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ACEs and Toxic Stress

 

​​The Effects Can B​​​e Long Lasting​​

The landmark Adverse Childhood Events (ACE) study​ was a collaboration between the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente's Health Appraisal Clinic in San Diego - led by Vincent Felitti, MD and Robert Anda, MD, MS. Examining the data for over 17,000 HMO members, it became clear that adults from all walks of life – different socioeconomic status, race, etc – were at much higher risk of long-term physical, mental, and behavioral health issues as a result of their exposure to adverse childhood events, such as violence.3 This can be understood more easily, perhaps, in the figure below.


The risk for long-term health complications increases as the ACE score increases. For example, if a child had both seen his mother physically abused and had also experienced physical and emotional abuse himself, he would have an ACE score of 3 and his risk would be significantly higher than an individual with an ACE score of 0 or 1. Over 63% of study participants had an ACE score of 1 or more. Over 12% had an ACE score of 4 or higher. This latter category showed significant increase in risk for health complications.
 
Some of the health issues and risk factors that individuals exposed to ACEs in childhood experience at a higher rate included:

  • Alcoholism and alcohol abuse
  • Chronic obstructive pulmonary disease (COPD)​​
  • Depressio​n
  • Fetal death
  • Health-related quality of life
  • Illicit drug use​​
  • Ischemic heart disease (IHD)
  • Liver disease
  • ​Risk for intimate partner violence
  • Multiple sexual partners
  • Sexually transmitted diseases (STDs)
  • Smoking​
  • Suicide attempts
  • Unintended pregnancies
  • Early initiation of smoking
  • Early initiation of sexual activity
  • ​Adolescent pregnancy


The Physiologic I​​mpact on the Brain​

Research in the last several years has shown that while many of these issues (eg, substance use, behavioral issues, and physical health concerns) have been treated symptomatically, there is actually an underlying issue that has been missed. Many of these negative impacts are results of maladapted neural connections in the brain. Further, research has shown that neural connections, which are particularly vulnerable in the early stages of life (even infancy), can be disrupted and damaged during periods of extreme and repetitive stress - “toxic stress” - like that which is experienced during ACEs.  Jack Shonkoff, MD, FAAP, the American Academy of Pediatrics (AAP), and others have done a tremendous service in synthesizing this research and presenting it in a way that both health professionals and the general public can understand. This is documented on the new AAP Web site for Early Brain and Child Development, Dr Shonkoff's Web site for the Center for the Developing Child, as well as in the AAP Policy Statement Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health​ and the AAP Technical Report The Lifelong Effects of Early Childhood Adversity and Toxic Stress​.​

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