"ACES" is an acronym for the Adverse Childhood Experiences Study, conducted in 1995 by the Center for Disease Control (CDC) and Kaiser Permanente. 17,000 patients of a medical clinic were interviewed about their childhood experiences. About 3/4 were white, 3/4 had a college degree. Here is what they found:
(1) Adverse Childhood Experiences are quite common, even among a middle-class population: more than 2/3 reported experiencing 1 ACE, and nearly a 1/4 had experienced 3 or more.
(2) There is a powerful, persistent correlation between the more ACEs experienced and the greater the chance of poor outcomes later in life, including dramatically increased risk of heart disease, diabetes, obesity, depression, substance abuse, smoking, poor academic achievement, time out of work, and early death.
In 2012, the Institute for Safe Families expanded upon the study, releasing the Philadelphia Urban ACES study, which included adverse childhood experiences related to community violence and racial discrimination. They found that:
More than half of participants in the Philadelphia ACE Study had experienced ACEs, with similarly high rates of household and community level adversities. The data from this study suggest that the actual rates of adversity experienced by children in Philadelphia--and likely other urban communities may be underestimated when based on household-level adversities alone (as in the original study).
And this is how adverse childhood experiences--trauma--came to be recognized as a potential public health issue.
What is considered to be an Adverse Childhood Experience?
As noted above, the first study focused on in-household experiences, including domestic violence, parental mental illness, abuse, etc, while the second included exposure to community violence, racial discrimination, removal by Child Protective Services. To get a clearer picture, you can take this quiz to discover your own ACES score. (This quiz is based off of the first, in-household based definitions of adverse childhood experiences. If you've experienced racism or community violence, your score is likely to be higher.
What does an ACE score mean?
For the purposes of this study and from a public health perspective, the ACE score is significant because it has been shown that when people have 3 or more ACES, they are much more likely to have significant challenges as adults, including but not limited to substance abuse and other risk-taking behaviors as well as chronic medical problems like heart disease, cancer, and diabetes.
ACES From a Therapist's Perspective
The ACES study was groundbreaking, because it really illuminated how powerful childhood trauma can be. It shifted the way that social services, mental health and even our educational system views people--changing the conversation from a "What's wrong with them!?!" to a more empathic and compassionate "What's happened to them?". It also has the power to influence social policy, allowing for more attention to the safety of our communities and well-being of our families.
But with its focus on long-term impacts and "chronic" nature of outcomes, the dialogue can sometimes leave little room for hope. As a therapist who has worked with hundreds if not thousands of people, many of whom who had high ACE scores, I know that there is room for authentic hope. This study measures events--terrible, painful events. But what it leaves out might be most important--the relationships that help us through it all. Almost everyone has had someone in their lives who, even once in a while, saw them for who they are and could be, nurtured and cared for them and their potential. A grandparent, a brother, a cousin, a teacher, a coach, a friend. And such a relational experience, no matter how brief or inconsistent, can often be enough to plant a seed toward health.
Therapy works in the same way. It's about finding that seed and watering it, giving it sunlight, checking in on it, and growing it so that it can become what it was always meant to be. When you have a therapist who can help you find that within yourself, who helps you to feel safe, to feel supported, those adverse childhood events somehow become less threatening, more in the past, and your present "self" becomes stronger. Go ahead and take the ACE quiz, know your ACE score. But don't forget that it's not the whole story.