The Other ACE (Not the Winning Card)

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The Other ACE (Not the Winning Card

Take a guess: what is a major risk factor for the development of alcoholism and also increases the chances of getting arthritis and cancer?

The answer is ACEs, or Adverse Childhood Experiences.

For many years there was a “nature vs nurture” debate about which is the most significant determiner of our health and personality, genes or environment? Spoiler alert: it’s both.

While much about us is genetically determined, or “pre-wired,” we all know that our life experiences have a large impact on our health and life trajectory.

In the late 1990s, a large study done by Kaiser Permanente in California looked at people’s psychological and social histories and documented a striking relationship between what they coined “adverse childhood experiences,” or ACE’s, and adulthood diseases and other health risks. In the decades since then, these findings have stood the test of time and been strengthened by further research. 

According to the CDC, “Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years). For example:

  • experiencing violence, abuse, or neglect
  • witnessing violence in the home or community
  • having a family member attempt or die by suicide

Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding, such as growing up in a household with:

  • substance use problems
  • mental health problems
  • instability due to parental separation or household members being in jail or prison.”

One’s “ACE score” (the number of adverse childhood experiences) correlates with the degree of risk for negative health outcomes. The scale ranges from a score of 0 to 10.  Even a score of 1 raises the risk substantially, and it escalates with each higher number, as trauma accumulates. Supportive relationships with caring adults can buffer these stressors, help children cope, and reduce the risk of damaging effects. 

In one study, people with an ACE score of 6 or higher died, on average, 20 years earlier than people with a score of zero.

ACEs are associated with a range of health, social, and economic problems. These include chronic illnesses (cancer, diabetes, heart disease, asthma, obesity, arthritis) and mental illness (depression, suicide, anxiety, PTSD). People exposed to ACE’s are more likely to engage in risky behaviors, be the victims and perpetrators of violence, smoke cigarettes, and become addicted to drugs and alcohol. The negative physical and mental health effects are present even independent of behavior (such as drinking and smoking). In other words, even though exposure to ACEs is associated with substance abuse and smoking cigarettes, the risks of accidents, cancer, and increased mortality go above and beyond those effects.

Chronic stress can be toxic. Our bodies respond to threats by releasing stress hormones such as cortisol and adrenaline to help us escape from dangerous situations. Prolonged elevation of our stress response systems, however, is very harmful. In children, it can disrupt the normal growth and development of the brain and body, with far-reaching effects. Immune system development is impaired, as are hormonal systems that regulate appetite, metabolism, weight, and reproduction.  Harmful impacts on brain development can lead to life-long problems with attention, learning, problem-solving, impulse control and regulation of mood. Chronic stress increases inflammation throughout the body, damaging organs such as the heart. As discussed in previous columns, recent research suggests inflammation as an underlying factor in many mental illnesses, including depression.

The damage to our development and health is often long term, lasting into adulthood and contributing to early death. These effects are also often passed on to the next generations, including through environmental influences; people who have experienced ACE’s themselves are at higher risk for substance abuse, depression, suicidal thoughts, difficulty maintaining stable relationships, and economic insecurity, thus potentially exposing their children to chronic stress.  What’s more, it is now becoming clear that toxic environmental stress can actually alter one’s DNA (through “epigenetics”), so these health impacts can be inherited biologically as well. The study of epigenetics has now informed us that nurture actually changes nature.

In addition to devastating human costs of ACEs, the financial costs to society (including taxpayers) are staggering. The estimates in the U.S. add up to hundreds of billions of dollars a year including: early mortality, disability, healthcare costs, lost productivity, public health systems, child welfare, special education, and criminal justice.

The social and emotional costs of childhood trauma-related mental illness, crime and violence, homelessness, child abuse, lower educational achievement, etc. are much more difficult to measure.

People who grow up in neighborhoods that are under-resourced are at higher risk of ACEs.  Related factors include unstable housing, fewer basic amenities such as supermarkets and pharmacies, more pollution (air, water, light, noise), fewer parks and green spaces, more access to drugs and alcohol, and higher levels of violence/crime. Family risk factors include: families with special needs children; families in which caregivers were victims of childhood abuse; families comprised of single parents and/or younger caregivers; families with less social support; and financial and food insecurity. (Although it is important to emphasize that plenty of abuse, neglect, substance abuse and mental illness occurs in higher socio-economic status neighborhoods and families.)  

The good news:

According to the CDC:

 “ACEs and their associated harms are preventable. Creating and sustaining safe, stable, nurturing relationships and environments for all children and families can prevent ACEs and help all children reach their full health and life potential.”

The solutions are, in large part, preventative and community focused. These include access to: social and emotional support for parents, financial supports for lower-income families, affordable health care, substance abuse treatment, quality education in all neighborhoods, high quality child care, and safe outdoor spaces for children to play. 

As Mr. Rogers said, “Anyone who does anything to help a child in his life is a hero.” 

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