ACEs Study - Information We Should All Know
Since the mid-1990’s the CDC has been running a study known as the Adverse Childhood Experiences Study, or ACE Study for short.
This study has involved a little over 17,000 participants, and continues to involve follow-up with these participants, meaning that it is an over-two-decade-long ongoing study. In addition to the original study, the CDC has also continued to do yearly surveys across all 50 states in the U.S. to continue to learn more about ACEs.
In the ACEs Study, the CDC has been collecting information about the prevalence and the impact of Adverse Childhood Experiences, and the results have been incredibly revealing.
WHAT ARE ACEs
First off, though, what are ACEs? What is an Adverse Childhood Experience? There are ten types of ACEs researched by the study, which are pictured in the helpful infographic above from the RWJF, including physical, emotional, or sexual abuse, physical or emotional neglect, or the experience of mental illness, substance abuse, incarceration, domestic violence, or divorce in the family.
You can also take the ACEs questionnaire below to see how many ACEs you’ve experienced. (A warning here about the questionnaire - If you have experienced trauma in your childhood, the questionnaire below directly references a variety of types of early trauma and could be potentially triggering to those with forms of PTSD. Feel free to skip it and read on.)
THE ACE QUESTIONNAIRE
Prior to your 18th birthday:
Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?
Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?
Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?
Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?
Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
Were your parents ever separated or divorced?
Was your mother or stepmother:
Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
Was a household member depressed or mentally ill, or did a household member attempt suicide?
Did a household member go to prison?
PREVALENCE OF ACEs
According to the ACEs Study, ACEs are incredibly common, with almost two-thirds of participants reporting having experienced at least one ACE (64%). Almost 40% of the participants in the original sample reported having experienced at least two ACEs. About 12.5% of the participants, or about 1 out of 8 of the original sample, reported having experienced at least four ACEs.
A majority of the participants in the original study were white, middle class, college educated, employed, and had access to health care.
A more recent 2018 analysis of results from subsequent studies of ACEs found that the prevalence of ACEs differs depending on demographics, and found these results:
“Of the 214 157 respondents included in the sample, 61.55% had at least 1 and 24.64% reported 3 or more ACEs.
Significantly higher ACE exposures were reported by participants who identified as black, Hispanic, or multiracial, those with less than a high school education, those with income of less than $15 000 per year, those who were unemployed or unable to work, and those identifying as gay/lesbian or bisexual compared with those identifying as white, those completing high school or more education, those in all other income brackets, those who were employed, and those identifying as straight, respectively.
Emotional abuse was the most prevalent ACE (34.42%), followed by parental separation or divorce (27.63%) and household substance abuse (27.56%).”
IMPACT OF ACEs
Given how common early experiences of trauma are, the ACEs Study and subsequent studies have also been collecting information about the link between early trauma and a variety of negative health outcomes.
Here are some examples of the links found with health risks for those with 4 or more ACEs compared with those with 0 ACEs:
2.5x greater risk for chronic obstructive pulmonary heart disease
2.5x greater risk for hepatitis
4.5x greater risk for depression
12x greater risk for suicidality
7x greater risk for alcoholism
4x greater risk for emphysema or chronic bronchitis
For a nice overview of the impact of ACEs on health outcomes, check out the TED Talk by California’s Surgeon General Dr. Nadine Burke Harris at the bottom of this blog.
WHAT DO WE DO WITH ALL THIS?
Let’s be clear about a few key points as we look over these links. First, it is not race, education, income, sexual orientation, or unemployment that causes these increased risk of negative health outcomes. It is lack of safety, exposure to violence, neglect, diminished access to healthcare, and the impact that these conditions have on the developing systems in the body of a child. An exploration of the prevalence of ACEs according to demographics simply confirms what other studies have found: that our society is less safe, more violent and neglectful, and has unequally accessible resources for various demographic groups.
Second, an increase in risk is not a determination of outcome. Experiencing ACEs may explain the adversity that people face, but ACEs do not in themselves determine how we might respond to adversity, or the kind of support and help that can help us overcome adversity.
Researchers have also begun to explore Positive Childhood Experiences (PCEs), protective factors, and resiliency to discover just what it is that helps people to survive the adversity of early trauma, and to do well in spite of it.
Some common themes are: a sense of safety, a feeling of belonging, being able to talk about feelings, having a sense of community to participate in, feeling supported, having someone who’s interested in you, having someone who you feel believes in you, and having a belief in your ability to impact and make change in your life.
It’s not hard to see the overlap between these factors that help develop resilience and the role of therapy. Therapy can help us develop a more complete picture of why we experience the adversity and difficulty that we experience, and to see if early traumatic experiences play a role. Therapy can also give us a safe place to talk about our feelings and experiences, to feel supported, and to know that someone is interested in our experiences, believes in us, and can help us discover our ability to make changes in our life.
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