Childhood Adversity: What the ACE Study Unveils
Those who have the privilege to know, have the duty to act.
In the 1990s, the CDC and Kaiser Permanente published a study on adverse childhood experiences (known as the ACE study). Events such as death of a parent, divorce, neglect and child abuse account for an ACE. Other ACE surveys include racism, witnessing violence outside the home, bullying, losing a parent to deportation, living in an unsafe neighborhood, and involvement with the foster care system. Other types of childhood adversity can also include being homeless, living in a war zone, being an immigrant, moving many times, witnessing a sibling being abused, involvement with the criminal justice system, etc.
Why is adversity in childhood different? For starters, children are especially sensitive to trauma. Their brain, immune system, nervous system and hormonal system are still developing. High doses of adversity create real concern in the amygdala, the brain's fear response center.
The adversity a child faces doesn't have to be severe in order to create deep, biophysical changes that lead to chronic health conditions later in life. Living with a parent who drinks too much, puts you down, is constantly depressed or angry can leave a profound imprint on your brain and immune responses.
Most Americans have one ACE. For a person with an ACE score of four or more, the relative risk of chronic obstructive pulmonary disease is three times higher than that of someone with an ACE score of zero. For depression, it is four and half times greater and for suicide, it is 12 times greater. A person with an ACE score of seven or more has triple the risk of lung cancer and three times greater the risk of heart disease (the number one killer in America).
Adverse childhood experiences are the single greatest unaddressed public threat facing our nation today.
- Dr. Robert Block, former President of the American Academy of Pediatrics
After learning that the study was published in 1992 , it was natural to wonder why my pediatrician of 15 years never addressed this. In fact, no teacher, doctor, gynecologist, therapist or medical professional EVER mentioned this study. It was only in my own inquiry to understand my body and mind better that I discovered Dr. Nadine Burke Harris and her TEDMEDTalk on the ACE study.
Suicides have become the second-leading cause of death among teenagers in the United States, surpassing homicide deaths, which dropped to third.
Recent studies have showed that death by suicide among girls between the ages of 10 and 14 has been increasing. Though young girls make up a very small portion of the total suicides, the rate in that group jumped the most — it experienced the largest percent increase, tripling over the last 15 years.
In a candid article, Dr. Nancy Hardt shares that the most important thing she DID NOT learn in med school was the ACE study. Hardt says,
'To be sure, had I understood them the way I do now, I would have been a better and more compassionate physician. Importantly, I would have avoided lots of mistakes. I never understood the addictions to food, drugs, alcohol and cigarettes, are imperfect solutions to the effects of toxic stress resulting from adverse childhood experiences. Toxic stress sets up pathways in the brains of traumatized children, pathways which persist into adulthood. We don't outgrow these pathways, so as we get older, we try "home remedies" to treat them.'
Dr. Hardt's transparency in what her medical training lacked helps us shape change in future medical trainings. The resources and science we have today are profound. Artificial Intelligence (AI) has learned empathy. Shouldn't our medical providers?
We have to ask more questions, do our research, and most importantly serve our future generation. Childhood adversity is not going to end, and sadly, child abuse is not going to stop. But we can improve the care we provide survivors. We can give them a chance of finding health and healing after being dealt such arduous circumstances.
My life and work have become aligned with finding joy and health after living many years with despair and illness. I'm a living testament that we DO NOT HAVE TO LIMP TO THE FINISH LINE.
Knowledge is power and knowing your score in powerful!
Life is not always a matter of holding good cards, but sometimes, playing a poor hand well.
Childhood Disrupted, Donna Jackson Nakazawa
The Body Keeps the Score, Bessel Van Der Kolk, M.D.
The Deepest Well: Healing the Long-Term Effects of Childhood Adversity, Nadine Burke Harris, M.D.