A third of all diagnosed mental health conditions in adulthood are directly related to adverse childhood experiences.
In this video, Andrew Hall explains the importance of Adverse Childhood Experiences.
Download the PowerPoint: Adverse Childhood Experiences – PowerPoint
The first study to look at Adverse Childhood Experiences, or ACEs, was in America in the mid-nineties. This study found a high correlation between the number of Adverse Childhood Experiences and the prevalence of risk taking behaviours, ill-health and life-long difficulties, greater than those experienced by the general population. In 2013 there was a study in England and in 2015 the Wales government also commissioned a study into Adverse Childhood Experiences. The results between the three studies are broadly similar, but in Wales, there were a greater proportion of people who lived with 4 or more Adverse Childhood Experiences.
Adverse Childhood Experiences relate to either a single, one-off event, or a continuous threat over a long period of time. The Adverse Childhood Events may affect the care of the child, put at risk their safety or security, make harder to trust people, or might threaten their ‘bodily integrity’ through physical or sexual abuse. For children and young people affected by Adverse Childhood Experiences, they often need to revert to their own innate safety responses. They need to adapt to survive. These responses may include finding safer places or people, and develop a sense that they are in control of their own environment. This sometimes means being in control of their own body.
Adverse Childhood Experiences in the American study fell into these broad groups. Adjustment may be global, for example, moving from one country to another, as a result of war or famine; or may be changes within the family dynamic or location. Other adverse experiences might include being treated inhumanely, perhaps even being tortured. Early adult responsibilities, as a young carer, or child worker, have their impact too. Adversity may include the loss of a close family member, or perhaps surviving a traumatic event when others did not.
In the England study participants were asked questions about nine areas:
- Were your parents ever separated or divorced?
- How often did your parents or adults in your home ever slap, hit, kick, punch, or beat each other up?
- How often did a parent or adult in your home ever hit, beat, kick, or physically hurt you in any way? This does not include gentle smacking for punishment
- How often did a parent or adult in your home ever swear at you, insult you, or put you down?
- How often did anyone at least 5 years older than you (including adults) ever touch you sexually?
- How often did anyone at least 5 years older than you (including adults) try to make you touch them sexually?
- How often did anyone at least 5 years older than you (including adults) force you to have any type of sexual intercourse (oral, anal, or vaginal)?
- Did you live with anyone who was depressed, mentally ill, or suicidal?
- Did you live with anyone who was a problem drinker or alcoholic?
- Did you live with anyone who used illegal street drugs or who abused prescription medications?
- Did you live with anyone who served time or was sentenced to serve time in a prison or young offenders’ institution?
From the sample of 4,000 people, just over half had experienced none of the nine ACEs in the questions asked. A quarter of participants recalled 2 or more Adverse Childhood Experiences. And 9% told researchers that they had experienced four or more ACEs. (In Wales, that figure was 14%)
The greater the number of Adverse Childhood Experiences, the greater the likelihood that this would have a life-long impact on quality of life and even life-span. The American study indicated that people with four or more ACEs could die as much as twenty years sooner than most people. Unsurprisingly experiencing adversity in childhood, leads to a greater risk of mental ill-health, including serious mental health conditions. But the highest increases in risk are for violence, as both victims and perpetrators; imprisonment; and for the use of illegal drugs.
The original American study showed how the impact of Adverse Childhood Experiences affect people right from conception throughout life. Early ACEs disrupt the development of the brain, which may lead to impairment in the development of social, emotional and cognitive skills and knowledge, often leaving them behind educationally. People with an increasing number of Adverse Childhood Experiences, adopt behaviours that put their health at risk, increasing further their risk of disease, disability and social problems.
The studies show how the impact of adversity can be reduced.
- positive and supportive family
- safe relationships with peers
- access to a supportive community
- ability to regulate emotions
- acquisition of problem-solving skills
- compassionate, supportive response
- early intervention from services
- trauma-informed systems
A positive and supportive family is a key protective factor, but in many cases, the adults are creating the adversity themselves. So whilst a positive and supportive family might not be a possibility for some children with a high number of ACEs, the other six, perhaps seven, could be offered or developed by schools and other organisations. Many of these protective factors can be taught. Perhaps the greatest protection factor that we can control, is the ability to develop and integrate trauma-informed systems.
Instead of asking ‘what is wrong with you’, perhaps we should be asking, ‘What has happened to you?’
Wales Study (2015)
The following sources reference the Wales study in 2015.
Original US Study
Adverse Childhood Experiences (CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study 1995 – 1997)
(Source: Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults, Felitti et al (1998, American Journal of Preventive Medicine)