Adverse Childhood Experiences

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The Centers for Disease Control and Prevention and Kaiser Permanente conducted a longitudinal study comprising 17, 377 middle-class adults with an average age of 57 years. The study examined the impact of Adverse Childhood Experiences (ACEs) on physical health and social functioning. They also examined the relationship between ACEs and adult health-risk-taking behaviors. The ACE Study divided childhood adverse experiences into 10 categories. Under Child Abuse, the three categories include emotional abuse, physical abuse, and sexual abuse; Child Neglect the two categories include emotional neglect and physical neglect; and Household Challenges the five categories include a mother treated violently, mental illness, divorce or separation, substance abuse, and an incarcerated family member. Participants were instructed to check the categories that reflected their childhood experiences. Each category equaled one point and based on the number of categories that were checked the participant could receive a score ranging from 0 to 10.

The study results showed that adverse childhood experiences are common and two-thirds of the participants had an ACE score in two or more categories and one in six participants had an ACE score in four or more categories. The study revealed that high ACE scores in the first 18 years of life are linked to poor outcomes in physical and mental health and social functioning. People with high ACE scores were significantly more likely to, as adults, engage in behaviors that placed their health at risk. The study found that an ACE score of six or more decreased one’s life expectancy by approximately 20 years compared to those participants with an ACE score of 0. It was also found that an ACE score of 7 or more increased suicide attempts by 3,100 percent compared to participants with an ACE score of 0.

One mechanism by which adverse childhood experiences result in long-term health consequences is by engaging in adult health-risk-taking behaviors. These include alcohol and drug abuse, having multiple sex partners, cigarette smoking, and compulsive eating leading to obesity. Adult health-risk-taking behaviors such as these are often an individual’s attempt at coping and self-regulating the experiences of emotional pain, anxiety, anger, and, or, depression related to unresolved adverse childhood experiences.

Cigarette smoking is associated with emphysema, lung and larynx cancer; and cardiovascular diseases, such as heart disease and stroke. There is also a strong link between a high ACE score, child sexual abuse, and obesity. Obesity is linked to multiple poor health outcomes, including high blood pressure, Type 2 diabetes, osteoarthritis, and breast, colon and liver cancers. Since the outcome of physical diseases associated with cigarette smoking and morbid obesity are not manifested for many years, the root causes of the diseases can easily go unnoticed. Felitti (2003) illustrates the disconnect between adverse childhood experiences, adult health-risk-taking behaviors, and biomedical disease by using the following example of cigarette smoking.

Smoking, which is medically and socially viewed as a ‘problem’ may, from the perspective of the user, represent an effective immediate solution that leads to chronic use. Decades later, when this ‘solution’ manifests as emphysema, cardiovascular disease, or malignancy, time and the tendency to ignore psychological issues in the management of organic disease makes improbable any full understanding of the original causes of adult disease (Felitti, p. 254).

Participants who received high ACE scores but did not engage in adult health-risk-taking behaviors were still susceptible to disease and negative physical health outcomes. Felitti suggests that long-term chronic and unrelieved stress overstimulates the brain and body, weakens the immune system, and poses an increased risk for the development of cancers and autoimmune diseases like multiple sclerosis, rheumatoid arthritis, and lupus.