I first learned of the adverse childhood experiences (ACE) study a few years ago as I was working on understanding how stress impacts our health and well-being through the psychoneuroimmunological system.

The ACE study was performed in the late 1990s by the Centers for Disease Control and Kaiser Permanente with 17,000 participants, and the goal of the study was to better understand how adverse experiences in childhood impact health later in life.

Detailed information about the process and the findings can be found here, but to summarize, the participants were asked to recall if they had adverse childhood experiences, of which there are 10. The questions focus on childhood experiences of abuse (physical, emotional, sexual) or neglect and include family issues such as parents’ use of drugs or alcohol, parents who divorced, or were incarcerated, and/or were mentally ill. The full questionnaire can be accessed here and you can calculate your own ACE score using the questionnaire.

By simply answering yes or no, one comes up with a score between 0-10. The original CDC-Kaiser study determined that patients who had an ACE score of 4 or more had a 4- to 12-fold increased risk for alcoholism, depression, and suicide vs. those who had a 0 score. There were also grave implications around individuals with higher ACE scores demonstrating increased risks for physical inactivity, smoking, severe obesity, alcoholism, drug use, sexually transmitted diseases, chronic illnesses, and early death.

When children have traumatic childhood experiences, their physiological stress response leads to issues with learning and relating to others, self-medicating, and engaging in risky or violent behaviors in attempts to find relief from the continuing stress. From disruptive or violent school experiences, extreme tolls on the healthcare system, and workplace-associated costs, the implications of this study are enormous. This provides a basis for our schools and communities to begin to support stress resilience programs, develop trauma informed schools, and for health care providers to assess both children and adults for their ACE score.

The good news is that stress resilience can also be supported in children, lowering the impact of childhood traumatic experiences. Having a supportive environment, with caring and involved teachers, coaches, clergy, neighbors, and/or caring relatives, can help children grow in their capacity to manage stress and lead healthier lives.

I teach about ACEs in our RN-BSN program at the University of Maine at Augusta, because nurses need this information as a tool for their own healing knowledge; this tool can also help support them with growing and maintaining their compassion for patients who present with multiple health issues, or those labeled as non-compliant. The ACE study helps us to understand how addiction is often related to childhood trauma, and the resultant brain physiology. That emerges under states of stress.

Health care providers can also use this knowledge to maintain and grow compassion for this population, knowing that brain development and physiology is largely responsible for the unhealthy and non-compliant behaviors we often associate with addiction and chronic illness.