Adverse Childhood Experiences

Dr. Nadine Burke Harris, founder and CEO of the Center for Youth Wellness, provides an impassioned plea for pediatric medicine to confront the prevention and treatment of trauma, head-on.

 

Adverse Childhood Experiences (ACEs) are stressful or traumatic events experienced before age 18. They are grouped into three categories: abuse, neglect, and household dysfunction (Felitti & Anda, 1998; RWJF, 2013). The term, “ACEs,” was coined in 1998 following the publication of the Adverse Childhood Experiences Study (ACE Study).
The ACEs Study and subsequent studies on the topic have surfaced a public health crisis hidden in plain sight.

ACEs are highly prevalent

In the ACE Study, the prevalence of at least one ACE was 67% and four or more ACEs was 12% (Felliti & Anda, 1998). In children, the prevalence of at least one ACE has ranged from one-third to nearly one-half of the population in nationally representative samples (Bethell et al, 2014; Bright et al, 2015; Wing et al, 2015) and among populations at high-risk for maltreatment, the rate reaches as high as 91% (Flaherty et al, 2013). Since 1990, many additional studies have replicated and expanded these findings around the ongoing and significant prevalence of this issue.

See the prevalence of ACEs in your state, on this map provided by Data Resource Center for Child and Adolescent Health.

ACEs are associated with health impairment across the life course

The study found that ACEs were not only common within the population, but were strongly related to the prevalence of numerous health problems (Felitti & Anda, 1998). The ACE study found that ACEs were not only common within the population, but were strongly related to the prevalence of numerous health problems (Felitti & Anda, 1998).
In children and adolescents, a greater number of ACEs have been associated with fair or poor general health (Bethell et al, 2014; Flaherty et al, 2013), illness requiring a doctor (Flaherty, 2013), fair or poor dental health (Bright et al, 2015), lifetime asthma (Bethell et al, 2014; Wing et al, 2015), ADHD (Bethell et al, 2014), autism (Bethell et al, 2014), and being overweight or obese (Bethell et al, 2014; Burke et al, 2011).

In addition, studies have found an association between ACEs in childhood and adolescence and delinquent behavior, bullying, physical fighting, dating violence, and weapon-carrying (Duke et al, 2010).
In adults, ACEs have been found to have a strong, dose-response association with cardiovascular disease, chronic lung disease, headaches, autoimmune disease, sleep disturbances, early death, obesity, smoking, general poor health, depression, posttraumatic stress disorder, anxiety, and substance abuse (Kalmakis & Chandler, 2015).

Source: Robert Wood Johnson Foundation, 2013

References

Anda RF, Dong M, Brown DW, et al. The relationship of adverse childhood experiences to a history of premature death of family members. BMC Public Health. 2009;9(1):106.
Bethell CD, Newacheck P, Hawes E, Halfon N. Adverse childhood experiences: Assessing the impact on health and school engagement and the mitigating role of resilience. Health Aff (Millwood). 2014;33(12):2106-2115. doi:10.1377/hlthaff.2014.0914.
Bright MA, Alford SM, Hinojosa MS, Knapp C, Fernandez-Baca DE. Adverse childhood experiences and dental health in children and adolescents. Community Dent Oral Epidemiol. 2015;43(3):193-199. doi:10.1111/cdoe.12137.
Burke NJ, Hellman JL, Scott BG, Weems CF, Carrion VG. The impact of adverse childhood experiences on an urban pediatric population. Child Abuse Negl. 2011;35(6):408-413.
Duke NN, Pettingell SL, McMorris BJ, Borowsky IW. Adolescent violence perpetration: Associations with multiple types of adverse childhood experiences. Pediatrics. 2010;125(4):e778-e786. doi:10.1542/peds.2009-0597.
Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245-258.
Flaherty EG, Thompson R, Dubowitz H, et al. Adverse childhood experiences and child health in early adolescence. JAMA Pediatr. 2013;167(7):622-629.
Kalmakis KA, Chandler GE. Health consequences of adverse childhood experiences: A systematic review. J Am Assoc Nurse Pract. March 2015. doi:10.1002/2327-6924.12215.
Robert Wood Johnson Foundation. The truth about ACEs. May 2013. http://www.rwjf.org/en/library/infographics/the-truth-about-aces.html.
Wing R, Gjelsvik A, Nocera M, McQuaid EL. Association between adverse childhood experiences in the home and pediatric asthma. Ann Allergy Asthma Immunol. 2015;114(5):379-384.