The Pair of ACEs

Adverse Childhood Experiences (ACEs) are stressful or traumatic negative experiences before age 18 that have long lasting effects on physical health, mental health, and social well-being. Most people have at least one ACE. ACEs can be intergenerational, meaning they are passed from a trauma survivor to their descendants or children. This is sometimes referred to as transgenerational or multigenerational trauma. People with intergenerational trauma may experience symptoms, reactions, patterns, and emotional and psychological effects from trauma that was experienced by previous generations. This is not limited to just parents or grandparents. The National Institute of Health reports that parental ACE scores are predictive of their child’s ACE score risk, meaning the more ACEs a parent or caregiver has experienced, the greater the risk of ACE exposure to their child or children. 

Resilience helps to counteract the effects of ACEs on the brain and body. Resilience is the ability to become strong, healthy, and successful again after something bad happens. We are all born with resilience, and it can be learned and developed at any age. Evidence shows that early experiences, both positive and negative, are critical in building and shaping how the brain develops.

The Adverse Childhood Experience (ACE) Study

The first large-scale population study which linked Adverse Childhood Experiences, or ACEs, to poor adult health outcomes, published in 1998, was conducted by a partnership between the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente. The study compared 10 categories of negative childhood experiences to a long list of poor health outcomes including heart disease, cancer, diabetes, and depression. 

The study revealed that ACEs are incredibly common, 64% of the participants experienced at least 1 ACE. The study also discovered that the more ACEs a person had, the higher their risk for health complications throughout life.

The 10 ACE categories studied include abuse (physical, emotional, and sexual), neglect (physical and emotional), parental divorce or separation, household violence, incarceration of a family member, substance use in the household, and mental illness of a family member. These 10 categories do not account for all possible types of childhood adversity.

Adverse Community Environments

In addition to the personal or individual traumatic experiences discussed above, Adverse Community Environments and social inequities can also contribute to an individual’s experience of trauma. This emphasizes the importance of a holistic approach to prevention.

The Pair of ACEs graphic (below) illustrates individual, community, and social factors that can all contribute to the experience of trauma. At the top of the image, near the branches of the tree, you will see examples of individual ACEs. Near the base and the roots of the tree, there are examples of systemic inequities. We can prevent further trauma from occurring and improve long-term health outcomes by focusing efforts not only on building individual resilience, but also on improving equity within the community. 

 Pair of Aces graphic

 

More information on ACEs can be found here: About Adverse Childhood Experiences (CDC)

Data on ACEs in Snohomish County

Adverse Childhood Experiences (ACEs) (Snohomish County Health Department)

Healthy Youth Survey Fact Sheet Archive (Snohomish County Health Department)

Health Outcomes

The consequences of ACEs are not limited to chronic health conditions seen later in life. Health and behavioral outcomes in children experiencing adversity may manifest as developmental delay, failure to thrive, or sleep disruption in infants; asthma, learning difficulties, or behavioral problems in school-age children; and obesity, frequent headaches, or engaging in risky behavior in adolescents. If adversity is addressed early enough in life, children have the opportunity to counter the negative effects of exposure to adversity by developing resilience and healthy coping mechanisms with the support of safe, stable, and nurturing relationships.

The original ACE Study identified linkages between ACEs and several high-risk behaviors and poor health outcomes. The CDC currently recognizes over 40 behaviors and health outcomes relating to ACEs in a dose-response relationship, meaning the more ACEs a person has, the higher their risk for one or more poor health outcomes.

The high-risk behaviors and poor health outcomes that result from ACEs as identified in the ACE Study include: 

  • Chronic obstructive pulmonary disease (COPD)
  • Depression
  • Early initiation of sexual activity
  • Early initiation of smoking
  • Fetal death
  • Financial stress
  • Illicit drug use
  • Ischemic heart disease
  • Liver disease
  • Multiple sexual partners
  • Poor work performance
  • Risk of intimate partner violence
  • Risk of sexual violence
  • Sexually transmitted diseases
  • Smoking
  • Suicide attempts
  • Unintended pregnancies

ACES Infographic(click graphic to make bigger)


Toxic Stress

Toxic stress occurs when a child experiences strong, frequent, and/or prolonged adversity in the absence of a safe, stable, and nurturing adult.

Toxic stress can disrupt or damage all of a child’s developing systems. Disruption of brain development may lead to increases in learning difficulties, hyperactivity, or problems with memory and attention. Repeated or severe activation of stress hormones can increase levels of inflammation throughout the body which can then, over time, cause damage to the heart and arteries. Toxic stress can also weaken the immune system, leading to a higher risk of infection or the development of autoimmune diseases.

More information on Toxic Stress: Toxic Stress Derails Healthy Development (Harvard University)