Understanding ACEs - Subject Matter Experts
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Adverse Childhood Experiences (ACEs) are traumatic events that can be acute, chronic, and/or complex. ACEs are common with 40% of children under the age of eighteen having suffered some sort of trauma. How each individual experienced a traumatic event mentally and physically determines the overall influence and impact.
According to Dr. Bruce Perry, the age when ACEs occur are of utmost importance. "The timing of adversity makes a huge difference in determining overall risk. Put simply, if you experience trauma at age two, it will have more impact on your health than that same trauma taking place at age 17." Experiencing an ACE, like abuse and neglect, can increase the odds of developing serious adult health issues like cancer, liver disease and heart disease. ACEs can also make people more prone to suicide, substance abuse, poor work performance and a host of other negative outcomes. Abuse of alcohol or drugs, exposure to neighborhood violence, and the occurrence of mental illness are among the most commonly-reported adverse childhood experiences in every state. |
The ACE study looked at three categories of adverse experience: childhood abuse, which included emotional, physical, and sexual abuse; neglect, including both physical and emotional neglect; and household challenges, which included growing up in a household where there was substance abuse, mental illness, violent treatment of a mother or stepmother, parental separation/divorce or had an incarcerated household member.
Respondents were given an ACE score between 0 and 10 based on how many of the 10 types of adverse experiences they reported experiencing. Experiencing an ACE, like abuse and neglect, can actually increase the odds of developing serious adult health issues like cancer, liver disease and heart disease. ACEs can also make people more prone to suicide, substance abuse, poor work performance and a host of other negative outcomes. Abuse of alcohol or drugs, exposure to neighborhood violence, and the occurrence of mental illness are among the most commonly-reported adverse childhood experiences in every state.
Respondents were given an ACE score between 0 and 10 based on how many of the 10 types of adverse experiences they reported experiencing. Experiencing an ACE, like abuse and neglect, can actually increase the odds of developing serious adult health issues like cancer, liver disease and heart disease. ACEs can also make people more prone to suicide, substance abuse, poor work performance and a host of other negative outcomes. Abuse of alcohol or drugs, exposure to neighborhood violence, and the occurrence of mental illness are among the most commonly-reported adverse childhood experiences in every state.
What is Sexual Abuse?
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Child sexual abuse is defined by the ACE study as "an adult or person at least 5 years older than you touching or fondling you or having you touch their body in a sexual way, or trying to or actually having oral, anal, or vaginal sex with you". Respondents were given an ACE score between 0 and 10 based on how many of the 10 types of adverse experiences they reported experiencing.
Child sexual abuse is among the most common ACEs, and it is the only one frequently perpetuated by someone outside the child’s family. Child sexual abuse is almost always committed by someone the child has a relationship with, and because of that children can experience very complex and confusing traumas; they may become intensely afraid of the perpetrator, or they may care about the perpetrator very deeply and see the abuse as something worth enduring in order to maintain that relationship. The abusive acts themselves may be painful or may not be, which can cause massive confusion and shame in the child. Sexually abused children may become deeply fearful of anything that reminds them of sexual contact or they may become sexually precocious, possibly to the point they are sexually offending against other children (some estimate that 40% of sexual abuse is committed by minors). And this wide spectrum of painful behaviors and consequences is further masked by a deep stigma and ignorance, often willful. Physical evidence of child sexual abuse is rare, and because of the complexity of the trauma and relationship with the abuser, victims seldom disclose the abuse until adulthood. |
What is Physical Abuse?
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The ACE study defined Physical Abuse as being frequently pushed, grabbed, slapped, having things thrown at you, or being hit you so hard that you had marks or were injured. Corporal Punishment is associated with more future aggression than less. "Spanked children are more aggressive, break more rules, and have lower receptive vocabulary scores." Mackenzie 2013 Research shows that spanking can cause children to become fearful. In one study, according to the AAP, young children who were spanked more than twice a month at age 3 were more aggressive at age 5. Physical Abuse is defined by the ACE study as being frequently pushed, grabbed, slapped, having things thrown at you, or being hit you so hard that you had marks or were injured. A child who experiences frequent violations or who experiences an assault so hard it leaves lasting physical evidence, runs the risk of living in constant or near constant fear, and that is the mechanism by which ACEs do their lifelong harm.
