About the Adverse Childhood Experience Study


From 1995 to 1997 more than 17,000 people, predominantly of middle-class backgrounds participated in one of the largest, most important public health investigations of our time. The Centers for Disease Control and Prevention and Kaiser Permanente conducted the Adverse Childhood Experience (ACE) Study which looked at the long-term effects of childhood abuse and household dysfunction. The study followed participants for well over a decade and established a strong graded relationship between the level of traumatic stress in childhood and poor physical and mental health in later life. The demographic make-up of this group highlighted the fact that childhood trauma was not uncommon in middle-class America, as some might have imagined.

Participants were asked ten questions which assessed their experience with the following 7 categories of childhood trauma:

Psychological Abuse Having a a parent with a substance use disorder Witnessing domestic violence
Physical Abuse Having a parent with mental illness
Sexual Abuse Having a parent with criminal behavior in household

According to acestoohigh.com:

This was the first time that researchers had looked at the effects of several types of trauma, rather than the consequences of just one. What the data revealed was mind-boggling.

First, it was discovered that there was a direct link between childhood trauma and the adult onset of chronic disease such as:

  • ischemic heart disease
  • cancer
  • hypertension
  • COPD
  • liver disease
  • stroke
  • diabetes
  • obesity
  • fatigue
  • compromised immune system

The study linked adverse childhood experiences to disease conditions that are among the leading causes of death in the United States. Additionally, individuals who experienced ACEs had a higher incidence of:

  • substance use disorder
  • mental illness such as depression and anxiety
  • suicide attempts
  • encounters with the law
  • work issues such as absenteeism
  • a high number of sexual partners over their lifetime
  • history of sexually transmitted diseases

About two-thirds of the adults (more than 11,000) in the study had experienced one or more types of adverse childhood experiences. Of those, 87 percent had experienced 2 or more types. This showed that ACEs usually didn’t happen in isolation and there was a direct correlation between the number of ACEs an individual had and the risk of multiple adverse outcomes.

Studies in neurobiology have demonstrated that “fear-based childhoods disrupt neurodevelopment and can alter normal brain structure and function.” Prolonged stress releases the hormone cortisol and can effect normal brain development and compromise the immune and nervous systems.

Important to note, according to a JAMA Pediatr. 2013 article, “Improving the Adverse Childhood Study Scale,” is that

The ACE Study list of preventable childhood adversities omits certain domains judged by many developmental researchers to be important in predicting long-term health and well-being outcomes. Among the predictors missing from the ACE Study model are peer rejection, exposure to violence outside the family, low socioeconomic status, and poor academic performance.

Witnessing community violence, lack of friendships or bullying and poor school performance have also been linked to poor health and social outcomes in adults.

Despite potential room for improvements, the ACE study serves as a relevant platform which can inform Americans about the importance of trauma informed care, which strives to understand, recognize, and respond to the effects of trauma, as well as the benefits of placing an increased focus on prevention and early childhood intervention.

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