Adverse CHildhood Experiences

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The Adverse Childhood Experiences (ACEs) study by Dr. Vincent Felitti (Kaiser Permanente, California) and Dr. Robert Anda (CDC) began by asking over 17,000 adults, who were members of a Health Maintenance Organization, about their childhood experiences. Then, using health records and assessments, they developed an understanding of how these 10 ACEs affected the health of the people in the group over their life spans.

Their survey tool was a sophisticated one. People were asked: “Sometimes physical blows occur between parents. While you were growing up, in your first 18 years, how often did your father (or stepfather) or mother’s boyfriends do any of these things to your mother (stepmother): Push, grab, or throw something at her? Kick, bite, hit her with a fist or hit her with something hard? Hit her repeatedly over at least a few minutes? Threaten her with a knife or gun or injure her with a knife or gun? (For more on the ACEs study visit http://www.acestudy.org/ and http://www.cdc.gov/nccdphp/ace.)

The prevalence of adverse childhood experiences across this group as a whole was remarkable. For example, 28% had been abused physically as a child, 17% had a mentally ill, depressed or suicidal person in the home, and 27% had a drug addicted or alcoholic family member.

The researchers made an especially significant finding: the greater the number of ACEs, the greater the risk for an array of poor physical, mental and behavioral health outcomes for patients across their life spans. In scientific terms, there was a direct “dose-response” relationship between adverse childhood experiences and serious health issues.

Table 1: Adverse Childhood Experiences (ACEs) as defined by Felitti & Anda (2009)

We cannot draw a straight line between ACEs and outcomes. However, we do know that the higher the ACEs score in a given population, the greater the probabilities of the following co-occurring conditions:

  • Alcoholism and alcohol abuse

  • Chronic obstructive pulmonary disease and ischemic heart disease

  • Depression

  • Fetal death

  • High risk sexual behavior

  • Illicit drug use

  • Intimate partner violence

  • Liver disease

  • Obesity

  • Sexually transmitted disease

  • Smoking

  • Suicide attempts

  • Unintended pregnancy

More than 75% of the 17,500 adults who participated in the ACEs study were college graduates, doing well enough economically to be employed and provided quality health insurance. Despite the traumatic hurricanes in their lives, they were able to succeed. Will the same be true for students who are seeking solace in our classrooms? What role can we play to support our students through these storms?

ACEs and School Performance

There is also a dose-response relationship between adverse childhood experiences and student learning. Several studies (Delaney-Black et al, 2002; Sanger et al., 2000; Shonk & Cicchetti, 2001), including one conducted in Washington (Grevstad, 2007), reveal that students dealing with trauma and trying to play chess in hurricanes . . .

  • are two-and-one-half times more likely to fail a grade;

  • score lower on standardized achievement test scores;

  • have more receptive or expressive language difficulties;

  • are suspended or expelled more often.