From painting pumpkins and apple picking to participating in nightly family dinners, one’s childhood experiences are the building blocks of their adult future. Unfortunately, it is also common for a young person to have experiences over the course of their childhood that are not as happy or positive.
For those who are exposed to trauma at a young age without any type of intervention, the long-term impact on their health and well-being can be detrimental. This two-part content series examining the effects of childhood trauma will begin by introducing some of the existing framework for identifying and understanding trauma: The Adverse Childhood Experiences (ACE) Study.
While the impact of trauma is lifelong, the significance of its impact can be decreased or minimized by consistent, supportive relationships and trauma treatment. It is never too late (or too soon) for survivors of childhood trauma to pursue healing. Recovery is possible.
Childhood Trauma and Development of the ACE Study
A landmark study on childhood trauma began by unconventional means in the ‘90s. Dr. Vincent Felitti was frustrated and searching for answers as to why the Kaiser Permanente obesity clinic he headed was incurring a 50 percent dropout rate from participants who were successfully losing weight – every year for five years in a row.
Dr. Felitti began interviewing dropouts from his weight loss program with a standardized set of questions, to try to find an explanation for the puzzling dropout rate. In doing so, he discovered that most of the 286 people being interviewed had been sexually abused as children, and had used overeating as a coping mechanism for anxiety and depression. When his findings attracted the interest of the Centers for Disease Control and Prevention (CDC) and epidemiologist Dr. Robert Anda, they teamed up with Kaiser Permanente to survey more than 17,000 volunteer participants about a potential link between childhood events and their impacts on adult health.
In developing a questionnaire for this study, Drs. Felitti, Anda and team identified a total of 10 types of Adverse Childhood Experiences, or ACEs. These experiences were divided into three categories:
- Abuse: Physical, Emotional or Sexual
- Neglect: Physical, Emotional
- Household Dysfunction: Mental Illness in the Home, Exposure to Domestic Violence, Separated or Divorced Parents, Incarcerated Family Member, Household Substance Abuse
This list of ACEs was used to establish an individual’s ACE score, or the sum of events in a person’s background. Each ACE is considered one point. A person with an ACE score of zero had not experienced any of the adverse events before the age of 18, whereas a person who had experienced any of those traumas could have a score ranging from one to the maximum score of 10.
Key Contributions of The ACE Study
After two years of initial surveying and more than 15 years of follow-ups, findings from The ACE Study were ground-breaking. The first wave of results included three key revelations:
- There was a direct link between adult onset of chronic disease in those who had experienced childhood trauma, along with a variety of other behavioral consequences, such as mental illness and incarceration.
- ACEs were not uncommon, with approximately two-thirds of participants receiving an ACE score of 1 or greater. Of those who had experienced at least one ACE, 87 percent had experienced two or more – suggesting that many, such as alcoholism and abuse, exist in comorbidity.
- The higher an individual’s ACE score, the more likely they were to suffer health complications as an adult.
The original ACE quiz can be accessed online, but should be completed with a licensed trauma therapist who can help if you struggle with the memories or impact of past childhood experiences.
Examining the Shortcomings of ACEs
Because the original ACE Study was conducted amongst volunteer members of a health organization, participants had steady employment and access to quality health care. The majority of these volunteers were also white (74 percent) and college-educated. After findings were analyzed, the Philadelphia Expanded ACE Study was one of many new initiatives seeking to address stresses that were not covered in the original study – those that are particular to the underprivileged, and those living in an urban area.
The Philadelphia study included five new ACEs:
- Expanded: Witnessing Community Violence, Living in an Unsafe Neighborhood, Experiencing Racism, Living in Foster Care, Experiencing Bullying
Psychologist Dr. Whitney Barrett has acknowledged other shortfalls of the original ACE Study, including that it does not account for all of the possible traumas a child could experience, such as the death of a parent. The original study only included criteria for separated or divorced parents, or an incarcerated parent.
In determining an individual’s ACE “score,” their trauma is also being reduced to a mere number without regard for the actual impact of the trauma on their lives – in other words, it does not factor a person’s resilience. Each individual will experience a traumatic event differently, and may have relationships with supportive adults who can help lessen the impact of the event. The original questionnaire does not factor in these positive variables.
The Importance of Trauma-Informed Care and Treatment
While an understanding of ACEs is helpful to address the impact of trauma on a child’s developing mind and body, the ACE questionnaire itself is just a starting point. Together, Trauma-Informed Care (TIC) and Trauma Treatment can help children, adolescents and families make a holistic approach to healing while avoiding re-traumatization.
- Trauma-Informed Care, or TIC, is an approach to providing human services that can help reduce the impact of trauma on a person’s everyday life – from health care to employment, law enforcement and beyond. Adopting a trauma-informed approach in any field of service usually requires a total paradigm shift for both the individual providers, and the organization as a whole.
- Trauma Treatment differs from TIC in that it is specifically designed to facilitate recovery from trauma. It is a type of therapy that aims to treat the symptoms or consequences of trauma.
The original ACE Study brought awareness to the fact that it is not uncommon for individuals to experience some kind of trauma during their formative, childhood years. Organizations who embrace TIC can help promote healing, provide a safe environment, and reduce the stigma of seeking treatment for past trauma from a licensed trauma therapist.
Getting Help with Past Trauma and Supporting Holistic Healing
The team of licensed therapists at St. Louis Center for Family Development (STLCFD) is trained to support trauma survivors, including supporting parents and their children. We will accompany you through the journey towards healing from past trauma without judgment or reservation.
STLCFD also offers Trauma-Informed Training and consultation to help organizations embrace a trauma-informed approach in their workplace – to improve outcomes, reduce re-traumatization and address secondary traumatic stress, amongst other benefits.
If you are suffering from adversity experienced in childhood or as an adult, we are here to help you. Click here to contact us today.
Next: What are some of the physical manifestations of unrelenting childhood trauma, and how can it cause changes in the human brain? Read Part II in our blog series.
Please Note: This website is not an emergency hotline. If you or someone you know are in crisis, please call the Behavioral Health Response Crisis Hotline at (800) 811-4760.