Is there an ACE up your sleeve?
Being a kid is tough. As much as our complicated adult lives are stressful, do you remember how hard it is being a kid? The days of worrying about “little things.” You know the stuff: Will I have dinner tonight? Is tonight going to be the night when my stepfather comes home angry and hits Mom? When will Mom be out of jail? I just hope Dad isn’t drunk. I just hope I have a bed to sleep in tonight. I really don’t like when people touch me there…
You know, normal kid stuff. You know, the stuff that sticks with you.
Drs. Robert Anda and Vincent Felitti have identified types of childhood trauma that have a lifelong impact on health and behavior — physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect. These are things like having a parent who’s an alcoholic, a mother who’s a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, or the disappearance of a parent through divorce, death or abandonment. Other types of childhood trauma include watching a sibling being abused, losing a caregiver (grandmother, mother, grandfather, etc.), homelessness, surviving and recovering from a severe accident, witnessing a father being abused by a mother, witnessing a grandmother abusing a father, etc. This research by the Kaiser Foundation on Adverse Childhood Experiences – or ACEs – is starting to help us better understand why children react the way they do to certain situations.
The original ACE study, published in 1998, confirmed what physicians, nurses, psychologists, social workers, substance abuse counselors and school principals had long suspected: that abuse, neglect and trauma in early childhood have a lifelong impact on health and behavior. But the study surprised even its authors in showing how many people were touched by adverse experiences.
The study, of more than 17,000 members of Kaiser Permanente, which is one of the largest not-for-profit health plans, asked participants about family dysfunction (parental separation or divorce, growing up with a household member with a mental illness or substance abuse problem, witnessing domestic violence, or incarceration of a household member), emotional, physical and sexual abuse, and emotional and physical neglect. The conclusion: ACEs were common. ACEs were highly interrelated; where there was one ACE in the life of a child, there tended to be others. And the effects of ACEs accumulated: the more ACEs a person had during childhood, the greater his or her risk for social, mental and physical health problems throughout the lifespan.
High ACE scores are correlated with a host of medical and social ills–not just heart disease and diabetes, but substance abuse, intimate partner violence, suicide attempts and adolescent pregnancy, divorce, financial problems, and difficulty performing in the workplace. Research has shown how that happens: childhood adversity can affect the developing brain, leading to social, emotional and cognitive impairments. That, in turn, can lead to risky behaviors such as smoking, substance abuse, overeating, and early and unprotected sexual activity. Those behaviors set the stage for dysregulation, disease, disability and early death. The ACE numbers tell a compelling story: ACEs are common in children and adults. They are corrosive to individuals, families and communities.
They cost money in emergency room care, missed days of work, substance abuse treatment and incarceration. (Source: http://communityresiliencecookbook.org/by-the-numbers/)
Interestingly, ACE scores also predicted healthcare utilization, healthcare spending, obesity, substance abuse, smoking, alcoholism, and prevalence of poorly controlled chronic disease better than anything we’ve ever found. In short, the terrible things that sometimes happen to children can cause a lifetime of health impacts. This is true even for middle class patients. However, poverty magnifies the potential to have a higher ACE score and probably exacerbates any traumas that have occurred. You can read the report of his study by clicking here. (Source: http://www.philly.com/philly/blogs/health-cents/The-Secret-to-Better-Care-It-Really-Is-All-in-Your-Head.html)
There are some who believe ACE scores should become a vital sign, as important as height, weight, and blood pressure. I remember the discomfort when a colleague recommended that I ask about sexual abuse history with our chronic pain patients. It is not that I didn’t know the correlation between sexual abuse and chronic pain, but I simply didn’t feel comfortable talking about it.
I imagine the same discomfort happened when we first started asking about smoking and drug use.
There is a paradigm shift that needs to happen from avoidance of talking about ACEs to understanding – and one that is illustrated beautifully by Stephen Covey (much more eloquently than I can articulate) in his popular book, The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change:
…one Sunday morning on a subway in New York…people were sitting quietly — some reading newspapers, some lost in thought, some resting with their eyes closed. It was a calm, peaceful scene. Then suddenly, a man and his children entered the subway car. The children were so loud and rambunctious that instantly the whole climate changed.
The man sat down next to me and closed his eyes, apparently oblivious to the situation. The children were yelling back and forth, throwing things, even grabbing people’s papers. It was very disturbing. And yet, the man sitting next to me did nothing. It was difficult not to feel irritated. I could not believe that he could be so insensitive to let his children run wild like that and do nothing about it, taking no responsibility at all. It was easy to see that everyone else on the subway felt irritated, too.
So finally, with what I felt was unusual patience and restraint, I turned to him and said, “Sir, your children are really disturbing a lot of people. I wonder if you couldn’t control them a little more?”
The man lifted his gaze as if to come to a consciousness of the situation for the first time and said softly, “Oh, you’re right. I guess I should do something about it. We just came from the hospital where their mother died about an hour ago. I don’t know what to think, and I guess they don’t know how to handle it either.”
At this point I need to offer an apology. I’m sorry to those who I misdiagnosed their chronic pain as whining, neediness, or a social visit. I’m sorry to the children and adults whose behavior I have judged without knowing their story. I’m sorry to my friends and colleagues who I’ve dismissed because I didn’t understand the impact that their life experiences have had on their struggles, attitudes, and fears.
But here’s the good news: I can change. I WANT to know how your experiences have impacted the way you feel. I WANT to know how we can work together to help you achieve your goals and your potential. Most of all, I want to help inspire others to do the same so we can build a stronger, more resilient, thriving community.
ACEs are not a life sentence: the behaviors, skills and interventions that help people to recover from trauma also nurture the next generation. Children who are resilient–able to stay calm and in control when faced with challenges–are less likely to miss days of school or to repeat a grade, even when they have two or more ACEs. And resilience is not just a gift of nature; it’s a skill that kids and adults can learn to help buffer and heal the damage caused by early adversity. (Source: http://communityresiliencecookbook.org/)
So, let’s continue the conversation. No, let’s accelerate the conversation.
Please join the discussion at a screening of the documentary, Paper Tigers – hosted by Wells Fargo and the Lancaster Education Foundation at JP McCaskey High School in Lancaster on May 12, 2016, at 6 p.m. This event will feature local community and education leaders for an in-depth discussion on ACEs and how we can contribute to supporting our youth in the community. For details and registration, please visit http://lancasteredfnd.org/.
