By Lisa Busch and Keryn O’Neill, MA PGCertEdPsych, Brainwave Senior Researcher
Our understanding of the link between adverse childhood experiences and adult health issues has been deepened by longitudinal research from the United States. These findings indicate strong links between adverse experiences during childhood including adolescence, and medical problems and unhealthy behaviours that occur later in life.
The studies focused on key adverse childhood experiences (‘ACEs’) and their lifelong impact on individuals. The data was collected from over 8,000 adults who were members of Kaiser Permanente’s San Diego Health Appraisal clinics in 1995.1 The data continues to generate a number of publications, known as the ACE studies, which look at various aspects of outcomes.
The adults were questioned in detail about their childhood experiences, and given an ‘ACE Score’ to count the number of categories of adverse experiences in their first 18 years of life. For the first wave of data, the adverse childhood events included psychological, physical and sexual abuse; violence against mother; and living with household members who were substance abusers, mentally ill or suicidal or who had been imprisoned. Further questions were added regarding emotional and physical neglect, residential mobility and parental education in a second wave of data collection. You can check your own score at www.acestudy.org/ace_score
This data enabled the researchers to explore the links between various health outcomes for these adults and their ACEs. The links turned out to be many, varied and significant.
Adverse childhood experiences are common and co-occurring
ACEs are common with over half reporting at least one and a quarter reporting two or more.2 At a general level, one study observed that once a child is exposed to one of these adverse situations in their home, he or she is ‘at risk’ of having been exposed to another. Where a person had experienced one type of ACE, he or she was 2 to 18 times more likely to have experienced another type. No one type of ACE was found to be independent of the others.3
Poor health outcomes
The research found a strong relationship between the degree of exposure to ACEs and multiple risk factors for several of the leading causes of death in adults, including alcoholism, drug abuse, heart disease and suicide.
Those with many ACEs were more likely to have many health risk factors later in life4 however, these consequences of early adversity may not be seen for many years.5
An adult with an ACE score of 4 or more was 2 – 4 times more likely to smoke, have poor health, had 50 or more sexual partners, and have had sexually transmitted disease compared to those with an ACE score of zero. An ACE score of 4 or more was also associated with a 4-12 fold increased likelihood of alcoholism, drug abuse, depression, and suicide attempt.6
Some of the findings in relation to specific health conditions were remarkable.
One study showed that the risk of developing Ischemic Heart Disease (IHD) i.e. angina or heart attack, was significantly increased among those exposed to even one ACE (with the exception of marital discord) and those with an ACE Score of 7 or more were more than 3 times more likely to have IHD than those with none. It was suggested that risk behaviours such as smoking, over eating and physical inactivity may occur as responses by individuals to cope with the stresses they have experienced.7
Another study found that childhood traumatic stress increased the likelihood of hospitalisation with an auto-immune disease such as coeliac disease, rheumatoid arthritis, multiple sclerosis, insulin-dependent diabetes, and irritable bowel syndrome. For women aged between 19 and 64, every increase in ACE Score increased the likelihood of an auto-immune disease related hospitalisation by 20%. These conditions may occur decades into adulthood and, it was suggested, may be as a result of the effect of the stress on the developing nervous system and immune function.8
Risky Sexual activity:
For women each type of ACE was associated with increases of early onset of sexual intercourse, multiple sexual partners and self-perceived risk of AIDS. As the ACE Score increased so did the prevalence of risky sexual behaviour.9
Positive experiences give some protection
On the positive side, the research also considered the potential protective effects of family strengths against early initiation of sexual activity, adolescent pregnancy and their long-term psychosocial consequences. Categories of “family strength” studied included “family closeness, support, loyalty, protection, love, importance and responsiveness to health needs.”10 Each category reported as being present (for women) was associated with a 30-40% decreased risk of adolescent pregnancy, and as the number of family strengths increased, the risk further decreased. These family strengths were found to be especially protective against early initiation of sexual activity for women who had experienced abuse or family dysfunction.11
What does this research tell us?
Brainwave shares research that informs the public as to why experiences during key periods of human brain development (childhood and adolescence) are so critical to health across the life-span.
These longitudinal studies add to the body of scientific knowledge to confirm the message that adverse childhood experiences contribute to the risk of poorer health outcomes. At a general level this research reinforces what we already know: If we wish to prevent poor adult health, and the associated spending, policy makers would be advised to take heed of the potentially long lasting effects of early childhood experiences.
The established connection between increased risk of serious or life threatening health conditions to a high incidence of adverse childhood experiences and the connection between childhood stress and specific health issues such as common auto-immune diseases, heart disease and early adolescent pregnancy or risky sexual behaviour are a powerful reminder that we cannot underestimate the impact of the early years on a person’s whole lifetime.
On a positive note, Brainwave takes heart at the findings regarding the protective effect of positive family experiences on the lives of the people studied. Such as it is, our work seems more important than ever!
- Dong et al., 2005
- Felitti et al., 1998
- Dong, Anda, et al., 2004; Felitti et al., 1998
- Felitti et al., 1998
- Anda et al., 2010
- Felitti et al., 1998
- Dong, Giles, et al., 2004
- Dube et al., 2009
- Hillis et al., 2001
- Hillis et al., 2010, p.18
- Hillis et al., 2010
Anda, R. F., Butchart, A., Felitti, V. J., & Brown, D. W. (2010). Building a Framework for Global Surveillance of the Public Health Implications of Adverse Childhood Experiences. American Journal of Preventive Medicine, 39(1), 93-98.
Dong, M., Anda, R. F., Felitti, V. J., Dube, S. R., Williamson, D. F., Thompson, T. J., . . . Giles, W. H. (2004). The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse & Neglect, 28(7), 771-784.
Dong, M., Anda, R. F., Felitti, V. J., Williamson, D. F., Dube, S. R., Brown, D. W., & Giles, W. H. (2005). Childhood residential mobility and multiple health risks during adolescence and adulthood: The hidden role of adverse childhood experiences. Archives of Pediatrics & Adolescent Medicine, 159(12), 1104-1110.
Dong, M., Giles, W. H., Felitti, V. J., Dube, S. R., Williams, J. E., Chapman, D. P., & Anda, R. F. (2004). Insights Into Causal Pathways for Ischemic Heart Disease. Circulation, 110(13), 1761-1766.
Dube, S. R., Fairweather, D., Pearson, W. S., Felitti, V. J., Anda, R. F., & Croft, J. B. (2009). Cumulative childhood stress and autoimmune diseases in adults. Psychosomatic Medicine, 71, 243-250.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson , D. F., Spitz, A. M., Edwards, V., . . . Marks, J. S. (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 Preventive Medicine, 14(4), 245-258.
Hillis, S. D., Anda, R. F., Dube, S. R., Felitti, V. J., Marchbanks, P. A., Macaluso, M., & Marks, J. S. (2010). The protective effect of family strengths in childhood against adolescent pregnancy and its long-term psychosocial consequences. The Permanente Journal, 14(3), 18-27.
Hillis, S. D., Anda, R. F., Felitti, V. J., & Marchbanks, P. A. (2001). Adverse childhood experiences and sexual risk behaviors in women: A retrospective cohort study. Family Planning Perspectives, 33(5), 206-211.
First published in Brainwave Trust Newsletter, Issue 17, Summer 2012