ACE Study

November 30, 2024 Zell D

The Adverse Childhood Effects Study (ACES) was conducted in 1995 by the Kaiser Permanente Institute in California. Lemme tell you the results were wildly eye opening and I wish they led to more policy changes across the world.

An ACE is a traumatic events that can occur during childhood and they are broken down into 3 categories: abuse (physical, sexual, or emotional), neglect, and household dysfunction.

ACEs can also include witnessing violence / experiencing other forms of trauma, such as natural disasters, community violence, or bullying. These experiences can have a significant impact on a child’s development and can affect their physical, emotional, and cognitive health throughout their life.

Research has shown that children who experience ACEs are at a higher risk for a variety of physical and mental health problems, including chronic diseases such as heart disease and diabetes, as well as mental health conditions such as depression, anxiety, and post-traumatic stress disorder (PTSD).

Additionally, ACEs can also have a negative impact on a child’s educational and social development, making it more difficult for them to succeed in school and form healthy relationships with others.

It’s important to note that ACEs are not limited to any specific socioeconomic group or community, they can affect people from all walks of life. And while some children may be more resilient to the effects of ACEs, it’s important to recognize that these experiences can have a lasting impact and that early identification, interventions and support can help prevent or mitigate the negative effects.

The term Toxic Stress arose from this research, referring to the prolonged and excessive activation of the body’s stress response systems in response to traumatic experiences, particularly during childhood.

When a child experiences traumatic events, such as abuse, neglect, or household dysfunction, the body’s stress response systems are activated. This is a normal response that helps protect the child from harm. However, when a child experiences multiple traumatic events over time, particularly without the support of nurturing adults, the stress response can become prolonged and excessive. This is known as toxic stress.

Toxic stress can have a negative impact on a child’s physical, emotional, and cognitive development, and can lead to a variety of health problems later in life, including chronic diseases such as heart disease and diabetes, as well as mental health conditions such as depression, anxiety, and post-traumatic stress disorder (PTSD).

It’s important to note that toxic stress can also be caused by community and systemic issues such as violence, racism, and chronic poverty, and that this type of stress can also have a negative impact on child and adult health outcomes.

It is also important to address the intergenerational trauma and the impact of community and systemic issues such as racism, poverty and discrimination. An integrated and holistic approach, that addresses both individual and systemic issues, can be effective in addressing the effects of toxic stress and promoting healing and resilience.

In psychotherapy, toxic stress is treated by addressing the underlying traumatic experiences that caused the stress response to become prolonged and excessive. This can involve a range of therapeutic approaches including talk therapy, cognitive-behavioral therapy, trauma-focused therapy, and somatic therapies, which focus on the body’s physical sensations and emotions.

Here are the ACE category questions from Harvard

For each “yes” answer, add 1. The total number at the end is your cumulative number of ACEs.

Before your 18th birthday:

Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?
Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?
Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?
Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?
Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
Were your parents ever separated or divorced?
Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
Was a household member depressed or mentally ill, or did a household member attempt suicide?
Did a household member go to prison?

Please note this is not diagnostic, it’s a really interesting and powerful screener.

There are a Lot of things like systemic racism, poverty, discrimination, natural disasters which are not accounted for. Also everyone is different and genetics can play a role in how one experienced the ACE. It’s about whether someone may be at risk, not who is absolutely at risk.

The therapeutic implications of this study are quite far reaching. It further shows us how much our development affects our experience of our Self in the world. Being in the world, we’re not in a vacuum and these painful experiences pack a punch in how we predict the future, how we react, how and what we choose to do. In therapy we explore these far reaching impacts to better develop strategies to integrate our past into a path forward.