Adverse Childhood Experiences

Adverse childhood experiences (ACEs) and their impact on health in adulthood were initially brought to the public’s attention in 1995 through research conducted by the Centers for Disease Control and Prevention (CDC) and the Kaiser Permanente health care organization in California. The initial ACEs study found a strong correlation between exposure to abuse or household dysfunction experienced during childhood 2 QUEEN’S DEPARTMENT OF FAMILY MEDICINE and major health risk factors in adulthood. These health factors were within the leading causes of illness, disability, and death as well as poor quality of life overall. In their research, Felitti et al (1998) found that adults who had experienced four or more ACEs showed a 12-times-higher prevalence to health risks such as alcoholism, drug use, depression, and suicide attempts. Additionally, children and youth of different races and ethnicities do not experience ACEs equally. A 2018 national US study found that 61 per cent of black non-Hispanic children and 51 per cent of Hispanic children had experienced at least one ACE, compared with 40 per cent of white nonHispanic children (Sacks and Murphy, 2018).

There were 10 types of childhood trauma measured in the ACEs study. Five were related to abuse and neglect, while others were related to parental social problems such as addiction, domestic violence, incarceration, and separation. The number of these types of traumas a child experienced determined their ACEs score. For example, a child who was physically neglected and had one alcoholic parent and another who was incarcerated would have an ACEs score of three. It is important to acknowledge that the ACEs score is meant as a guideline; if a child experienced other types of toxic stress over months or years, then those would likely increase the risk of health consequences. The graphic on page 3 captures the original types of ACEs (e.g., childhood abuse, neglect, and household dysfunction) as well as expanded ACEs that consist of additional experiences that impact childhood trauma (bullying, community violence, lack of neighbourhood safety, racism, and living in foster care).

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