An ACE up your sleeve?

Adverse Childhood Experiences (ACEs) are increasingly associated with poor life outcomes. Nina Vaswani talks about what’s classed as an ACE (you might be surprised), with a focus on childhood bereavement and CYCJ research, findings from which will be published soon. 

What’s your ACE score? Do you know? I’m not telling you mine, but I will reveal that it’s greater than 1, along with more than one-in-four of the population according to a study carried out in England.

ACEs stands for Adverse Childhood Experiences. The ten most often measured adverse experiences can be categorised as abuse (sexual, physical and emotional); neglect (physical, emotional); and household dysfunction (parental separation, domestic violence, household substance abuse; household mental illness; household imprisonment). Over the past 20 years an increasing ACE ‘score’ has been associated with a whole range of health-harming behaviours and negative health outcomes, including:

  • Heart disease
  • Smoking
  • Teenage pregnancy
  • Diabetes
  • Stroke
  • Substance misuse
  • Suicide

The cumulative effect of ACEs is that people with a large number of ACEs are at in increased risk of premature death.  Up to 20 years can be taken off the life expectancy of someone with a high ACE score.

“Woah!” I might hear you say. “Are you not worried about your ACE score?”  Or you might be thinking “So what? I’ve experienced ACEs and I don’t go around abusing drugs.”  Both are equally valid points.  The ACEs research is robust, and has been hugely important in raising awareness about the lasting impact that adversity in childhood can have, but a high ACE score need not be a ‘life sentence’ and there are some limitations to the application of ACEs too.

Firstly, the ACEs framework is a good indicator of childhood adversity but it is, by its nature, a simplistic measure.  Calculating an ACE ‘score’ doesn’t tell us much about the nature, intensity and duration of adversity or what support someone might need.  For example, while any traumatic or abusive event can have a long-lasting impact, sustained emotional abuse may leave a different lifetime imprint to a one-off verbal assault.

Also, everyone responds to adversity differently.  There will be individual characteristics and qualities that might help someone be more resilient to life’s challenges and traumas, such as temperament or cognitive style.  There may also be mediating or mitigating factors.  ACEs research is now beginning to consider whether the presence of a consistent, positive and appropriate adult may be one such factor, and early findings from England and Wales suggest that an ‘Always Available Adult’ can have a significant ameliorating effect on ACE exposure. These findings are also useful in helping suggest directions for policy and practice in relation to ACEs, something which was missing in the early ACE studies.

There are also important adverse experiences that are not typically included in ACE studies. Those of you who are aware of my research will not be surprised to hear that I think childhood bereavement is the most obvious one.  There are others too, and it is important to remember that even seemingly innocuous events can have a lasting impact, especially if they are part of a wider pattern of adversity and trauma.

Despite this the ACEs research has, albeit in a slow-burn over two decades, become increasingly influential.  The simplicity of the ACE construct, while in some respects a limitation, has also helped provide a powerful message to policymakers, practitioners and the general public alike. Some people may worry that ACEs stigmatise and label children as ‘damaged’, or that the pervasiveness of ACEs across all strata of society might play down the effects of abuse, neglect and adversity on some of our most vulnerable children.  However, I think that anything that raises awareness of and increases understanding of the experiences of children and young people can only help to make our society a more tolerant and resilient place and help people feel less alone.  I know from my research with bereaved young people in HM YOI Polmont that their backgrounds are filled with multiple and traumatic bereavements, and that young people feel terribly isolated and shameful about their experiences.  Hearing through groupwork that other young people had been through similar experiences was a powerful revelation on their journey through their trauma and on towards recovery, and also helped change the way they viewed and interacted with their peers:

“Going to that group I realised I wasn’t the only one that had bad things happen to them in their life…It was eye-opening ken what I mean? …from my point of view it was like, ken when you wake up you know you’re not the only one caught in that eh? It was sort of like a relating thing, you kinda feel like you can understand how they feel and it felt good to feel that way, feel like you can relate to them in a way that not a lot of people can.”

