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Understanding ACEs

Updated: Aug 25, 2020

Note: This information is excerpted from the 2017 KIDS Network Children's Scorecard. Adverse Childhood Experiences (ACEs) have been in the news recently, as agencies across the country look to build on the latest findings in neuroscience and social work to deliver more effective social services. But what are ACEs? What impact do they have on children and families? How prevalent are they in our County? And what can we do about them? Read on to find out! Overview

ACEs are stressful experiences that occur in the first 17 years of life, and can have a profound impact on a child’s developing brain and body. The 10 recognized ACEs include specific types of abuse, neglect, and household dysfunction.

Research on ACEs shows a clear dose-response relationship: the more ACES experienced during childhood, the greater the impact on adult health and livelihood. Without intervention, adults who have experienced four or more ACEs as children are dramatically more likely than their peers to have life-threatening physical, mental, and behavioral health challenges. They are also likely to have lower educational attainment and earnings, and to experience unemployment or incarceration.

A retrospective study of adults in Santa Barbara County released in 2014 showed that approximately 57% had experienced at least one ACE while growing up, and over 13% had four or more ACEs.

Children who have been exposed to adversity are not doomed to poor outcomes. Resilience can be strengthened at any age, with appropriate interventions and the presence of reliable and nurturing relationships.

Background

The Centers for Disease Control and Prevention (CDC) and Kaiser Permanente collaborated on the original ACE study, conducted from 1995 to 1997. The study was the first of its kind to examine the connection between childhood stressors and lifelong health and to make the case that adverse experiences can have a profound impact on a child’s physical health, learning, and emotional well-being, with consequences that extend into adulthood. Later researchers confirmed and built upon the findings of this landmark study.

The original study included ten ACEs, which fall into three types. abuse (physical, sexual, or emotional), neglect (physical or emotional), and household dysfunction (mental illness, incarcerated relative, mother treated violently, substance abuse, divorce). The study found that the more ACEs (stress factors) a child had, the more likely that disease and mental health problems would emerge by adulthood.

New research is underway to examine the impact of other types of trauma that were not included in the original ACE study. Examples include exposure to community violence, bullying, homelessness, and racial/ethnic discrimination.

Problem It is estimated that 44.3% of children ages 0-17 in California have at least one Adverse Childhood Experience, and 18.2% have two or more. In a retrospective study of adults in Santa Barbara County, where the adults were asked to recall their childhood experiences, 57.5% had a least one ACE and 13.3% had four or more ACEs.

These statistics are based on the original ten ACEs and do not take into consideration some of the adversities that are significant for many children in Santa Barbara County. Housing instability and food insecurity are factors that create stress for local children, and issues of race and bullying are reportedly escalating within our schools and communities. Children of immigrant parents are especially vulnerable to immigration trauma and the persistent fear of losing a parent through deportation. In responding to ACEs, efforts should be made to include all behaviors, experiences, and trends that make children feel unwelcome, unwanted, or unsafe.

Effects Childhood stress reshapes the young brain by triggering the release of cortisol, the “fight or flight” hormone. In normal amounts, cortisol is important for a child’s development; levels rise in response to stress, and fall when the stressor passes and children learn emotional regulation. But when children are exposed to multiple chronic stresses (such as neglect, abuse and parental depression or discord), particularly in the absence of a supportive adult, cortisol levels rise and remain high. Excessive or prolonged activation of the stress response is known as toxic stress, and it impacts the child’s developing brain, immune and hormonal systems. Toxic stress changes the parts of the brain that control executive functions and memory, impacting how a child behaves and how a child learns. These impacts often create problems for children at home and school. One study found that children with three or more ACEs were three times more likely to fail academically, five times more likely to be chronically absent, and six times more likely to have behavioral problems like disruptive or violent outbursts.

The effects can continue into adulthood. Compared to those who have not experienced traumatic events, adults with four or more ACEs are 12 times more likely to attempt suicide, 10 times more likely to use injection drugs, seven times more likely to be an alcoholic, and five times more likely to suffer from depression. They are four times as likely to be diagnosed with Alzheimer’s or dementia, twice as likely to suffer from heart disease, and nearly twice as likely to have asthma, kidney disease, cancer, or diabetes. They are 21% more likely to be below 250% of the Federal Poverty Level, 27% more likely to have less than a college degree, and 39% more likely to be unemployed.

The consequences of high ACEs can be staggering, but children who have been exposed to adversity are not doomed to poor outcomes. Indeed, they can be helped substantially if reliable and nurturing relationships are present in their lives and appropriate treatments are provided as needed.

Solutions Prevention of Adverse Childhood Experiences will require a widespread understanding of family and community stressors, and a commitment to building the protective factors that strengthen families and promote resilience. In the meantime, negative outcomes associated with high ACEs can be reduced by supporting resiliency in children, youth, and families. The following list provides examples of how to do that:

Screen young children for ACEs and link families to interventions that can promote healing and resilience.Encourage partnerships between the medical and social service sectors to identify and support vulnerable children who may be experiencing trauma or toxic stress.Strengthen resiliency by addressing individual and family needs and connecting families to resources that will alleviate stress and build protective factors.Support resiliency for individuals by encouraging proper nutrition and sleep hygiene, exercise, mindfulness, and healthy relationships.Increase access to trauma-informed mental health services.Create networks of support that include Family Resource Centers, schools, faith-based organizations, medical homes, and treatment-focused organizations.Develop trauma-informed and resiliency-focused systems of care, made up of organizations and service providers who understand the widespread impact of trauma and who commit to using trauma-informed approaches to service delivery.


The newly formed Santa Barbara County ACEs Connection Steering Committee is working to put this knowledge into action for our community.


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