How are ACEs defined - The cycle of ACEs
‘Ten Adverse Childhood Experiences – ‘Felliti The ‘Classic ACEs Profile’
- Physical neglect: failure to supervise or provide for the child
- Emotional neglect: caregiver unable to express affection or love for the child due to personal problems
- Physical abuse: severe assault or physical abuse such as shaking or hitting
- Sexual abuse: child experienced sexual abuse or forced sex
- Emotional abuse: caregiver engaged in psychological aggression towards the child such as threatening
- Caregiver treated violently: domestic violence of an adult in the home including slapping hitting or kicking
- Caregiver substance-abuse: active alcohol and drug abuse by a caregiver
- Caregiver mental illness: serious mental illness or elevated mental health symptoms
- Caregiver divorce/family separation: child’s parent(s) deceased, separated or divorced or child was abandoned or placed in out of home care
- Caregiver incarceration: caregiver spent time in prison or is currently in jail or detention centre
Vincent Felliti and his colleagues at the Kaiser Permanente Organisation (1998 ) defined the forms of Adverse Childhood Experiences as
- Forms of Maltreatment – Emotional Abuse, Physical Abuse, Sexual Abuse, Physical Neglect, Emotional Neglect, Mother treated Violently,
- Household dysfunction – Household substance abuse, Household Mental illness, Incarcerated household member, and Parental separation or Divorce
What was unique in Fellitti’s approach was that he established an ACEs score by assessing the early experiences of more than 17000 individuals in the USA . Through retrospective recall he established whether they had been subject to the known range of different forms of maltreatment, and also their experiences of a range of household dysfunction, including household substance abuse, mental health, separation, divorce, incarceration. The higher the score of ACEs reported , the worse their subsequent health as adults ,the greater their risks of health-harming behaviours heart disease, cancer, stroke, type 2 diabetes, chronic bronchitis, fractures, hepatitis and poor self-rated health
When Fellitti et al.’s original paper on ACEs was published in 1998, it created considerable interest because it demonstrated the impact of Childhood adversity powerfully. Their findings confirmed the idea that prevention of adversity in childhood could significantly impact on adult health and well-being, partnering and parenting. This hypothesis is one that those of us working in the Child and Adolescent Mental Health field have held dear for many years. ‘The Child is Father of the man’
There is now more than 20 years of research which has significantly extended and confirmed Felliti’s original formulation of a risk index which included the significantly harmful experiences children have suffered, as well as the highly streesful contexts they have been living in.
ACEs are now defined
As situations which lead to an elevated risk of children and young people experiencing damaging impacts on their health, and other social outcomes across the life course. They are Experiences – which require significant adaptation by the developing child in terms of psychological, social and neurodevelopmental systems, and which are outside of the normal expected environment (adapted from (McLaughlin, 2016).
An ACEs profile is a cumulative risk score – reflects challenges across multiple domains (Dube 2021)
The cycle of ACEs
Shanta Dube recently described the cycle of ACEs ( Dube 2020):
- The impact of childhood adversity– abuse, neglect, and stressors in the home.
- Adolescent outcomes – substance use, suicidality, mental health, early pregnancy, substance misuse, and sexually harmful behaviour and exploitation.
- Adult outcomes, chronic diseases, substance use, obesity, STD/HIV risk, Sexual risk behaviour, Mental health, Suicidality, Emotional dysregulation
- Impact on Parenting – The cycle is completed through the harmful intergenerational impact on parenting of the unresolved impact of ACEs.