Adverse Childhood
A Brief Review of the Facts
Origins of ACE studies
CDC and Kaiser Permanente (Robert Anda, MD
Vincent Felitti, MD et al, 60 medical studies, 19952010)
“Adverse Childhood Experiences and Population
Health, State of Washington: The Face of a Chronic
Public Health Disaster” (Robert Anda and David Brown,
July 2, 2010)
*Available on request
The findings are in
10 Specific Adverse Child Experiences (ACEs) have
been identified
Patient-reported childhood experiences matched
against more than 17,300 HMO medical records
Childhood “stressors” directly connected
to costly adult psychological, emotional
and physical illnesses
Studies Identified 10 ACE Categories -“Stressors”
1. Recurrent emotional abuse
2. Recurrent physical abuse
3. Sexual abuse
4. Witnessed domestic violence
5. Household alcohol or drug abuse
6. Household mental illness
7. Parents separated/divorced
8. Incarcerated household member
9. Emotional neglect
10. Physical neglect
ACE 1. Recurrent Emotional
As a child, did you experience…
Excessive verbal abuse such as yelling, swearing?
Fear of physical harm?
ACE 2. Recurrent Physical Abuse
As a child, did your parent or guardian…
Push you, grab you, slap you, throw something at
Hit you so hard it left marks?
ACE 3. Sexual Abuse Stressor
As a child…
Were you touched in sexual way?
Were you sexually molested?
ACE 4. Domestic Violence
As a child, did you witness a male …
Push grab, slap or throw something at your mother?
Kick, bite or hit her with his fist?
Threaten her with a knife or gun?
ACE 5. Household Alcohol or
Drug Abuse
As a child, did you…
Live with a problem drinker or alcoholic?
Live with someone who used street drugs?
ACE 6. Household Mental Illness
As a child…
was anyone in your house mentally ill or depressed?
ACE 7. Divorce or Separation
As a child…
were your parents separated or divorced?
ACE 8. Incarcerated Household
As a child, was anyone in your family in jail?
ACEs 9 and 10: Emotional
and Physical Neglect
Prepare yourself for a sample of the
findings from several studies
Research Confirms Compounding Effects of ACES
-- The more ACEs and,
-- The more intense the ACEs …
…The more adult emotional, mental and physical health
Suicidal Ideation and ACEs
Children with adverse childhood experiences tend to think more
about killing themselves.
(Cicchetti et al, 2010)
Adult Suicide Attempts and ACEs
Adverse Childhood Experiences compound the risk of
suicide attempts in adulthood.
(Dube et al, 2001)
Adult Mental Illness and ACEs
ACEs increase incidence of mental illness in adulthood.
(Edwards et al, 2003)
Adult Depression and ACEs
The more ACEs, the greater the likelihood of adult
(Chapman et al, 2004)
Promiscuity and ACEs
ACEs increase the likelihood of sexual intercourse by age 15
increasing the likelihood of AIDS and other STDs.
(Hillis et al, 2001, Anda et al, 2002b)
Teen Drug Use and ACEs
The more ACEs, the more teenage drug use.
Dube et al 2003 (b)
Adult Health Problems and ACEs
The more stressors in childhood, the more adults show
increased physical health problems.
(Dube et al, 2003a)
Adult Heart Disease and ACEs
ACEs are linked to a higher rate of Ischemic heart disease
in adults.
(Dong et. al, 2004)
Changed Brain Structure and
Child maltreatment is linked to a variety of changes in
brain structure.
(Anda et al, 2004)
Lasting Health Effects of ACEs
Attributed to the neurological and biological effects of
“toxic stress” on children.
(Dube et al, 2003a)
Explanation for lifetime effect of
Increases in
heart rate, blood pressure, serum glucose, stress
hormones, “fight or flight”…
Related to long-term disruptions in
brain architecture, immune systems, metabolic
regulation, cardio-vascular function
(Center on Developing Child, Harvard University)
The power of STRESSORS
ACEs have differing effects on children (Fortunately not all
ACEs result in adult conditions)
Some children and adults appear more resilient than others
Not all childhood “stress” is harmful
Some harm from ACEs may be reparable
Some stressors may be “toxic”
Each childhood STRESSOR exaggerates the effects of
The words of Dr. Anda explain my mission
The chronic public health disaster of adverse childhood
experiences and their effects on human development are real.
The public health impact of ACEs can now only be ignored
as a matter of conscious choice. Thus, with this information
comes the responsibility to use it.
Robert Anda, MD
Center for Disease Control and Prevention
July 2, 2010
Anda et al, “Adverse Child Experiences, Alcoholic Parents, and Later Risk of Alcoholism and Depression”, J Psychiatric Serve 53: 1001-1009, August 2002 (a)
Anda et al, “Adverse Childhood Experiences and Risk of Paternity in Teen Pregnancy”, Obstetrics and Gynecology, Volume 100, Issue 1, pp. 37-45, July 2002 (b)
Anda et al, “The Enduring Effects of Abuse and Related Adverse Experiences in Childhood”, Child Abuse and Neglect, Volume 28, Issue 7, pp. 729-737, July 2004
Chapman et al, Adverse Childhood Experiences and the Risk of Depressive Disorders in Adulthood, Journal of Affective Disorders, 2004, Volume 82, Pages 217-225.
Cicchetti et al, “Interaction of Child Maltreatment and 5-HTT Polymorphisms: Suicidal Ideations among Children…” Journal of Pediatric Psychology, 2010; 35: 536546
Dong et al, “Insights Into Causal Pathways for Ischemic Heart Disease”, American Heart Association Journal, 2004, 110: 1761-1766.
Dube, et al, “Child Abuse, Household Dysfunction and the Risk of Attempted Suicide Through the Life Span”, JAMA 2001; 28: 3089-96
Dube, et al, “Adverse Childhood Experiences and Personal Alcohol Abuse as an Adult…”, Addictive Behaviors, Volume 27, Issue 5, September-October 2002, pp 713-725
Dube (a), et al, “The impact of adverse childhood experiences on health problems…” Preventive Medicine, Volume 37, Issue 3, September 2003 (a), Pages 268-277
Dube, et al, Child Abuse, Neglect, and Household Dysfunction and the Risk of Illicit Drug Use…, Pediatrics, Volume 111, No. 3, March 2003 (b), pp. 564-572
Edwards, et al, “Relationship Between Multiple Forms of Childhood Maltreatment and Adult Mental Health…” Am J Psychiatry 160:1453-1460 (August, 2003)
Hillis et al, “Adverse Child Experiences and Sexually Transmitted Diseases in Men and Women…”Pediatrics, Vol 106, No 1, July 2000, p. e11
Hillis et al, “Adverse Childhood Experiences and Sexual Risk Behaviors in Women…” Family Planning Perspectives, Volume 33, No % (September-October, 2001, pp.
Hillis et al, “The Association Between ACEs and Adolescent Pregnancy, Long-Term Psychosocial Consequences and Fetal Death”, Pediatrics, Vol 113, No2, Feb 2004,
pp 320-327
For more Information
Centers for Disease Control and Prevention
Children’s Trust Fund of Michigan
Prevent Child Abuse America