5 Factors Linked to Higher Risk of Early Life Adversity

The CDC recently compiled the largest and most diverse collection yet of adverse childhood experiences (ACEs) data, based on self-reported responses to a cross-sectional survey of 214,157 individuals living in various geographic regions across the United States. The authors believe that identifying specific variables that put some people at higher risk of being exposed to childhood adversity can provide valuable public health information about the ripple effects of ACE exposure—such as opioid use and misuse—from generation to generation.

Source: Kat Jayne/Pexels

This paper, “Prevalence of Adverse Childhood Experiences From the 2011-2014 Behavioral Risk Factor Surveillance System in 23 States,” was published September 17 in JAMA Pediatrics. The authors explain the importance of their research findings: “Early life adversity is associated with leading causes of adult morbidity and mortality and effects on life opportunities. These findings highlight the importance of understanding why some individuals are at higher risk of experiencing adverse childhood experiences than others, including how this increased risk may exacerbate health inequities across the lifespan and future generations.”

“What is the prevalence of adverse childhood experiences across 23 states stratified by demographic characteristics?” was the research question that prompted this CDC study.

The findings of this monumental research effort significantly update the estimated frequency of adverse childhood experiences in the U.S. adult population. For example, we now know what percentage of people are exposed to the most common adverse childhood experiences. In order of prevalence, these ACEs are emotional abuse (34.42%), parental separation or divorce (27.63%), and household substance abuse (27.56%).

The massive swaths of data collected via BRFSS reveal that childhood adversity is common across all sociodemographic groups, regardless of where someone lives, but that certain variables are associated with a higher risk of being exposed to early life adversity before the age of 18. Finding ways to reduce adverse childhood experiences has the potential to improve overall well-being and life outcomes for people from every demographic.

Notably, the latest CDC findings show that people over the age of 18 from the five sociodemographic groups below reported higher exposure to adverse childhood experiences than adults in other groups. People from the following five groups were more likely to have been exposed to early life adversity.

• Black, Hispanic or multiracial individuals
• Those with less than a high school education
• Someone who earns less than a $15,000 annual income
• People who were unemployed or unable to work
• Respondents who identified as gay/lesbian or bisexual. Unfortunately, to the best of my knowledge, this study does not include information about those who identify as transgender. Hopefully, future research on this topic by the CDC will include everyone under the LGBTQ umbrella.

How Do Researchers Calculate ACE Scores?

The ACE module consists of ten items that includes physical abuse, emotional abuse, sexual abuse, physical or emotional neglect, household mental illness, household substance use, household domestic violence, incarcerated household member, and parental separation or divorce.

Someone’s “Lifetime ACE prevalence” is based on adding up all of the adverse experiences from childhood and then giving a rating of 1.00-10.00. The higher the score, the greater someone’s exposure to adverse childhood experiences. Based on over 200,000 respondents evaluated for this study, 62% experienced at least one ACE, and 25% reported three or more ACEs.

Below is a recap of how the ACE numbers add up for various sociodemographics as adults. In comparison to study participants who identified as white, those who completed high school (or above) education, those in all other income brackets, those who were employed, and those identifying as straight—higher than average ACE scores were reported by study respondents who identified as:

• Black (average ACE score, 1.69)
• Hispanic (average ACE score, 1.80)
• Multiracial (average ACE score, 2.52)
• Less than a high school education (average ACE score, 1.97)
• Income of less than $15 000 per year (average ACE score, 2.16)
• Unemployed (average ACE score, 2.30)
• Unable to work (average ACE, 2.33)
• Gay/lesbian or bisexual (average ACE score, 2.67)

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"This report demonstrates the burden of ACEs among the U.S. adult population using the largest and most diverse sample to date. These findings highlight that childhood adversity is common across sociodemographic characteristics, but some individuals are at higher risk of experiencing ACEs than others. Although identifying and treating ACE exposure is important, prioritizing primary prevention of ACEs is critical to improve health and life outcomes throughout the lifespan and across generations,” the authors said in a statement summing up the significance of their findings. "By ensuring that all children have access to safe, stable, nurturing relationships and environments, we can prevent or alleviate the effects of ACEs, thereby achieving multiple public health goals.”

Are There Any Silver Linings to Experiencing Childhood Adversity?

From a parent's perspective, everybody hopes that his or her child would be rated an absolute zero on the ACE scale in adulthood. As a father, my knee-jerk reaction is to shield and protect my 10-year-old daughter from any adverse childhood experiences. Ironically, I know from life experience that, for me, having an ACE score of four has, in many ways, been a blessing in disguise. When it comes to certain aspects of my development such as cognitive flexibility and divergent thinking, I suspect that having a less-than-perfect childhood fortified a more resilient and open mindset.

Although I've always had a hunch that some of the early life adversity I experienced during adolescence had a silver lining, I recently stumbled on some empirical evidence that suggests why some people become more iconoclastic in the aftermath of childhood adversity.

Of course, the million-dollar question is: What ingredients contribute to otherwise traumatic childhood experiences leading to some unanticipated benefits in adulthood?

One answer posited by Rodica Damian of the University of Houston called the "Diversifying Experience Model" is that unexpected events (e.g., early life adversity) can push individuals outside the frameworks of their ordinary everyday lives and force them to embrace new and uncommon ideas.

In a recent study, "The Diversifying Experience Model: Taking a Broader Conceptual View of the Multiculturalism–Creativity Link," (2018) Damian and co-authors Małgorzata Gocłowska and Shira Mor write:

"Our review identifies a range of diversifying experiences (e.g., multicultural exposure, unexpected adversity, violations of expectations) that have been found to influence creativity. We introduce the Diversifying Experience Model (DEM), where we argue for a curvilinear relationship between diversifying experiences and creativity, whereby creativity improves as a result of moderate (but not low or high) levels of diversifying experiences. We also propose adaptive personal resources as the key moderator, and threat and challenge appraisals as the key mediators of the diversifying experience–creativity relation. When adaptive resources are high, moderate diversifying experiences are appraised primarily as a challenge, facilitating creativity, whereas when adaptive resources are low, moderate diversifying experiences are appraised primarily as a threat, derailing creativity."

In a follow-up blog post, I'm going to do a deeper dive into the work of Rodica Damian and explore how an inverted-U "sweet spot" of diversifying experiences and someone's degree of adaptive personal resources influence creativity, cognitive flexibility, divergent thinking, and overall post-traumatic growth after early life adversity.