Expanding Understanding: Adverse Childhood Experiences

Adverse Childhood Experiences and Long-Term Health

In 1998, the Centers for Disease Control and Kaiser Permanente Health Systems partnered to launch an ambitious study on the effect of adverse childhood experiences on an individual’s long-term physical, mental, social and emotional health. Known today as the ACE Study, it is widely recognized that the publication of this paper marked the beginning of an approach to mental and emotional healthcare practices now commonly called “trauma-informed care.” Such a lofty goal was not the initial intent of the study, however; doctors working for Kaiser were originally interested in why so many people were unable to complete their weight-loss programs, which were recommended by both their healthcare and insurance providers. When doctors realized that many of their weight-loss patients were still struggling with issues from childhood, they expanded the study to include the general population and administered questionnaires to almost 14,000 adults in the San Diego area of Southern California. What they found was shocking: more than half of the adults surveyed had experienced at least one or more of the adversity criteria, and of those, over 80 percent tended to display physical, social or emotional issues upon reaching adulthood.

Adverse Childhood Experiences: The 1998 Definitions

The ACE Study identified exposure to the following indicators as “Adverse Childhood Experiences:”

  • Physical, emotional or sexual abuse
  • Physical or emotional neglect
  • Domestic violence
  • Living with an individual struggling with substance abuse, an individual diagnosed as mentally ill or an individual who was incarcerated or sentenced to be incarcerated

The ACE Study was subsequently confirmed by various other research institutions around the country, and the ACE indicators became the standard reference point for healthcare professionals attempting to determine whether or not issues from childhood might be contributing to physical, emotional or social problems experienced by patients during adulthood.

New Research on Adverse Childhood Experiences: Updated Definitions

More recently, Dr. Roy Wade of the Children’s Hospital of Philadelphia realized that children he dealt with on a daily basis lived through experiences that were not listed among the ACE indicators but should be. Dr. Wade and the Institute for Safe Families spearheaded a study conducted in the Philadelphia area in 2012-2013 that focused on the childhood experiences of individuals who had grown up in low-income, urban areas. In addition to the original criteria from 1998, this study added exposure to the following indicators as “Adverse Childhood Experiences:”

  • Experiencing racism and/or bullying
  • Living in foster homes
  • Living in an unsafe neighborhood
  • Witnessing violence

Though Dr. Wade himself anticipated the outcome of the study, the numbers are no less shocking than those released in 1998: when the new, urban-centered indicators were added, just over 80 percent of the individuals surveyed responded that they had experienced at least one or more of the ACE indicators, about one-third had experienced physical or emotional abuse and over 40 percent had witnessed some type of violence.

New Directions: Understanding how ACEs Affect Behavior and Health

Researchers like Dr. Wade believe that adopting an approach to the behavioral, emotional and physical health of children that considers not only their perceived physiological pathologies but also their developmental circumstances will allow doctors, teachers and child care workers to help children in more productive and effective ways than the “evaluate, diagnose and medicate” paradigm which is prevalent today. In addition, the expansion of what constitutes an “Adverse Childhood Experience” has the potential to redefine how student behavior is managed in schools across the country, particularly in urban and low-income environments. If teachers and administrators accept the possibility that many of their students might be living in a state of constant stress and adversity, they may be more likely to view even the most challenging behaviors from a compassionate point of view and develop empathetic strategies that seek not to modify the behavior, but rather to understand the child.