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The Adverse Childhood Experiences study, authored by Dr. Vincent Felitti and Dr. Robert Anda and funded by the Centers for Disease Control, helps to clarify the underlying, long-term, and multigenerational impact of seven categories of adverse childhood experiences: physical, sexual or psychological abuse as a child, or living as a child in a household with a member who was: mentally ill, imprisoned, a victim of domestic violence, or a substance abuser. In the largely middle-aged, middle-class, educated population who were the subjects of this study, - the largest study of its kind ever done to examine the effects of childhood adversity over the lifespan - only 48% of the population had no categories of adverse childhood experiences. Two-thirds of the women in the study reported at least one childhood experience involving abuse, violence or family strife. One in four was exposed to two categories of abusive experience, and one in 16 to four categories. The authors found a strong, graded relationship to the number of adverse childhood experience categories and a wide range of physical, emotional, and social problems including: smoking, chronic obstructive pulmonary disease, hepatitis, heart disease, fractures, diabetes, obesity, alcoholism, fifty or more sexual intercourse partners, other substance abuse including IV drug use, depression and attempted suicide, teen pregnancy (including paternity), sexually transmitted diseases, rape, hallucinations, poor occupational health and poor job performance. According to the authors – and to a growing body of research – adverse childhood experiences lead to disrupted neurodevelopment in early childhood which then leads to emotional, cognitive, and social impairment in childhood and adolescence. These impairments leave children vulnerable to the adoption of many different health risk behaviors which lead directly or indirectly to a variety of diseases, various forms of disabilities, and social problems – and eventually early death. The bottom line is that adverse childhood experiences determine the likelihood of the ten most common causes of death in the United States. With an ACE Score of 0, the majority of adults have few, if any, risk factors for the diseases and problems mentioned above. However, with an ACE Score of 4 or more, the majority of adults have multiple risk factors for these problems or the diseases themselves. As the authors of the study state, “ACEs are the leading determinant of the health and social well-being of our nation”. What is remarkable is that the majority of people reading these words will not have heard of this study – arguably the most significant public health study ever done. The press have only given it minimal if any coverage, the government has taken little notice, the President has not held a press conference. In a way, it is simple, “Hurt people, hurt people” and the solution is to stop the infliction of pain on children. But I recognize that the road from childhood adversity to adult disease is a complex one, and the solutions to the problem of child maltreatment will be similarly complex because the solutions must successfully address virtually every social problem we have. After so many years of immersion in this knowledge, it all seems so obvious to me, and the solutions farther away than ever because the solutions are not medical or even social – they are economic and political. The ACEs study has received so little attention because it is so straightforward and clear in the enormity of its implications. In the present political climate I see no indication that we will mobilize the resources required to devote ourselves to what is needed – a Manhattan Project directed at minimizing childhood adversity, not building more weapons of mass destruction.
For more information about the ACEs study go to: http://www.cdc.gov/nccdphp/ace/ Video about the ACEs Study made by Cavalcade Productions
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