Adverse Childhood Experiences
Adverse childhood experiences (ACEs) are traumatic events that occur before age 18. These events include abuse (physical, emotional, and sexual), neglect (physical, emotional), and household dysfunction (such as domestic abuse, family member incarceration, substance abuse, parental loss through divorce or death, and parental depression/mental illness). ACEs can be accessed using a validated and standardized questionnaire. You can find you ACE score here.
ACEs are strongly associated with negative health outcomes in adulthood. Having experienced traumatic events during childhood may increase your risk for health problems in adulthood such as:
- asthma
- obesity
- metabolic syndrome and chronic inflammation
- diabetes
- cardiovascular disease
- cancer
- unhealthy behaviors
- physical inactivity
- kidney disease
- stroke
- sleep disorders
- depression and anxiety disorders
- substance abuse
- violent behaviors
- suicide risk
- premature mortality (early death)
An ACE score of 4 or more (reporting four traumatic events during childhood) is generally considered to be "high-risk" because this score significantly increases the risk for many of the above negative health outcomes. But even an ACE score of 1 (reporting one traumatic event during childhood) increases your risk. However, it's important to remember that your ACE score does not determine your fate. Instead, it can be used to examine the odds that people (such as yourself) with a given ACE score will develop a given health outcome.
In general, experiencing a specific ACE does not point to a specific negative health outcome. For example, if a person with heart disease experienced family member incarceration, emotional neglect, and divorce during childhood (the ACEs), we cannot know whether a specific ACE contributed more than the others to the outcome of heart disease. Instead, an ACE score of 3 (regardless of what the ACE is) has been shown to increase risk for heart disease. In other words, much of the evidence on ACEs only assesses overall score in relation to the health outcome and does not assess a specific ACE. Additionally, pinpointing specific ACEs to specific outcomes becomes more difficult when there are multiple ACEs and a variety of health outcomes. If a person experienced family member incarceration, emotional neglect, and divorce during childhood and has heart disease, depression, and obesity in adulthood, we cannot say whether a specific event in childhood led to a specific health outcome in adulthood. However, some emerging studies do assess specific ACEs and their relation to specific health outcomes such as parental death and heart disease/stroke.
ACEs also have a graded dose-response relationship with negative health outcomes. This means that with each ACE, the risk (assessed as an odds ratio) for developing the health outcome increases. For example, a person with an ACE score of 5 is more likely to have depression than a person with an ACE score of 2 (all other things being equal). This example remains true if you swap out "depression" for any of the negative health outcomes mentioned.
Knowledge is Power: Using Your ACE Score to Improve Your Health
People are complex, so attributing a specific health outcome to a single ACE is the wrong question. Instead, the power of ACE scores lies in understanding that an overall score is a more indicative predictor of potential health risks. An ACE score can be thought of like a prediction tool, but it is not a crystal ball. Similar to genetic testing and family history, it helps gauge your likelihood of negative health outcomes. This information empowers you to take preventative action to improve your health and well-being across your lifespan.