The ACE Study

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It makes no sense, but one of the most remarkable and important findings in recent psychological research hasn’t gotten the attention it deserves and still has not had much impact on the practice of psychotherapy. I’m talking about the ACE Study.

In the 1990’s, the CDC and the health care giant, Kaiser Permanente, teamed up to recruit more than 17,000 adult research subjects, who filled out a short questionnaire, asking about their adverse childhood experiences. That’s what ACE stands for: adverse childhood experiences. They then compared their answers to a list of common ailments. They found a very strong correlation between the degree of adverse childhood experiences and a decline in both physical and mental health for the person later in life.

Adverse childhood experiences can be things like physical, sexual, or emotional abuse, physical neglect, violence towards the mother, mental illness in the family, and parental separation, divorce, death, or incarceration. These experiences proved to be far more common than anyone ever imagined. Two-thirds reported at least one and 87% of those, a second; one eighth had four or more.

The more adverse childhood experiences, the more the adult is likely to have high-risk behaviors such as smoking, alcohol and drug abuse, promiscuity, and overeating. They are correlated with illnesses like depression, heart disease, cancer, chronic lung disease and shortened lifespan. Having four adverse childhood experiences makes you seven times more likely to be alcoholic. It doubles your chance of getting cancer and quadruples the risk of emphysema. If you had more than six adverse childhood experiences, you are thirty times more likely to attempt suicide.

Correlation is not the same thing as causation; but, oh, the numbers. Look at the sheer numbers of participants saying the same things. These numbers cannot be ignored; but they have been.

Despite the ACE study, people go on believing that genetics are the cause of alcoholism. There is a genetic factor, but adverse childhood experiences are far more powerful. Some still say that mental illness is caused by a chemical imbalance, despite the fact that no chemical imbalance has ever been found. They go on acting as if the way we treat children doesn’t matter.

So, how do adverse childhood experiences translate into adult health problems? That’s the big mystery, but we do have a theory. When kids are overloaded with stress hormones, they can’t pay attention. They have trouble trusting adults and developing healthy relationships with peers. They become loners and never get the lessons people get from other people that helps them cope. They turn to chemicals or high-risk activities to escape. Using drugs, overeating, and engaging in risky behavior then leads to bad health. In addition, we’re beginning to see that severe and chronic stress creates inflammatory responses that then leads to disease.

As strong as the findings of the ACE study are, we should not underestimate the power of resiliency. Further studies are being conducted on the exceptions to the trend, the people who have high ACE scores, but don’t go on to develop a million problems. There are mitigating factors: friends, relatives, teachers, and neighbors who provide an island of stability for a child from a troubled home. There’s the determination that traumatized people can have to not let the past define them. There are people who learn from mistakes, both their own and their parents, and commit themselves to not passing on their adverse childhood experiences to their children.

What would happen if we took the ACE study more seriously? We would know that the way we treat people, especially children, makes a difference. We would make child welfare a priority. For instance, schools would be empowered to look into the home life of a child who presents with a condition like attention deficit disorder, to see if anything could be done to help before sending them to a doctor. If we took the ACE study seriously in the mental health field, we would know safety is the key to sanity, and not re-traumatize people when they come for help. We would create sanctuaries, not community residences, and treat people with respect, not drugs.
Click here to go to the ACE portion of the CDC website.