PROTECTIVE FACTORS AND RISK
FACTORS
(ADVERSE CHILDHOOD
EXPERIENCES -ACE’s)
Judy Harrison, Executive Director
Louisiana Children’s Trust Fund
November 2013
Principles of Brain Development
-The outside world shapes the brains wiring.
-The outside world is experienced through the
senses--seeing, hearing, smelling, touching,
and tasting--enabling the brain to modify
connections.
-The brain operates on a “use it or lose it” principle
-Relationships with other people early in life are
the major source of development of the emotional
and social parts of the brain.
I Am Your Child
Reiner Foundation
 “Discovery consists of looking at the
same thing as everyone else and thinking
something different.”
 A.Szent-Gyorgyi
What are Protective Factors?
 Parental Resilience
 Social Connections
 Knowledge of parenting and child
development
 Concrete supports in times of need
 Children social and emotional competence
 Nurturing and attachment
Risk Factors:
Adverse Childhood Experiences
 Experiences that represent health or social
problems of national importance:




Childhood abuse and neglect
Growing up with domestic violence, substance
abuse or mental illness in the home
Parental discord
Crime
Adverse Childhood Experience (ACE)
Study
 Largest study of its kind ever done to
examine the health and social effects of
childhood experiences throughout the
lifespan of participants (17,000)
 Kaiser Permanente and CDC
 Retrospective study of an HMO population
 Average age 57 years
Categories of ACEs
 ABUSE

Abuse




Emotional
Physical
Sexual
Neglect


Emotional
Physical
 HOUSEHOLD DYSFUNCTION




Mother treated violently
Household sustance abuse
Parental separation or divorce
Incarcerated household member
Adverse Childhood Experiences Are
Very Common
 Percent reporting types of ACEs:





Alcohol abuse- 23.5%
Mental illness- 18.8%
Battered mother- 12.5%
Drug abuse- 4.9%
Criminal behavior- 3.4%
 Childhood Abuse:



Psychological- 11.0%
Physical- 30.1%
Sexual- 19.9%
 Total number of categories of ACEs that each participant reported
•Example: Experiencing physical abuse as a child is an ACE score of
one.
Experiencing physical abuse plus witnessing IPV is an ACE score
of
two.
ACE Score Prevalence
Number of individual adverse
childhood experiences
0
1
2
3
 4 or more


47.9%
24.9%
13.1%
7.3%
6.8%
More than half had at least one ACE
More than one in four had 2 or more ACEs
Prevalence Maybe Underestimated
 Sampling excludes persons in institutions,
prisons, hospitals or who are homeless
 Retrospective nature of ACE questions raises
potential for recall error
 Generational and socio-cultural influences

Older adults may have forgotten some of their
childhood experiences
Different interpretations of experiences
Corporal punishment interpreted differently
between young and old participants
ACE Study Findings
 As ACE score goes up, so does the risk for
 Organic disease (pulmonary, heart & liver)
 Adult alcoholism & drug abuse
 Depression and suicide attempts
 Multiple sexual partners
 STD’s and rape (5% to 33%)
 Hallucinations
 Risk for intimate partner violence
 Addictions
 Dying early
 Job problems and lost time from work
Summary of Findings
 Adverse Childhood Experiences (ACE’s) are
very common
 ACE’s are strong predictors of health
behaviors in adolescence and adult life
 This combination of findings makes ACE’s
one of the leading, if not the leading
determinant of health and social well-being of
our nation
ACE’s module administered in
Louisiana in 2009
 Percentage of adults participants (8147)
reporting ACE’s (by number of ACE’s
reported)





0 ACE’s
1 ACE’s
2 ACE’s
3 ACE’s
4 ACE’s
43%
25%
13%
10%
12%
ACE CATEGORIESLouisiana participants
Abuse
Physical
Sexual
Emotional
11%
10%
21%
Household Dysfunction
Mental Illlness
Substance Abuse
Divorce/Separation
Domestic Violence
Incarceration
17%
27%
27%
15%
7%
What Does All This Mean?
•ACEs very common
•Strong predictor of later health and mortality risks
•Combination of ACEs increases risks
•Protective factors may buffer the effect of ACEs
(•Journal of Adolescent Health October 2013
Supplement on Protective Factors interrupting cycle of
maltreatment across generations)
•Importance of prevention!
Elements of Future Success in
Child Health and Well-Being
-Recognizing that child abuse and neglect and other ACEs
are like diseases that are self-replicating and interrupting
the cycle
-Fully documenting the long-term health, social, and
economic costs of child abuse and neglect
-Educating our culture about the importance of child
development via the schools (high schools and colleges
medical school and residency training)
-Multidisciplinary teamwork to develop new approaches
to teaching child development, recognizing and treating
child abuse and neglect and domestic violence, and treating
parents impaired by alcohol, illicit drug abuse, or mental illness
REFERENCES
 http://wichildrenstrustfund.org/files/Wisco
nsinACEs.pdf
 http://www.paltech.com/web/NCCAN/files/Merrick%20AC
ES%20Webcast%20CLEARED.pdf
 http://www.cdc.gov/ace/
 http://friendsnrc.org/