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CHILD ABUSE SURVIVORSHIP IN THE NEWS:
Childhood Trauma May Shorten Life By 20 Years
CDC Research Finds Problems in Childhood Can Be Lifelong
By JOSEPH BROWNSTEIN
ABC News Medical Unit
Oct. 6, 2009
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I want to pause for a moment from the ongoing themes of my present writing to mention again the important work being done by the Center for Disease Control (CDC) in regard to tracking the longterm consequences of Adverse Childhood Experiences (ACE) including child maltreatment, traumas and abuse.
But first I want to let you know about an interesting website I found while pursuing a Google search on the ACE study called The Survivor Archives Project. This is a trauma hope and healing site that invites readers to personally submit to their archives, journal and library.
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The CDC-ACE study is not without limitations. All 17,421 participants were insurance members which means that information from the many other uninsured levels of our society were not included. If they had been (or are in the future) how much more child abuse connected lifelong adult devastation would be seen?
I would like to see the model of this study expanded through the use of the ACE questionnaires in a far wider variety of settings, preferably included in every human well-being study our nation produces. At the moment, I want to simply highlight the important work the CDC has been doing over the past 14 years with its studies of the consequences of child abuse for survivors for your thought and consideration by presenting some information from their website on Adverse Childhood Experiences as follows:
The Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted on the links between childhood maltreatment and later-life health and well-being. As a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente’s Health Appraisal Clinic in San Diego, Health Maintenance Organization (HMO) members undergoing a comprehensive physical examination provided detailed information about their childhood experience of abuse, neglect, and family dysfunction. Over 17,000 members chose to participate. To date, over 50 scientific articles have been published and over 100 conference and workshop presentations have been made.
The ACE Study findings suggest that these experiences are major risk factors for the leading causes of illness and death as well as poor quality of life in the United States. Progress in preventing and recovering from the nation’s worst health and social problems is likely to benefit from the understanding that many of these problems arise as a consequence of adverse childhood experiences.
Here is one website about the study:
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About the study:
The ACE Study was initiated at Kaiser Permanente from 1995 to 1997, and its participants are over 17,000 members who were undergoing a standardized physical examination. No further participants will be enrolled, but we are tracking the medical status of the baseline participants.
Each study participant completed a confidential survey that contained questions about childhood maltreatment and family dysfunction, as well as items detailing their current health status and behaviors. This information was combined with the results of their physical examination to form the baseline data for the study.
The prospective phase of the ACE Study is currently underway, and will assess the relationship between adverse childhood experiences, health care use, and causes of death.
More detailed scientific information about the study design can be found in “The relationship of adult health status to childhood abuse and household dysfunction,”* published in the American Journal of Preventive Medicine in 1998, Volume 14, pages 245-258.
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The ACE Pyramid represents the conceptual framework for the Study. During the time period of the 1980s and early 1990s information about risk factors for disease had been widely researched and merged into public education and prevention programs. However, it was also clear that risk factors, such as smoking, alcohol abuse, and sexual behaviors for many common diseases were not randomly distributed in the population. In fact, it was known that risk factors for many chronic diseases tended to cluster, that is, persons who had one risk factor tended to have one or more others.
Because of this knowledge, the ACE Study was designed to assess what we considered to be “scientific gaps” about the origins of risk factors. These gaps are depicted as the two arrows linking Adverse Childhood Experiences to risk factors that lead to the health and social consequences higher up the pyramid. Specifically, the study was designed to provide data that would help answer the question: “If risk factors for disease, disability, and early mortality are not randomly distributed, what influences precede the adoption or development of them?” By providing information to answer this question, we hoped to provide scientific information that would be useful for the development of new and more effective prevention programs.
The ACE Study takes a whole life perspective, as indicated on the orange arrow leading from conception to death. By working within this framework, the ACE Study began to progressively uncover how childhood stressors (ACE) are strongly related to development and prevalence of risk factors for disease and health and social well-being throughout the lifespan.