The idea that it is OK or even necessary to use corporal punishment to discipline children is deeply ingrained in many cultures, and this incubates the idea in many parents’ minds that hitting children is acceptable or necessary. If a parent believes that it’s OK to use physical force to discipline a child, it becomes easier for the parent to use more force as the child’s behavior gets worse, and all the research out there shows that corporal punishment makes children’s behavior worse. This can lead to a downward spiral where the parent(s) hit more and harder to make the child behave, and the child’s behavior keeps deteriorating, prompting the parent(s) to use more frequent and severe corporal punishment. |
What is Emotional Abuse?
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The ACE study defines emotional abuse as a parent or other adult in the household often swearing at you, insulting you, putting you down, humiliating you, or acting in a way that made you afraid that you might be physically hurt. Emotional abuse can also be defined as the repeated degrading of another person’s mental health and well-being through nonphysical actions. It’s important to notice the word “often” here; a single instance of parental bad behavior is not enough to cause a lifetime of trauma for children. And the perception of the victim is also important here; it is the victim’s interpretation of the incident rather than the actual incident itself that is important.
Even if a family member, friend, or romantic partner doesn’t get physically violent with you, they could still be emotionally abusing you. Emotional abuse, verbal abuse and psychological abuse are also harder to spot than physical abuse because the signs are generally less obvious than physical evidence of abuse. However, being in an emotionally abusive relationship can cause low self-esteem, PTSD, depression and other mental health problems. Emotional abuse often stems from anger and frustration at children, poor understanding of child development, poor understanding of how to discipline a child, poor ego strength on the parent’s part, and poor parental attachment. |
What is Emotional Neglect
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Emotional neglect is defined by the ACE study as often feeling that no one in your family loved you or thought you were important or special, or your family not looking out for each other, feeling close to each other, or supporting each other. Many of our adult problems come down to varieties of emotional neglect suffered in childhood. Many of us are wandering the world bearing a lot of emotional damage. We may be depressed, anxious or very difficult around sex and relationships. We might in certain moods ask ourselves where the difficulties came from. The Still Face Experiment, devised by Professor Ed Tronick - which gives us an insight into the vulnerability of, and need for love in young children. Emotional Neglect may be hard to detect in early childhood, but the side effects are a hallmark of trauma and our compassion for others.
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What is Physical Neglect?
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Physical neglect s defined by the ACE study as often feeling that you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you, or that your parents were too drunk or high to take care of you or take you to the doctor if you needed it. This physical neglect definition is different from the definition that child protective agencies typically use because it is from the child’s point of view. Child protective services will typically define physical neglect as a parent not providing food, clothing, shelter, medical care, or education for a child when they have the means to do so.
Globally, the level of childhood obesity is increasing at a startling rate and there are more children overweight in Europe than any other continent. United European Gastroenterology highlights the importance of healthy early nutrition in helping to reduce the levels of childhood obesity, both now and in generations to come. The ACE study demonstrates that the fear and stress of physical neglect are as damaging to them as actual abuse. See sample interview with a child. |
What is Domestic Violence?
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Domestic violence can be summarized as seeing your mother, stepmother, father, or adults in the home push, grab, slap, or use objects to hurt each other. Often, adults in the home will be seen kicking, biting, fighting, or repeatedly hurting each other physically. Watching loved ones act violently shatters a child’s belief that they can be safe in their home or in their skin. A parent who is being abused is very stressed and is unlikely to be able to function as well as a parent as they otherwise would. Sometimes children will try to defend their victimized parent, which places them at horrible physical and emotional risk, and sometimes they mimic the abusive parent’s words and actions, which can cause guilt, and habituates them to behaving violently.
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What About Divorce, Abandonment, or Death?
