Adverse Childhood Experiences
In recent months I have heard trauma informed care mentioned at various meetings and events I have attended. Colleagues from health, education, social services, housing, the police and the voluntary sector are all taking about the need for early intervention and prevention. It seems that the word is getting out about the need for all of us to work together to address the consequences of Adverse Childhood Experiences, otherwise known as ACEs.
The term ACEs was first mentioned in a study published in the American Journal of Preventive Medicine in 1998 by Vincent Felitti and Robert Anda. Their research examined the link between traumatic events in childhood and poor health outcomes in later life. A questionnaire was developed comprising ten questions covering specific experiences in childhood such as – ‘Was a household member depressed or mentally ill, or did a household member attempt suicide?’ Respondents indicate whether or not they have experienced each of the ten events and the count is totalled to create an ACE score. The research examined the results from over seventeen thousand individuals. The findings showed a causal link between an individual’s prolonged exposure to a set of stressful or adverse experiences in his/her childhood with no positive support, otherwise known as ‘toxic stress’ and subsequent adult diseases and health risks including addictions, chronic health conditions and lower life expectancy. As the ACE score increases, so does the risk for these outcomes. The study showed that the impact of ACEs can be significant. Individuals with an ACE score of four are twice as likely to be diagnosed with cancer. An ACE score of six or higher can reduce an individual’s life expectancy by twenty years. What is remarkable is that the ACEs study revealed a previously hidden public health issue with far reaching implications for health outcomes, wellbeing and public finances. It is extraordinary that this remains, twenty years later, a little known body of work – but thanks to some key initiatives, things are starting to change.
In the 2016 documentary by director James Redford, Resilience: The Biology of Stress & The Science of Hope, Anda and Felitti describe their journey to the ACEs study. The film also describes the inception of a movement among professionals and community members, who are using the results of the study and the underpinning brain science to formulate and implement interventions to remove the source or ameliorate the effects of stress on children and young people, providing better chances for building resilience and producing some impressive outcomes.
In September I attended a conference in Glasgow entitled ‘the ACE Aware Nation’. The conference had been organised on the back of a national campaign across Scotland, screening Resilience and galvanising support. Over two thousand delegates listened to a succession of inspiring, passionate speakers tell their stories. The conference was characterised by a determination to make a difference to the lives of those in need of help, understanding and support. American paediatrician, Nadine Burke Harris, described her path (documented in her book: The Deepest Well) to discovery of the implication of ACEs for her practice and how she has gone on to establish not just solutions for her own community but an organisation that is changing practice around the World.
For those of us who work in any capacity with children and families, realising the implications of ACEs and how we can help, changes our perspective. Instead of asking, ‘What is wrong with you?’ we start to ask, ‘What has happened to you?’ This opens the door to understanding, kindness and compassion, all essential components for repair and healing.
An ACEs approach is not an opportunity to pathologise or diagnose stressful conditions, is is rather a means to initiate conversations and to explore the reasons behind behaviours. It provides a way in to understand and to address the causes of stress.
To find out more –
Anda, R. and Feliitti V. (1998) American Journal of Preventive Medicine – Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study, Available online: https://www.ajpmonline.org/article/S0749-3797(98)00017-8/abstract
ACE Aware Nation conference www.aceawarescotland.com
Resilience documentary: The Biology of Stress and The Science of Hope – https://kpjrfilms.co/resilience/
Nadine Burke Harris, The Deepest Well https://www.panmacmillan.com/authors/dr-nadine-burke-harris/the-deepest-well/9781509823963
Bruce D. Perry, The Boy Who Was Raised as a Dog https://www.amazon.com/Boy-Who-Raised-Psychiatrists-Notebook-What/dp/0465056539
https://www.70-30.org.uk/ Campaign for 70% reduction in child abuse and neglect
by the year 2030.
https://www.wavetrust.org/ Designing practical solutions to create long term transformation