The Adverse Childhood Experience (ACE) Study

The Adverse Childhood Experience (ACE) was the biggest study of its kind ever created (Rousseau, 2023). In 1958, Dr. Vincent Felitti and his colleague Dr. Robert Anda of Kaiser Permenente studied more than 50,000 patients, finding clear characteristics or commonalities (Rousseau, 2023). It is highlighted that the most damaging statistic found is how the trauma could later manifest into adults (Rousseau, 2023). Furthermore, as the number of ACE  categories higher, the number of conditions also increases (Rousseau, 2023). When there is exposure to one category, there is an 80% likelihood of exposure to another category (Rousseau, 2023). These ACE categories include, alcoholism and alcohol abuse, chronic obstructive pulmonary disease, depression, drug use, heart and liver disease, risk of partner violence, smoking, suicide, and overall decline in quality of life (Rousseau, 2023). 

Expanding more about the ACE study, Felitti and Anda spent more than a year creating ten new questions that involved defined categories of adverse childhood experiences which included, physical and sexual abuse, physical and emotional neglect, and family dysfunction like having parents who were divorced, mentally ill, addicted, or in prison (van der Kolk, 2014). Ultimately, the ACE study showed that traumatic life experiences during childhood and adolescence are a lot more common than previously expected (van der Kolk, 2014). It is stated that the study respondents were mainly White, middle class, middle aged, well educated, and financially secure enough to have good medical insurance, highlighting that only one-third of the respondents stated no adverse childhood experiences (van der Kolk, 2014). Additionally, the study revealed that the effects of trauma permeated these patients’ adult lives (van der Kolk, 2014). An example mentioned is that high ACE scores turned out to correlate with higher workplace absenteeism, financial issues, and less lifetime income (van der Kolk, 2014). 

Furthermore, Felitti and his team discovered that adverse experiences are interrelated, even though they are usually studied individually (van der Kolk, 2014). For example, people do not usually grow up in a household where one brother is in prison, but everything else is okay (van der Kolk, 2014). Incidents of abuse are never ‘standalone’ events, and for each additional adverse experience reported, the toll in later damages rises (van der Kolk, 2014). Felittti and his team also discovered that the impact of childhood trauma initially became noticeable in school (van der Kolk, 2014). Referring to the ACE study results, more than half of those with ACE scores of four or higher reported having learning or behavioral issues, which was compared with three percent of individuals with a score of zero (van der Kolk, 2014). It is expressed that as the children matured, they did not ‘outgrow’ the impact of their early experiences (van der Kolk, 2014). Felitti highlights, ‘“Traumatic experiences are often lost in time and concealed by shame, secrecy, and social taboo”’ (van der Kolk, 2014). However, the ACE study revealed how the effects of trauma permeated these patients’ adult lives (van der Kolk, 2014). 

Moreover, after Robert Anda presented the results of the ACE study, he realized that they had found the gravest and most expensive public health issue in the United States, which is child abuse (van der Kolk, 2014). Anda’s calculations entailed that the overall costs surpassed those of cancer or heart disease (van der Kolk, 2014). In addition, eliminating child abuse in America would lessen the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, IV drug use, and domestic violence by three-quarters (van der Kolk, 2014). Eradicating child abuse in America would also have a huge impact on workplace performance, and greatly lessen the need for incarceration (van der Kolk, 2014). Furthermore, follow up studies and papers are still showing up around the world regarding the ACE study. However, the day to day reality of those who suffered child abuse, as well as children in outpatient clinics and residential treatment centers around the country remains the same (van der Kolk, 2014). The only difference now, is that they receive high doses of psychotropic agents, which makes them more manageable, but will also affect their ability to feel pleasure and curiosity, to grow and develop emotionally and intellectually, and to ultimately become contributing members of society (van der Kolk, 2014). 

Expanding more on psychotropic agents, the reason why taking medications could be effective, is because it could be used to lessen extreme or debilitating symptoms as an initial step in trauma recovery (Rousseau, 2023). A few of the symptoms that could be lessened with medication include, sleep disorders, hyperarousal, emotional reactivity, depression, and intrusive or recurring thoughts and images (Rousseau, 2023). However, it is highlighted that an approach that may work for one person, may not work for another, potentially even increasing the other person’s experience of trauma symptoms (Rousseau, 2023). Nonetheless, pharmacotherapy, or the use of medication, is one approach to addressing the impact of trauma, specifically in situations where people will experience symptoms like anxiety, depression, or other mental health problems associated with traumatic experiences. Pharmacotherapy would be a very effective approach, especially in tandem with other therapeutic approaches, like psychotherapy in order to provide a comprehensive treatment plan (Alcohol and Drug Foundation, 2021). 

Elaborating more on pharmacotherapy, from a neurology perspective, there are many different neurotransmitters in one’s brain (Rousseau, 2023). All in all, pharmacotherapy works by manipulating neurons and neurotransmitters to gain the desired effect (Rousseau, 2023). In addition, medications can be effective in reducing specific symptoms associated with trauma such as, intrusive thoughts, nightmares, or panic attacks. Furthermore, medicines that target the autonomic nervous system, like propranolol or clonidine, could help in lessening hyperarousal and reactivity to stress (van der Kolk, 2014). This group of drugs works by blocking the physical effectiveness of adrenaline and the fuel of arousal, therefore lessening nightmares, insomnia, and reactivity to trauma triggers (van der Kolk, 2014). Additionally, blocking adrenaline can help to keep the rational brain online and make choices possible (van der Kolk, 2014). Ultimately, a detailed approach by a mental health professional is crucial to identify the most appropriate treatment approach, whether it involves medication, psychotherapy, or a combination of both.

Lastly, referring back to the importance of the ACE study, the implementation of this research could be very beneficial if integrated in one’s workplace. For example, providing training among professionals to recognize and respond to people affected by adverse childhood experiences. This could provide more awareness into one’s potential trauma history, guiding more efficient and sensitive methods. Another implementation could be developing support systems that consider the findings of the ACE study in order to help those affected by childhood trauma. Overall, the goal is to use the ACE study’s findings to apply more informed, understanding, and efficient approaches when dealing with people who have experienced childhood traumatic events.

Resources:

Australian Drug Foundation. (2021). Pharmacotherapy for young people. Alcohol and Drug Foundation. https://adf.org.au/talking-about-drugs/seeking-help/pharmacotherapy-young-people/what-is-pharmacotherapy/#:~:text=Pharmacotherapy%20is%20the%20treatment%20of,with%20a%20legally%20prescribed%20substitute.

Rousseau, D. (2023). BU Learn. Retrieved from https://learn.bu.edu/bbcswebdav/pid-12438217-dt-content-rid-91014393_1/courses/23fallmetcj720_o2/course/module1/allpages.htm

Van, K. B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma.  

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