Adverse Childhood ExperiencesA Brief Review of the FactsAs reported by: Richard T. Cole PhDProfessor, Michigan State University

Origins of ACE studies

CDC and Kaiser Permanente (Robert Anda, MD Vincent Felitti, MD et al, 60 medical studies, 1995-2010) “Adverse Childhood Experiences and Population Health, State of Washington: The Face of a Chronic Public Health Disaster” (Robert Anda and David Brown, July 2, 2010)

*Available on request

The findings are in10 Specific Adverse Child Experiences (ACEs) have been identifiedPatient-reported childhood experiences matched against more than 17,300 HMO medical records

Childhood “stressors” directly connected to costly

adult psychological, emotional and physical

illnesses

Studies Identified 10 ACE Categories -“Stressors”

1. Recurrent emotional abuse

2. Recurrent physical abuse

3. Sexual abuse

4. Witnessed domestic violence

5. Household alcohol or drug abuse

6. Household mental illness

7. Parents separated/divorced

8. Incarcerated household member

9. Emotional neglect

10. Physical neglect

ACE 1. Recurrent Emotional Abuse

As a child, did you experience…Excessive verbal abuse such as yelling,

swearing?Fear of physical harm?

ACE 2. Recurrent Physical Abuse

As a child, did your parent or guardian…Push you, grab you, slap you, throw

something at you?Hit you so hard it left marks?

ACE 3. Sexual Abuse Stressor

As a child… Were you touched in sexual way?Were you sexually molested?

ACE 4. Domestic Violence Stressor

As a child, did you witness a male …

Push grab, slap or throw something at your mother?

Kick, bite or hit her with his fist?Threaten her with a knife or gun?

ACE 5. Household Alcohol or Drug Abuse

As a child, did you…Live with a problem drinker or alcoholic?Live with someone who used street

drugs?

ACE 6. Household Mental Illness

As a child…was anyone in your house mentally ill or

depressed?

ACE 7. Divorce or Separation

As a child…were your parents separated or

divorced?

ACE 8. Incarcerated Household Member

As a child, was anyone in your family in jail?

ACEs 9 and 10: Emotional and Physical

Neglect

Prepare yourself for a sample of the findings from several studies

Research Confirms Compounding Effects of ACES (Stressors)

-- The more ACEs and, -- The more intense the ACEs …

…The more adult emotional, mental and physical health illness.

Suicidal Ideation and ACEsChildren with adverse childhood experiences tend to think more about killing themselves.

(Cicchetti et al, 2010)

Adult Suicide Attempts and ACEs

Adverse Childhood Experiences compound the risk of suicide attempts in adulthood.

(Dube et al, 2001)

Adult Mental Illness and ACEs

ACEs increase incidence of mental illness in adulthood.

(Edwards et al, 2003)

Adult Depression and ACEs

The more ACEs, the greater the likelihood of adult depression.

(Chapman et al, 2004)

Promiscuity and ACEs

ACEs increase the likelihood of sexual intercourse by age 15 increasing the likelihood of AIDS and other STDs.

(Hillis et al, 2001, Anda et al, 2002b)

Teen Drug Use and ACEs

The more ACEs, the more teenage drug use.

(Dube et al 2003 (b)

Adult Health Problems and ACEs

The more stressors in childhood, the more adults show increased physical health problems.

(Dube et al, 2003a)

Adult Heart Disease and ACEs

ACEs are linked to a higher rate of Ischemic heart disease in adults.

(Dong et. al, 2004)

Changed Brain Structure and ACEs

Child maltreatment is linked to a variety of changes in brain structure.

(Anda et al, 2004)

(

Lasting Health Effects of ACEs

Attributed to the neurological and biological effects of “toxic stress” on children.

(Dube et al, 2003a)

Explanation for lifetime effect of ACEs

Increases in heart rate, blood pressure, serum glucose, stress hormones, “fight or flight”…

Related to long-term disruptions in brain architecture, immune systems, metabolic regulation, cardio-vascular function

(Center on Developing Child, Harvard University)

The power of STRESSORSACEs have differing effects on children (Fortunately not all ACEs result in adult conditions)Some children and adults appear more resilient than othersNot all childhood “stress” is harmfulSome harm from ACEs may be reparableSome stressors may be “toxic”Each childhood STRESSOR exaggerates the effects of others

The words of Dr. Anda explain my mission

The chronic public health disaster of adverse childhood experiences and their effects on human development are real. The public health impact of ACEs can now only be ignored as a matter of conscious choice. Thus, with this information comes the responsibility to use it.

Robert Anda, MD

Center for Disease Control and Prevention

July 2, 2010

SAMPLE SOURCES -- MORE THAN 60 STUDIES…Anda et al, “Adverse Child Experiences, Alcoholic Parents, and Later Risk of Alcoholism and Depression”, J Psychiatric Serve 53: 1001-1009, August 2002 (a)

Anda et al, “Adverse Childhood Experiences and Risk of Paternity in Teen Pregnancy”, Obstetrics and Gynecology, Volume 100, Issue 1, pp. 37-45, July 2002 (b)

Anda et al, “The Enduring Effects of Abuse and Related Adverse Experiences in Childhood”, Child Abuse and Neglect, Volume 28, Issue 7, pp. 729-737, July 2004

Chapman et al, Adverse Childhood Experiences and the Risk of Depressive Disorders in Adulthood, Journal of Affective Disorders, 2004, Volume 82, Pages 217-225.

Cicchetti et al, “Interaction of Child Maltreatment and 5-HTT Polymorphisms: Suicidal Ideations among Children…” Journal of Pediatric Psychology, 2010; 35: 536-546

Dong et al, “Insights Into Causal Pathways for Ischemic Heart Disease”, American Heart Association Journal, 2004, 110: 1761-1766.

Dube, et al, “Child Abuse, Household Dysfunction and the Risk of Attempted Suicide Through the Life Span”, JAMA 2001; 28: 3089-96

Dube, et al, “Adverse Childhood Experiences and Personal Alcohol Abuse as an Adult…”, Addictive Behaviors, Volume 27, Issue 5, September-October 2002, pp 713-725

Dube (a), et al, “The impact of adverse childhood experiences on health problems…” Preventive Medicine, Volume 37, Issue 3, September 2003 (a), Pages 268-277

Dube, et al, Child Abuse, Neglect, and Household Dysfunction and the Risk of Illicit Drug Use…, Pediatrics, Volume 111, No. 3, March 2003 (b), pp. 564-572

Edwards, et al, “Relationship Between Multiple Forms of Childhood Maltreatment and Adult Mental Health…” Am J Psychiatry 160:1453-1460 (August, 2003)

Hillis et al, “Adverse Child Experiences and Sexually Transmitted Diseases in Men and Women…”Pediatrics, Vol 106, No 1, July 2000, p. e11

Hillis et al, “Adverse Childhood Experiences and Sexual Risk Behaviors in Women…” Family Planning Perspectives, Volume 33, No % (September-October, 2001, pp. 206-211

Hillis et al, “The Association Between ACEs and Adolescent Pregnancy, Long-Term Psychosocial Consequences and Fetal Death”, Pediatrics, Vol 113, No2, Feb 2004, pp 320-327

MORE FINDINGS AVAILABLE __ CDC DOCUMENT

For more Information

Centers for Disease Control and PreventionChildren’s Trust Fund of MichiganPrevent Child Abuse America