth of adults
reported ACEs in two or more categories. Over 6% reported exposures in four
or more categories. A study of my state’s (WA) high school students showed
in a average classroom, 42% of students reported three or more ACEs.
Among those who reported physical abuse, 84% had two or more additional ACEs.
Research over the last dozen years clearly links ACEs to the leading causes of
death. More adverse childhood experiences lead to more adult risk behaviors
including more smoking, physical inactivity, alcoholism, drug use, risky sexual
practices. These behaviors in turn lead to a litany of chronic conditions and causes
of death: depression, suicide attempts, severe obesity, alcoholism, bronchitis,
emphysema, bone fractures, hepatitis, heart disease, cancer, HIV, the list goes on.
This makes ACEs the most powerful determinant of public health.
Adverse childhood experiences are surprisingly common in the earliest years,
are generally unrecognized, can be identified during childhood by history from children
or caretakers, and can start to manifest damage as ill health, negative behaviors, or
cognitive impairment during childhood.
ACEs define child temperament. Adverse experience generates stress. The child’s brain
responds with its fight, flight or freeze survival mechanism. When the stress is constant,
this high-anxiety state becomes toxic, and normal. The child’s brain is wired for a dangerous
world. S/he becomes edgy, hot-tempered, impulsive, hyper vigilant, and learns to favor brawn
over brains. This makes parenting more challenging, which leads to more adverse childhood
experiences, and so it goes.
Home visiting is an important strategy to break the cycle by reducing ACEs starting in
pregnancy. More on that next time. SS
Best place to start learning about ACEs: CDC’s Website: Adverse Childhood
Experiences at http://www.cdc.gov/nccdphp/ace
Felitti, VJ; Anda, RF; Nordenberg D; et al. (1998)Relationship of Childhood Abuse and Household
Dysfunction to Many of the Leading Causes of Death in Adults. Am Journal of Preventive Medicine
Felitti, VJ. (2009) Adverse Childhood Experiences and Adult Health . Academic Pediatrics 9,
131-2. See several related articles in this issue.