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Separation, Abandonment, Divorce, or Death, a.k.a. “SADD” can be defined as a form of trauma. The question is very straightforward, “Were your parents ever separated or divorced?” Divorce is the second-most-common ACE experienced by children in each age group. From a child’s point of view, divorce represents a huge change in their family, and in their understanding of how the world works and where they fit into it. They are likely to move to another house, they are likely to see one parent less than they’re used to, they may change schools, and they may slide into a different income bracket. The problem with divorce that often is overlooked is its impact on the children. Adults can better tolerate even the extreme stress of most divorces better than children can. The nastier and more volatile the divorce experience is, the greater the impact on the children and the degrees of stress they experience. Sometimes parents become vicious towards each other; sometimes one person may be more vindictive, vengeful and manipulative than the other. Or one parent becomes immobilized and overwhelmed by feelings of loss and rejection.
While ACEs don't, in and of themselves, cause divorce, they can put you at higher risk of problems that might put a strain on your marriage, including depression and other mental health issues and substance abuse. Life isn't perfect, as you well know. You may not be able to spare your child the pain of a parental breakup, but you can help him or her develop the resiliency to recover from this experience. Divorce, death, and separation are one of the more common ACEs, so it’s worth understanding why this is such a life-altering trauma, one they can lead to shorter sicker lives. |
What is Parental Addiction?
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A chemical addiction of any sort can impair a parent's ability to connect with their child. The ACE study defined parental addiction in a fairly straightforward way “ Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?” Someone who is addicted, not just a casual user, to a chemical is going to be in an altered mental state regularly. Depending on their chemical of choice, this may render them less aware of their surroundings, minimally responsive, overly responsive, irritable, aggressive, or with impaired judgement, sensory perception or motor skills. An addicted parent may use bill or rent money to support their habit, this can cause relationship issues with other members of the household. These behaviors expose children to potentially dangerous adults, increased risk of parental arrest, and foster care placement.
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What About Parental Mental Illness?
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Parental Mental Illness can be defined as a form of trauma due to the parent’s inability to properly care for their children. The ACE study ask the question: "Have you ever lived with anyone who was mentally ill or suicidal, or severely depressed for more than a couple of weeks?" Growing up in a family dealing with mental health issues can cause confusion, fear, anxiety, lack of parental attention, and a concern on the part of the child about their own mental health. A mental health struggle within the household is one of ten "adverse childhood experiences" that may cause physical or emotional symptoms in a child. The fact that a parent has a mental health challenge does not in and of itself mean that a child will have difficulty in their childhood or adulthood. Instead, the issue is whether the parent is able to develop support and coping tools to positively raise the child.
One specific concern is that mental illness sometimes has genetic components that can be passed on to children. This does not mean that every parent with a mental health condition will have a child who has those same challenges. At times the inconsistency of the family relationship can cause long-term trauma for children due to the unpredictability of the illness. Adults who are experiencing mental illness are often torn by the desire to be good parents and the very real challenges of raising children for any parent. Phrases like "But mom, the other kids' parents come to their concerts," or "Dad, you promised you would come to my game this time," can tear at one's soul. These parents are concerned not only with how to get through life, but this very day. Parents with greater exposure to ACEs are more likely to have children with behavioral health problems. |
What About Family Members and Jail?
Incarceration of a parent can be defined as a form of trauma due to the parent’s absence in the child’s life. The ACE study’s questionnaire ask: “Did a household member go to prison?” Approximately seven million children in the United States have an incarcerated parent, or a parent who has been recently released from jail or prison. Over 8 in 10 prisoners reported at least 1 ACE, and nearly half had 4 or more ACEs. Prisoners with 4 or more ACEs were 4 times more likely to have ever served a sentence in a young offender institution (YOI) than those with no ACEs. There are deep connections between ACEs and the justice system, given that family member incarceration is one of the ACE criteria that increases risk of developing toxic stress in children, and that many symptoms of the toxic stress response (such as impairment of impulse control or mental health disturbances) significantly increase risk of justice involvement.
While most individuals with significant ACEs do not encounter the criminal justice system, exposure to ACEs is a well-documented risk factor for justice involvement, which may be an important indicator of severe and untreated toxic stress. This increased risk is mediated through a complex interaction of biological and social factors, including biological susceptibility, family and social supports, income, education and access to treatment services. The Welsh ACE studies found that half of adults in the general population in Wales suffered at least one ACE in childhood, and over one in 10 suffered four or more [1,2]. Individuals who had suffered four or more ACEs were 20 times more likely to have been incarcerated at some point in their lives. |
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