Adverse Childhood Experiences: What You Need To Know

There was a great study on adverse childhood experiences (“ACEs”), that was done in the 1990s, which demonstrated the long term effects of early traumas.

Undertaken by researchers from the Centers for Disease Control and Prevention, it involved a survey of more than 17,000 people, who were asked about their childhood experiences and current health status and behaviours.

Using data from an earlier study on the most common types of traumas, it asked participants whether they had experienced one of ten types of childhood trauma — these included five personal and five related to family.

The participant’s “ACEs” score was therefore determined out of ten, based on the number of these traumas they had experienced.

Those with no traumas in their history, for example, ranked ‘0’, with the ranking going up to 10, for those who had experienced all of the listed traumas.

These scores were then compared against survey data on health issues and troubling behaviours in adulthood.

For those with higher scores, the study demonstrated significantly higher levels of risk for health, social, and emotional problems, with the more types of trauma experienced statistically demonstrating the greater likelihood of problems.

ACEs are fairly common, with around two thirds of the US population having at least one ACE in their history. For prison populations, as you’d expect, the statistics are worse, with 97% of prisoners having at least one, and (based on a Welsh prison population survey), are likely to have had more than one.

Something that troubles me to this day, is that despite my relatively lengthy practice as a lawyer, including work with families and children (where knowledge of this study would have been highly relevant), I didn’t learn about it until after I left my career in law.

It reflects the lack of understanding so many people (including professionals) have around these things though — and the judgement where there shouldn’t be.

Parallel research in this area

At the same time that the ACEs study was being done, parallel research on children’s brains found that toxic stress damages the structure and function of a child’s developing brain.

When children are overloaded with stress hormones, they’re in flight, fright or freeze mode.

This was determined by a group of neuroscientists and paediatricians, including neuroscientist Martin Teicher and paediatrician Jack Shonkoff (Harvard University), neuroscientist, Bruce McEwan (Rockefeller University) and child psychiatrist Bruce Perry (Child Trauma Academy).

(Definitely worth looking their work up if you’re interested in learning more).

There is also a growing body of research around there being an underlying physiological link between trauma and disease.

Bessel Van der Kolk (psychiatrist), in a book I think every person should read — “The Body Keeps the Score” — notes that severe and chronic stress leads to bodily systems producing an inflammatory response that leads to disease.

He notes that trauma interferes with the brain circuits that involve focusing, flexibility, and being able to stay in emotional control.

A constant sense of danger and helplessness promotes the continuous secretion of stress hormones, which wreaks havoc with the immune system and the functioning of the body’s organs.

How we deal with ACEs

For some, traumatic childhood experiences are one-off events that we got appropriate support for at the time, and may have emerged from largely unscathed.

For others, a lack of appropriate support can mean such an event looms larger in the sub-conscious, festering into psychological issues, which in turn, can lead to poor decision making and exposure to other traumatic events and experiences, both later in childhood and into adulthood.

Those who experience repeated trauma’s, are, as demonstrated, at the greatest risk.

The ‘stoic’ approach to managing the memories and effects of such experiences, is the one traditionally valued though.

While many recognise that most of us have past traumas or troubling events in our history, the cultural understanding across the West, has traditionally been to push these things down, with little regard for the impacts of doing so.

Many people also refuse to confront the demons of their past, simply because they are too painful or might adversely impact their relationships.

These experiences often haunt people through their lives though, often impacting their ability to maintain meaningful relationships, leading to substance abuse and criminality for some, and affecting physical and mental health, and prosperity more generally.

My “ACE’s SCORE”

From the outside looking in, I appear “successful” on many fronts.

I have a collection of post graduate qualifications, including a masters in law with first class honours, and built a successful career as a lawyer over the better part of a decade.

I have four children and have travelled the world with them. All have the benefits of good education, with my oldest now a professional herself.

In appearance at least, my family and I live a comfortable middle class life — although we don’t own our own home and sometimes struggle to meet all our expenses (having quit my legal career around 6 years ago), we don’t have things particularly “tough” either.

Despite these apparent “successes”, my teens and twenties were filled with poor decision-making and traumas.

Among others, these included sexual grooming and abuse, reckless drug-taking, teenage pregnancy at 16, my sister self-harming and attempting to kill herself, an abusive early marriage (with stalking and other violence that continued long after it ended), and financial troubles that threatened my professional success.

I’ve also moved around a lot, and in the past, suffered from serious anxiety.

Now at age 37, my life has calmed. My decisions tend to be better.

With lots of work on understanding my psychology and the things driving it, I also have a better grasp on why I have done or do the things that I do.

