Building healthy futures through ACE scores

Is your life determined by the age of 18? 

According to the ACE Study better known as the Adverse Childhood Experience Study conducted at Kaiser Permanente in San Diego from 1995 to 1997, our livelihood depends on our childhood experiences of trauma in seven categories: psychological abuse, sexual abuse or household dysfunction such as substance abuse, mental illness, a violent mother or criminal behavior in the household. The study undertaken in a primary care setting with more than 17,000 participants assessed the relationship between childhood exposures and disease conditions leading to death. The causes were assessed by the patient’s medical histories provided in a clinical health appraisal questionnaire, while the childhood exposures were assessed through a survey which determined the ACE score.The ACE score is the total count of the number

of these childhood exposures to traumatic events. Approximately 66 percent of participants reported one ACE event, and more than 20 percent reported three or more events. The most prevalent event of childhood exposure was substance abuse in the household.

By analyzing the relationship between childhood exposures and health risk factors, it was determined that the prevalence and risk increased for smoking, obesity, depressed mood and suicidal attempts. A strong relationship was also observed in childhood exposure (across all trauma categories) and the presence of disease states such as diabetes and ischemic heart disease.

But how are childhood experiences linked to risk factors and diseases leading to death?

It is believed that the core of our negative habits are used as coping measures in the face of stress. Children can react with anger, anxiety or depression when facing an adverse experience and eventually resort in time to smoking, substance use or overeating. As these adverse experiences accumulate, so do significant risk factors leading to disease.

The ACE score is generally not commonly used by clinicians in daily practice but it can be useful in starting a conversation with the patient about sensitive subjects of trauma. The clinician can counsel the patient about understanding the relationship between these experiences and negative habits. Referrals for psychotherapy and wellness programs can then be made.

The ACE study has also impacted the creation of child abuse prevention programs, with a greater awareness of the impact of abuse and safeguarding children, especially here in Pennsylvania. Recently, 23 pieces of legislation were enacted changing how the state responds to abused children with expansions as to what legally is considered abuse.

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