According to Robert Block, former president of the American Academy of Pediatrics “Adverse childhood experiences are the single greatest unaddressed public health threat facing our nation today.” For integrative practitioners, this statement can offer valuable insight for supporting more complex patients. Adverse Childhood Experiences (ACEs) are strongly correlated with risky adult health behavior as well as increased frequency of disease and even premature death. Clinically, patients that feel “stuck” in their healing process, struggle with interpersonal relationships, and/or frequently refer to their childhood could potentially be victims of unresolved childhood trauma .
The Kaiser Ace study was conducted from 1995 – 1997 and was the first major evaluation of the impact of traumatic childhood events on adult health outcomes. The study’s 17,000 participants were interviewed about their experiences with family dysfunction, mistreatment, and childhood conditions. Their answers were then compared against their current health status and behaviors. The ACE health questionnaire inquired about physical, verbal, and sexual abuse towards the subject or other members within the household. It also evaluated for other sources of household disruption including incarceration of a parent, mental illness, drug use, divorce/separation, or lack of access to basic needs such as food or clean clothes. The more “yes” answers equated to a higher ACE score. The study findings concluded that ACEs occur across all demographics with at least two-thirds of the study participants indicating a score of at least one ACE with over 20% reporting three or more. The higher the ACE score, the greater the risk of negative health outcomes .
Childhood adversity can influence adult health patterns in numerous ways. Early exposure to stress can change brain patterns within the reward and impulse control centers, increasing the risk for substance abuse and mental health challenges. In fact, according to a subsequent 2018 study, patients with ACEs were 30% more likely to abuse alcohol . Likewise, ongoing elevation of cortisol and adrenaline can influence adrenal health, blood sugar management, and alter the immune system. Thus, ACEs have been linked with an increased risk of cardiovascular disease, autoimmunity, and diabetes .
While preventative measures are most important for the management of ACEs, integrative practitioners can take an active role in caring for adult patients who are victims of childhood trauma. The current ACE survey is an 18-question survey derived from the original Kaiser questionnaire that can be utilized as a simple screening tool. Screening for ACEs can enhance clinical assessment and better tailor patient communication and treatment strategies for challenging health conditions.
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feletti, J et al.(1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventative Medicine
https://www.cdc.gov/violenceprevention/aces/about.html
Loudermilk, E, et al. (2018). Impact of adverse childhood experiences (ACEs) on adult alcohol consumption behaviors. Child Abuse & Neglect
DeQuattro, K, et al. (2019). Relationships between adverse childhood experiences and health status in systemic lupus erythematosus. Arthritis Care and Research.
Suglia, S. F et al. (2018). Childhood and adolescent adversity and cardiometabolic outcomes: A scientific statement from the American Heart Association. Circulation.
