More Startling ACES Outcomes

As we discussed in the last post, adverse childhood experiences are very common and destructive.  An ACE score of 4 or more is considered to be a threshold at which negative outcomes increase exponentially.  To illustrate this point further, consider these facts:

  • Depression – With an ACE score of 4 or more, an individual is 460% more likely to be suffering from depression.
  • Suicide – With 4 or more ACES, the Sad Childrisk of attempted suicide increased 1220%. With an ACE score of 7 or more, risk of suicide increases 3000%. 2/3 of all suicide attempts, 64% of adult suicide attempts, and 80% of child and adolescent suicide attempts have been shown to be directly related to adverse childhood experiences.
  • Smoking – a very serious health risk behavior. With an ACE score of 6 or more, an individual is 250% more likely to be an adult smoker, which in turn contributes to an increase in negative health outcomes.
  • Alcohol – In 2/3 of all individuals suffering from alcoholism, the addiction is directly attributed to childhood trauma. Teens who have issues with drugs and alcohol are 6-12x more likely to have been physically abused and 18-21% more likely to have been sexually abused. Also, 75% of all women is drug and alcohol treatment programs have been sexually abused at some point in their life.
  • IV drug use – A boy with an ACE score of 6 or more, has a has a 4600% increased risk of becoming an IV drug user later in life. In 78% of women who use IV drugs, their drug use is directly attributed to childhood trauma.
  • Rape – A women with an ACE score of 4 or more is 900% more likely to be a victim of rape.
  • Domestic violence – A women with an ACE score of 4 or more is also 500% more likely to be a victim of domestic violence.
  • Mortality – People with an ACE score of 6 or more have an average life expectancy of 60 compared to people with an ACE score of 0 who have an average life expectancy of 79. A high number of adverse childhood experiences effectively reduces life expectancy by almost 20 years. One reason for this is the increase in negative health outcomes associated with ACES due to suppression of the immune system and toxic environments.

The Incidence of Adverse Childhood Experiences (ACES)

The Adverse Childhood Experiences (ACE) study began in 1995 at Kaiser Permanente in California with the goal of determining what impact, if any, negative experiences during childhood had on adult health outcomes. The initial study included over 17,000 participants and is still actively tracking health outcomes for those individuals today. The participants were all given a physical exam and a confidential survey that assessed childhood experiences as well as current heath information. The researchers used that data to determine how adverse childhood experiences were related to health outcomes in adulthood.

Adverse childhood experiences (ACES) are defined in 10 categories of experience up to 18 years old:

  1. Childhood abuse – can be emotional, physical, or sexual
  2. Childhood neglect – can be emotional or physical
  3. Growing up witnessing – domestic violence, substance abuse, mental illness, loss of a parent (divorce, separation, abandonment, death), crime (incarceration)

What did the researchers find? First of all adverse childhood experiences are incredibly common:

Almost 2/3 of the participants in the study reported at least one ACE.

  • Of people who have at least one ACE, most – 87% – have more than one.
  • 22% of study participants reported sexual abuse.
  • More than one in every 5 participants had an ACE score of 3 or more.
  • Four or more ACES is considered to be a threshold above which there is a particularly higher risk of negative physical and mental health outcomes. For example, with 4 or more ACES, the risk of chronic pulmonary lung disease is increased by 390%, hepatitis 240%, and depression 460%. Risk of suicide increases 1220%. Nationally, the data at this threshold level is lowest in NJ and NY and highest in Oklahoma, Montana, and West Virginia.
  • Women are 50% more likely than men to have 5 or more ACES.

The most common ACE in the study was physical abuse. 28% of study participants reported that they had been physically abused as a child. This was followed by parental substance abuse, which was reported by 27% of participants. 23% of participants experienced the loss of a parent. 21% of participants experienced sexual abuse on at least one occasion. 17% lived with a parent who was suffering from mental illness. 15% experienced emotional neglect and 13% lived in a home where they witnessed domestic violence. 11% of participants reported psychological abuse and 10% experienced physical neglect. The least common ACE studied was having an incarcerated parent, with 6% of study participants reporting this experience.

It is also important to note again, that the presence of one ACE dramatically increases the risk level for subsequent ACES to also be present. For example, if no one in the family abuses alcohol, there is about a 15% likelihood of sexual abuse. If one parent abuses alcohol, that risk increases to about 30%. If there are two or more individuals in the home who abuse alcohol the risk that sexual abuse is also present jumps to 45%.

In addition to being incredibly common, ACES are incredibly destructive. ACES are associated across the lifespan with increased emotional problems, more health risk behaviors, serious social problems, adult disease and disability, increased health, behavioral health, correctional and social services costs, and poor life expectancy. The number of ACES has a linear relationship with every outcome that has been studied up to this point. The higher one’s ACE score, the higher risk for every negative outcome. Some examples, ACES are shown to increase the risk of heart disease, chronic lung disease, liver disease, suicide, HIV and other STDs, drug and alcohol abuse, depression.aces