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
- Teenage pregnancy
- Substance misuse
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.
About our blogger
Nina Vaswani is a Research Fellow with CYCJ, and the lead for the Research workstream. Find out more.