M
ost folks intuively know that childhoodexperiences shape adult lives. But a new line of research is greatly expanding our understanding of thisprocess—documenng how nurturing, stable environmentshelp children develop the cognive and emoonal skills androbust sense of self they need to thrive as adults.The research, coming this year to Iowa, also shows hownegave experiences can derail those processes, leading toa host of health problems and risk behaviors in adulthood.Adverse childhood experiences, or ACEs, are broadlydened as incidents during childhood that harm social,cognive and emoonal funconing. Frequent or prolongedexposure to such events creates toxic stress that damagesthe architecture of the developing brain.The negave outcomes are serious. On the health side,they include diabetes, hypertension and heart disease,depression, morbidity and early death. On the risky-behavior side, they includesmoking, overeang,alcoholism and drug use.Evidence shows thatthe more ACEs a personexperiences, the morelikely poor healthoutcomes become. Ongoing research by the Centers forDisease Control nds that, worst case, trauma in childhoodcould take as many as 20 years o life expectancy.Adverse childhood experiences don’t guarantee badoutcomes for adults, but they increase the odds of struggle.And they are largely preventable.
What are adverse childhood experiences?
ACEs are incidents that dramacally upset the safe,nurturing environments children need to thrive.The original, seminal ACEs work, conducted from 1995to 1997 by invesgators Robert Anda and Vincent Feli,included surveys of more than 17,000 KaiserPermanente HMO members about their childhoodexposure to nine dierent adverse experiences:
Recurrent physical abuse
•Recurrentemoonalabuse•
Contact sexual abuse
•
An alcohol and/or drug abuser in the household
•
An incarcerated household member
•
Someone in the household who is chronically
•depressed,mentallyill,instuonalizedorsuicidal
Mother is treated violently
•
One or no parents
•Emoonalorphysicalneglect•
Those results, combined with the ndings of physicalexams and ongoing tracking of members’ healthexperiences, strongly documented the link betweenadverse childhood experiences and negave health andbehavioral outcomes later in life.
Adverse Childhood Experiences (ACEs)
A new way of understanding adult health risks in Iowa
Iowa’s adult
populaonhas
health problemsstrongly associatedwith ACEs.
March 2012
Why are adverse childhood experiencesso damaging? Toxic stress
Extensive research on the biology of stress shows that healthydevelopment can be derailed by excessive or prolongedacvaon of the body’s stress response systems, withdamaging eects on learning, behavior and health.Learning to cope with stress is an important part of childdevelopment. When we are threatened, our bodies prepareus to respond by increasing our heart rate, blood pressureand stress hormones, such as corsol. When a young child’sstress response systems are acvated within an environment of supporve adult relaonships, these physiological eects arebuered and brought back down to baseline. The result is thedevelopment of healthy stress response systems.Toxic stress occurs when a child experiences strong, frequentand/or prolonged adversity—physical or emoonal abuse,chronic neglect, caregiver substance abuse or mental illness,exposure to violence and/or the accumulated burdens of familyeconomic hardship—without adequate adult support.The prolonged acvaon of stress response systems disruptsthe development of brain architecture and other organs andincreases the risk for stress-related disease and cogniveimpairment. The more adverse experiences in childhood, thegreater the likelihood of developmental delays and later healthproblems, including heart disease, diabetes, substance abuseand depression.
— from the Harvard Center for the Developing Child, hp://developingchild.harvard.edu/topics/science_of_early_childhood/toxic_stress_response/
Learning about ACEs in Iowa
Iowa advocates are just starng to explore the prevalenceof ACEs, but we already know the Iowa adult populaon hashealth problems strongly associated with ACEs in naonalstudies. In 2010, an esmated:66% (1,534,756) of Iowans we• re overweight or obese8% (173,877) had been told they were diabec, and•another 6% (122,236) prediabec8% (178,514) had cardiovascular disease•16% (373,256) were current smokers, and 23% (542,497)•former smokers5% (120,555) were heavy drinkers, and 17% (391,803)•binge drinkers
1
These health outcomes are costly. Esmates aributed $738million in Iowa health care costs to adult obesity in 2003,with almost 50 percent of those costs paid by Medicare($165 million) and Medicaid($198 million).
2
Chroniccardiovascular healthcondions cost Iowans anesmated $1.34 billionannually.
3
The total cost of diabetes in Iowa exceeds$1.5 billion a year.
4
Long term, one of the most important ways to containhealth costs is not by nding cheaper ways to treat suchcondions, but prevenng them in the rst place. Prevenngor migang the eects of ACEs is one place to start.To document ACEs in the Iowa populaon, health plannersthis year added specic ACEs-related quesons to an annualstate health survey conducted by the CDC. The BehavioralRisk Factor Surveillance System is a mely and accuratesource of Iowa data on health risk behaviors, prevenve-health pracces, and health-care access, primarily relatedto chronic disease and injury. Responses on ACEs will beavailable for analysis in fall 2013.
Toxic stress occurs when a child experiencesstrong, frequent and/or prolonged adversity.
One way to containhealth costs is by
prevenngchronichealthcondions
and risky behaviors.Addressing ACEs is aplace to start.
Connued on page 4
The more ACEs, the higher the risk of poor adult outcomes
Anda and Feli’s work on ACEs has helped build anew understanding of the cumulave eect of adverseexperiences on human development. The likelihoodof risky behavior or poor health outcomes increasessubstanally with the number of ACEs reported, asdemonstrated in the chart below.
Outcome
No ACEs 1-3 ACEs 4-8 ACEs
Heart disease 1 in 14 1 in 7 1 in 6Smoker 1 in 16 1 in 9 1 in 6Alcoholic 1 in 69 1 in 9 1 in 6Suicide aempt 1 in 96 1 in 10 1 in 5IV-drug user 1 in 480 1 in 43 1 in 30
— from “The High Cost of Adverse Childhood Experiences,”PowerPoint, Washington State Family Policy Council (2007).
The good news? We know how to reducedamage from toxic stress
The most eecve prevenon is to reduce young children’sexposure to extremely stressful condions, such asrecurrent abuse, chronic neglect, caregiver mental illnessor substance abuse, violence and/or repeated conict.Research shows that, even under stressful condions,supporve, responsive relaonships with caring adultsas early in life as possible can prevent or reverse thedamaging eects of toxic stress response.There are increasingly sophicated intervenons to helpfamilies stabilize themselves. We also know there arefactors that can minimize the damage from ACEs:Caring relaonships with parents, extended family and•other caring adultsGood health and a history of adequate development•Good peer relaonships•Hobbies and interests•Acve coping style•Posive self-esteem•Good social skills•Internal locus of control•Easy temperament•Balance between seeking help and seeking autonomy•
— from “Adverse Childhood Experiences in Wisconsin: Findings from the2010 Behavioral Risk Factor Survey,” Children’s Trust Fund, Children’sHospital and Health System and the Child Abuse Prevenon Fund.
Supporveadultrelaonshipshelpchildren
develop healthy stress response systems.Not every adult with a history of adverse experiences will have poorhealth outcomes, but many willexperience some problems, and some
willexperienceseriousdicules.
Adverse Childhood ExperiencesDisrupted Neurodevelopment
Social, Emoonal &Cognive ImpairmentAdopon of Health-RiskBehaviorsDisease,Disability& Social ProblemsEarlyDeath
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