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Major Findings
Childhood abuse, neglect, and exposure to other traumatic stressors which we term adverse childhood experiences (ACE) are common. Almost two-thirds of our study participants reported at least one ACE, and more than one in five reported three or more ACE. The short- and long-term outcomes of these childhood exposures include a multitude of health and social problems. The ACE Study uses the ACE Score, which is a count of the total number of ACE respondents reported. The ACE Score is used to assess the total amount of stress during childhood and has demonstrated that as the number of ACE increase, the risk for the following health problems increases in a strong and graded fashion:
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In addition, the ACE Study has also demonstrated that the ACE Score has a strong and graded relationship to health-related behaviors and outcomes during childhood and adolescence including early initiation of smoking, sexual activity, and illicit drug use, adolescent pregnancies, and suicide attempts. Finally, as the number of ACE increases the number of co-occurring or “co-morbid” conditions increases.
Content source: Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion
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Adverse Childhood Experiences Study Questionnaires – AVAILABLE TO EVERYONE
This is the simplest version of the ACE questionnaire I have seen that consists of ten questions: What’s YOUR ACE Score? Help me calculate my ACE Score.
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THE ACE SCORE:
The ACE Study used a simple scoring method to determine the extent of each study participant’s exposure to childhood trauma. Exposure to one category (not incident) of ACE, qualifies as one point. When the points are added up, the ACE Score is achieved. An ACE Score of 0 (zero) would mean that the person reported no exposure to any of the categories of trauma listed as ACEs above. An ACE Score of 10 would mean that the person reported exposure to all of the categories of trauma listed above. The ACE Score is referred to throughout all of the peer-reviewed publications about the ACE Study findings
Below are the links to the actual forms used (and to be used) for research purposes.
The Family Health History and Health Appraisal questionnaires were used to collect information on childhood maltreatment, household dysfunction, and other socio-behavioral factors examined in the ACE Study. The questionnaires are not copyrighted and there are no fees for their use. As a courtesy, a copy of articles on any research conducted using items from the questionnaires is requested.
Family Health History Questionnaire
Male Version (PDF–190K)
Female Version (PDF–180K)
Health Appraisal Questionnaire
Male Version (PDF–85K)
Female Version (PDF–89K)
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Adverse Childhood Experiences Definitions
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Future Directions
The ACE study is now in its 10th year and the prospective phase is currently underway. In this ongoing stage of the study, data are being gathered from various sources including outpatient medical records, pharmacy utilization records, and hospital discharge records to track the subsequent health outcomes and health care use of ACE Study participants. In addition, an examination of National Death Index records will be conducted to establish the relationship between ACE and mortality among the ACE Study population.
International interest in replications of the ACE Study is growing. At present there is knowledge of efforts to replicate the ACE Study or use its questionnaire in Canada, China, Jordan, Norway, the Philippines and the United Kingdom. In Puerto Rico, the link between women’s cardiovascular health risks and ACE are under study. In addition, the World Health Organization has included the ACE Study questionnaires as an addendum to the document Preventing Child Maltreatment: A Guide to Taking Action and Generating Evidence. (October 2006*) (PDF)
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Related Links
CDC Resources
CDC’s National Center on Birth Defects and Developmental Disabilities
CDC’s National Center for Injury Prevention and Control
- Child Maltreatment
- Preventing Child Maltreatment: Program Activities Guide
- Using Evidence-Based Parenting Programs to Advance CDC Efforts in Child Maltreatment Prevention—Research Brief 2004
Other Government Resources
The Department of Health and Human Services Administration for Children and Families
Research Institutes
American Professional Society on the Abuse of Children*
International Society for the Prevention of Child Abuse and Neglect*
Voluntary Organizations
Victim Assistance
National Children’s Advocacy Center*
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Overview Article:
Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The adverse childhood experiences (ACE) study.
American Journal of Preventive Medicine. 1998;14:245-258.
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New Publication: Childhood Stress and Autoimmune Disease in Adults
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PUBLICATIONS ON MAJOR FINDINGS BY:
A Video Series on: THE ACE STUDY
The ACE Pyramid — ACE Study Links Childhood Trauma— These results, appearing in the November 2009 issue of the American Journal of Preventive Medicine, are the latest from the ACE Study (Adverse Childhood Experiences). The research project, now in its 14th year, is one of the largest investigations ever conducted on the links between childhood maltreatment and health and well-being later in life. The ongoing study looks at how both positive and negative experiences and childhood stressors are strongly related to development and affect risk factors for disease, health and social well-being throughout the lifespan.
The ACE Study — The Good Works in Trauma — From the Institute for Educational Research and Service and the National Native Children’s Trauma Center
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Stop the Storm 