Why 10 Adverse Childhood Experiences (ACEs)?
From a blog by ACEs Connection
Legislators, caregivers, and the media increasingly recognize that childhood adversity poses risks to individual health and well-being. The original Adverse Childhood Experiences (ACEs) Study, (see earlier blog - Adverse Childhood Experiences (ACEs) and future health), has helped raise public awareness about this critical public health issue. However, as the use of ACEs questionnaires for identifying potentially harmful childhood experiences has gained popularity, it is important to understand how ACEs differ from other commonly used terms, including childhood adversity, trauma, and toxic stress.
Childhood adversity is a broad term that refers to a wide range of circumstances or events that pose a serious threat to a child’s physical or psychological well-being. Common examples of childhood adversity include child abuse and neglect, domestic violence, bullying, serious accidents or injuries, discrimination, extreme poverty, and community violence. Research shows that such experiences can have serious consequences, especially when they occur early in life, are chronic and/or severe, or accumulate over time. For example, the effects of childhood adversity can become biologically embedded during sensitive periods of development and lead to lifelong physical and mental health problems. However, adversity does not predestine children to poor outcomes, and most children are able to recover when they have the right supports—particularly the consistent presence of a warm, sensitive caregiver.
Trauma is one possible outcome of exposure to adversity. Trauma occurs when a person perceives an event or set of circumstances as extremely frightening, harmful, or threatening—either emotionally, physically, or both. With trauma, a child’s experience of strong negative emotions (e.g., terror or helplessness) and physiological symptoms (e.g., rapid heartbeat, bedwetting, stomach aches) may develop soon afterward and continue well beyond their initial exposure. Certain types of childhood adversity are especially likely to cause trauma reactions in children, such as the sudden loss of a family member, a natural disaster, a serious car accident, or a school shooting. trauma affects each child differently, depending on his or her individual, family, and environmental risk and protective factors. For example, two children who experience the same type of adversity may respond in distinct ways: One may recover quickly without significant distress, whereas another may develop post-traumatic stress disorder (PTSD) and benefit from professional help.
Toxic stress can occur when a child experiences adversity that is extreme, long-lasting, and severe (e.g., chronic neglect, domestic violence, severe economic hardship) without adequate support from a caregiving adult.
Adverse childhood experiences (ACEs)—a term coined by researchers Vincent Felitti, Robert Anda, and their colleagues in their seminal study conducted from 1995 to 1997—are a subset of childhood adversities. No ACEs lists or screening tools identify all childhood adversities. It is important to assess each child’s well-being to inform the type(s) of services that would most benefit that child. Gaining a full picture of a child can avoid overtreatment of children who have been exposed to ACEs but are functioning well.
Why 10 ACEs in the original study?
The 10 ACEs were simply the most common in a clearly middle class population of over 17,000 Americans, 75% of whom went to college. The ACE Study brought to light that there are certain things we've been taught not to see, nor speak about, nor ask questions about, and that when one explores those taboo subjects, one finds not only unexpectedly high prevalence, but a powerful relationship, years later, to major public health problems and to life expectancy. Using the 10 categories of ACEs, selected because they were the most common in the middle class population, a person experiencing any 6 of the 10 categories had a shortened life expectancy of 19.7 years.
If things are this bad in a clearly middle class population, they surely don't get better if you're part of an oppressed minority, living on the street, or a recent immigrant from some war-torn country. Are there other ACEs? Certainly so.
The increased public understanding that childhood adversity, including ACEs, can cause trauma and toxic stress—and, in turn, have a lasting impact on children’s physical and mental health—presents an important opportunity to turn this awareness into action. For example, caregivers and other practitioners can learn about and implement trauma-informed care in child and family service systems. However, we need to understand the full range of childhood adversity and considerable variation in children’s responses to it.
The film 'Resilience' is a great resource for raising awareness and starting a conversation in your community, especially parents, about ACEs and the effect of childhood trauma. When we can have screenings again, why doesn't your church take up the Resilience Challenge - a free screening of the film and panel/audience discussion.
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