Coming to understand the impact of traumatic events in my childhood, has been at the core of this.

Even today though, as I head towards 40, these events — now long in the past — continue to impact on my well-being and potential for a more fulfilling life.

My ACEs score is 8 out of 10 — a score that very troubled people tend to have.

Understanding the link between my childhood experiences and the troubles I had in my teens and into adulthood, was freeing though.

Having raised my children very differently (and although their lives haven’t been perfect), the differences in their ability to navigate life is also clear, as compared to the more troubled lives of my sister and I.

Of the five ‘personal traumas’ for which there are questions in the ACEs study, I experienced all five, including physical, verbal and sexual abuse and physical and emotional neglect.

These came at varying times in my childhood.

Physical and verbal abuse, alongside emotional neglect, were a feature of my earlier childhood — I wrote about this last week.

After my mother kicked me out of her home at 13, I then also experienced a period of heightened vulnerability, which led to sexual grooming and abuse by a scout leader when I was 14.

My father was also verbally abusive, and although I had a roof over my head, physical and emotional neglect were features of my teen years, after I moved in with my father.

Things like not having enough to eat, a winter jacket, appropriate shoes, or bus money to get to school (more than an hours walk away and very uncomfortable without a jacket in winter and the right shoes) might seem like small things, but for a kid that desperately needed someone to show they cared, they were egregious violations of parental responsibility.

My father also spent most evenings and weekends at the office, meaning he wasn’t around for any of the things that happened in my teens, including the night that I was raped as a 14 year old.

When my sister attempted to kill herself, the focus was naturally on her, but I don’t think a thought was ever given as to how I was meant to manage the trauma of seeing these events too.

I was only 14 and in the throngs of my own set of issues — which neither of my parents were around to notice.

Combined with the earlier traumas inflicted by my mother, these ‘neglects’ led to intense feelings of loneliness, which in turn opened me up to grooming and sexual abuse, harmful sexual relationships and drug-taking.

I also dropped out of school at 15, after finding myself working full-time (in a fast-food joint), as I sought to meet my own physical needs, including access to enough food, bus money and appropriate clothes and shoes. I started plotting how to move out on my own around that age too.

Alongside the 5 ‘personal traumas’ of the ACEs study, I also experienced three of the five ‘family member’ traumas. These included:

• My parents separating when I was 3 (divorcing when I was 5) and my actively being made aware of the acrimonious nature of their separation;
• My 13-year old sister being diagnosed with bi-polar disorder when I was 14, after intentionally harming and attempting to kill herself, destroying a hospital room and being admitted to an adult mental-health ward (where I visited her); and
• Living with an older boyfriend from age 15, whom I used street drugs with daily.

The only two traumas I managed to skip from the ACEs list included my mother not being a victim of domestic violence and my not experiencing a family member being imprisoned.

Although an adverse ACEs score is not definitive of problematic outcomes, statistically speaking, my ACE’s score of 8 (out of a possible 10), puts me at significantly higher risk of adult onset of chronic disease, including heart disease, lung cancer, diabetes and many autoimmune diseases, as well as depression, suicide, being violent and a victim of violence.

I wrote last week about the abusive relationship I ended up in at 19, with stalking and other violent behaviours continuing long after the marriage ended.

I suffer from health issues today that I suspect are related to my history of trauma.

Statistically speaking, someone with my ACEs score has a 100% likelihood of needing antidepressants. Unlike my sister, I’ve managed to ward that one off for now, but my pain related condition did see me become reliant on tramadol for a time — which acts much like an antidepressant does — and was a prop for a time.

I have PTSD too, which although is a lot better than it once was, continues to have an impact on my sensitivity to things like sound and stress.

I don’t feel sorry for myself over these things — they are simply a practical consequence of what I have faced.

I do wish our societies had a broader understanding of the impacts of early childhood traumas though — a lack of understanding has been a significant part of my struggle.

A broader understanding of the impact of trauma within the medical profession, legal systems and psychology/psychiatry more generally is also needed to create better outcomes and fairness — I have yet to meet anyone with trauma issues in their past, who having sought help for issues related to them, hasn’t had a difficult time (generally a failure to empathise) with at least one of the “professionals” involved in their care.

We also need to deliberately implement appropriate support services specifically intended to diagnose and address issues related to childhood trauma. This includes decent metal health services.

It will never be enough, and ideally preventing the causes of childhood trauma should be the long term goal too. Recognising and mitigating against the effects of trauma, and thereby helping to prevent inter-generational harm, is a first step in that respect too though.

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