Biology
Adversce Childhood Experiences (ACEs) and toxic stress literally get “under the skin.”
The landmark study that started it all
The landmark Centers for Disease Control & Prevention (CDC)-Kaiser Permanente Adverse Childhood Experiences (ACE) Study in the mid-1990s proved the link between ACEs and the increased probability of disease, disability, and adverse life outcomes. Hundreds of subsequent studies in the decades since have broadened the scope and deepened our understanding of ACEs.
Three big takeaways from decades of research that revolutionized the way we look at childhood adversity are:
A lot of us experience ACEs
About two-thirds of the 17,000 adults in the original study had experienced at least one of the ten ACEs identified in the study, and over a third had experienced two or more. It also showed that ACEs affect all communities, regardless of race, culture, or socio-economic status. Later studies showed some populations are more greatly affected than others.
Toxic stress changes our bodies
Toxic stress literally changes a child’s brain and body in ways that can increase our risk of illness, and make life more challenging, whether or not we’re engaging in high-risk behaviors.
The effects of ACEs are cumulative
The higher our number, the greater the probability we may experience the effects. ACEs are strongly associated with 9 out of the 10 leading causes of death in the U.S. and over 40 common health conditions.
A paradigm shift
The discovery of a link between ACEs and the probability of negative health — and life — outcomes prompted a paradigm shift. Childhood adversity could no longer be swept under the rug; it affects so many of us, can have serious short and long-term impacts, and is heavily influenced by systemic factors and our living conditions. The effects of toxic stress brought on by ACEs have societal, health and well-being, and economic costs that affect millions of people and cost billions of dollars in the United States alone.
Original CDC-Kaiser Permanente ACE study
The Centers for Disease Control & Prevention (CDC)-Kaiser Permanente Adverse Childhood Experiences (ACE) Study is one of the largest investigations of childhood abuse and neglect and household challenges and later-life health and well-being. The ACEs Study was conducted in the mid-1990s involving over 17,000 Southern California Kaiser adult members. If you’d like to learn more about the original study, explore the link below:
Beyond the 10
Since the mid-1990s when the original ACEs study was conducted, the medical and scientific fields have learned a lot about the impact of other childhood adversities that weren’t identified in the original study. These include other childhood risk factors for toxic stress such as discrimination, poverty, and racism.
We’ve also learned that economically disadvantaged groups, communities of color, LGBTQ communities, immigrants and refugees, and children who were involved in the criminal, legal or child welfare systems are disproportionately impacted by ACEs and toxic stress. We also know that these populations have other risk factors for toxic stress, increased incidence of ACE-associated health conditions, and barriers and/or decreased access to buffering resources due to structural or systemic factors.
This list describes some of these common and impactful childhood adversities:
Beyond the 10 ACEs
Discrimination
Poverty
Racism
Other
Violence
Violence
Intergenerational
and Cultural Trauma
and Cultural Trauma
Separation
Adjustment or Other
Major Life Changes
Major Life Changes
Bereavement
and Survivorship
and Survivorship
Adult Responsibilities
as a Child
as a Child
Discrimination based on race, ethnicity, gender identity or sexual orientation (such as LGBTQ+), religion, learning differences, or disabilities
Poverty, chronic economic hardship and material deprivation
Racism, systemic and institutional
Other violence, like getting bullied, experiencing violence yourself, or seeing others get hurt in your neighborhood, community or school
Intergenerational and cultural trauma, like the displacement and genocide of indigenous people, slavery, and the Holocaust
Separation from a parent or caregiver because of immigration or foster care
Other big changes in life, like migration or immigration, being a refugee or seeking asylum, moving to a new area where you don’t know anyone, or separation from someone important to you
Bereavement and survivorship, like having a relative or caregiver die, or surviving an illness, injury or accident, or natural disaster
Adult responsibilities as a child, like caring for someone who’s sick or disabled, or being the one responsible for getting food on the table at a young age
From the American Academy of Pediatrics: The Impact of Racism on Child and Adolescent Health
From the National Academies of Sciences, Engineering and Medicine: A Roadmap to Reducing Child Poverty
Resilience
Resilience is our ability to endure or recover from stress, and it’s built on a variety of different levels: biological, social, and emotional.