The language of ACEs is becoming common parlance, and there has even been a film made about how the ACEs research has developed, which has been screened in towns and cities across Scotland this summer as well as at film festivals across the world. Hopefully, as society begins to better understand the drivers of negative or harmful behaviours, we can improve how we support the people we come across in daily life, whether they are our family, friends, neighbours, colleagues or service users.

CYCJ Research into Adverse Childhood Experiences

Of interest to us at CYCJ is that mounting adversity is also associated with an increased risk of violence (as victim or perpetrator) and imprisonment, as well as the harmful health outcomes outlined above.  Over the past few months we have been undertaking our own research into the childhood experiences of young people who have been referred to our IVY service, for young people who present a high risk of harm to themselves and others.

We’ll be publishing our findings later this year, but we certainly found elevated exposure to adversity in our young people (when bereavement was included young people had experienced on average around five ACEs).  We also found what we think might be some gender differences in relation to ACE exposure among people in the youth justice system, but also in how individuals, professionals and society may respond to males and females who have experienced adversity.

Keep an eye on the CYCJ website and our e-bulletin for more information coming soon.

About our blogger

Nina Vaswani is a Research Fellow with CYCJ, and the lead for the Research workstream. Find out more.


5 responses to “An ACE up your sleeve?”

  1. Derek McCabe says:

    An insightful read into the effects of ACE. We at Reach Advocacy see the effects of this in the adult population we work with (Substance use and mental health). We just started an SQA Advocacy Training programme in HMP Barlinnie and the 6 candidates stories converge with your findings. We are using advocacy and rights to help shine a light on ACE and other environmental factors that can adversely influence development throughout the life-course and quality of life. We look forward to reading your findings and hopefully some of the recommendations can transfer equally to the adult population prison population.

    • Nina Vaswani says:

      Thanks for the feedback Derek. Good to hear our work chimes with your experience – I have absolutely no doubt that there are strong parallels with the adult prison population. It sounds like your work is important in raising awareness of the impact of ACEs.

      • Derek McCabe says:

        Apologies for the delay in responding Nina. Thank you taking the time to reply, there is such an overlap in adult prison population and I think this supports the work being carried out by yourself and others on ACE. We are hoping to take the findings from such research and to look at how we can include some of the approaches in the adult population. I hope yo don not mind, we have referenced your work in a blog for the CYJC and we look forward to reading the completed report in HM Polmont. Kind Regards

  2. Emer McCarry says:

    Interesting but wondering why separating a child from all they are familiar with is not included as an ACE ? If a baby loses his mother through adoption he loses the physical , social emotional and genealogical link with who they are. I am referring to children who were removed from their natural parents and never have contact or any information about them. They also not only lose their mother but their father, possibly other siblings, grandparents and so forth. If that child has no connection with their medical social, family, spiritual history how will they ever know who they are and where the have come from? How do you present as having suffered a loss when you were so young that you could not verbalise or articulate that loss? In my experience this trauma is generally unrecognised for the natural parents (and extended family) or the child who is lost to adoption and they are stigmatised marginalised and never recognised therefore they remain parents to loss. Their children show up in mental health and criminal justice where I work and no one seems to make a connection with the fact they were traumatised when removed from all they knew in the world. When will this trauma be acknowledged and validated ?

    • Nina Vaswani says:

      Hi Emer. Thanks for taking the time to comment. I absolutely agree – in the blog I discuss some of the limitations of the ACE framework, and one is that the simplicity of the framework cannot capture the complexity and breadth of human experience. I highlight bereavement as a missing ACE, but, as you quite rightly acknowledge, separation from birth family is another. You have eloquently described the fact that separation and loss, even at a very early age can have a lifelong impact on young people (and for their wider families too). In some ways these losses can be just as hard, if not harder, to deal with than bereavement as they can be more ambiguous, and there often isn’t a shared family history or memories from which to base work. However, if these losses are directly acknowledged and handled sensitively then practice in this area can be, and often is, good. It is also worth noting that the ACE framework, even with its limitations, is doing a lot to raise awareness of the impact of adversity and trauma among individuals and professionals that may not have previously considered that connection. That in itself is hugely valuable.

      It is also possible to incorporate what we know are other ACEs in to your work with people – many ACE studies/questionnaires vary on the combination of ACEs included. Good luck with your work.

      Nina

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