Updated: Mar 28, 2018
Childhood adversity has a profound impact on health, even into adulthood. Though this has been known since it was initially established by the large-scale Adverse Childhood Experiences (ACEs) study in 1998 , it was recently popularized by Oprah on the March 11, 2018, episode of 60 minutes (watch here). The original study by Feletti, et al, identified risk for ischemic heart disease, cancer, stroke, respiratory pathologies, hepatitis, and skeletal fractures in individuals with elevated ACE scores. Basically, your ACE score is as valuble of information as your blood pressure in health risk information for you and your doctor. That’s why clinics around the country including those founded by those leading the way in ACEs awareness like Dr. Nadine Burke Harris, and Dr. Bruce Perry (Center for Youth Wellness, Saint A's), and even out backyard Harriet Lane Clinic and others (read here), are calculating scores as the new “vital sign”. ACE scores are calculated based on seven categories including psychological abuse, physical abuse, sexual abuse, substance abuse by a household member, mental illness in a household member, mother treated violently and criminal behavior in a household member. Since, many additional studies have identified a relationship between ACEs and specific adult health outcomes including cancer diagnoses[2, 3], sleep disturbance[4, 5], adverse pregnancy outcomes, migraine, and a variety of cognitive and mental health conditions[8, 9]. Further, numerous studies have also deconstructed the ACE score to assess how aspects of the childhood experience may individually be related to adult health and disease outcomes. For example, child abuse alone has been linked to obesity and chronic pain.
ACE scores are calculated based on seven categories including psychological abuse, physical abuse, sexual abuse, substance abuse by a household member, mental illness in a household member, mother treated violently and criminal behavior in a household member.
Though these seven initial ACEs have been linked with significant disease outcome, other childhood experiences not fully assessed by the ACE score, such as socioeconomic status and social isolation, have also been associated with cardiovascular disease, diabetes type II, and risk factors for these and other diseases in adulthood. Specifically, social isolation, was identified by one study as contributing to inflammation independent of risk factors of adversity and other adversity types. Importantly, the original ACE study recognizes that self-rated health is a significant predictor of mortality[1, 21] and should be included in such analyses.
In an effort to understand the possible underlying mechanisms of these associations, many studies have identified a relationship between adverse experiences in childhood and biological dysfunction such as inflammation, metabolic disturbances, and HPA axis abnormalities. Childhood adversity seems to yield dysfunction across multiple physiologic systems, effecting the stress burden known as “allostatic load”. There is even evidence that childhood adversity can have an impact on cellular aging and epigenetic modifications to the genome[15, 16]. Full disclosure of self interest here and stay tuned as I dig into this in my own future work. In the meantime, if you want to learn more I recommend following the blog ACEs Too High (Here).
So you might ask, now that I know my ACE score may influence my disease risk as much as my blood pressure, what can I do about it? The answer, or resilience, according to experts in the field, popularized by Oprah, starts with “relationships”. Though few studies have aimed to address how the risk can be moderated, those that have suggest that certain conditions and characteristics, including resilience[22, 23], mindfulness and parental warmth, may moderate the association between childhood adversity and poor health, or disease risk factors, in adulthood. Each of these is an example of relationships. If one has a strong relationship with self and others, they are well on their way to building resilience against the ACEs they have experienced. Importantly, building healthy habits such as eating well, getting good sleep, and avoiding smoking and substance use can be just as significant in the battle against ACEs risk.
The answer, or resilience, to ACEs starts with RELATIONSHIPS...Importantly, building healthy habits such as eating well, getting good sleep, and avoiding smoking and substance use can be just as significant in the battle against ACEs risk.
Though these relationships exist, research is still needed to understand their underlying mechanisms. A review article written by Danese and McEwen, calls for future research in stating, “…because of the fragmentation in the data so far, future studies should aim to directly test mediation hypotheses by measuring childhood adversities, biomarkers, and clinical outcomes in the same individuals”.
Despite the many questions in the field of ACEs that are yet to be answered, as a doctor I can tell you that it is just as important to know your ACE score as it is to know your blood pressure. Simply recognizing your own ACEs and understanding their associated health risks will take you one step closer to health. While research is underway, you can work on measuring your blood pressure, and building your personal resilience through lifestyle improvement and healthy relationships! So I ask you, do you know your ACE score?
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