In 1995 Vincent J. Felitti, MD, the director of the department of preventive medicine at Kaiser Permanente (California HMO) began a collaborative study with Dr. Robert Anda, an epidemiologist for the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. The multiphase study, which is ongoing, was designed to measure the long-term effects of childhood trauma on adult health. Their first article, titled “The Relationship of Adverse Childhood Experience to Adult Health: Turning Gold Into Lead,” detailed the startling and very troubling results.
Commonly referred to as the ACE study, this cohort survey of over 17,000 adult respondents assigned an ACE score based on the presence or absence of negative childhood events in ten different categories including physical and sexual abuse, neglect, and various household dysfunctions. The results demonstrated very strong, linear correlations between adverse childhood experiences and negative adult outcomes. When subjects were determined to have high ACE scores they were found to suffer from chronic diseases and destructive behaviors such as: obesity, depression, early sexual activity, history of smoking, cancer and heart disease.
Likelihoods of negative outcomes were determined by measuring outcomes of high ACE scores versus subjects with no ACE history. The following is a list of negative adult outcomes and their likelihood based on ACE score:
ACE Scores > 4
- Smoking – 2 times more likely
- Alcoholic – 7 times more likely
- Sexual activity before age 15 – 7 times more likely
- Cancer – 2 times more likely
- Heart disease – 2 times more likely
- Liver disease – 2 times more likely
- Lung disease – 4 times more likely
ACE Scores > 6
- Attempted suicide – 30 times more likely
ACE Scores > 5 (Men)
- Injectable drug use – 46 times more likely
One can look at these results and, as I did, assign these results to self-destructive behaviors that resulted from the childhood traumas, and not organic disease. And then I read a little farther…in respondents who showed high ACE scores but demonstrated no negative or self-destructive behaviors there was a 360% increased risk of ischemic heart disease, the number one cause of death in America. In other words, adults who are by all apparent measures well-adjusted, happy people still face a high risk of premature death as a result of the childhood traumas they seem to have overcome. The prime suspect for this result as well as the others is, of course, stress. But it is not quite simple. It is not the stress that causes the disease, but the poor stress management that was learned during these adverse childhood experiences.
The human stress response is a primordial reaction designed to manage acute short-term stress. It is the fight or flight reaction that helped us out-run the tiger when we were still wearing skins and foraging for food. It is a blunt instrument designed for one specific purpose and none other. The chronic repetitive stress that humans face on a daily basis while worrying about mortgages, relationships and careers, etc. poses an entirely different challenge to our bodies. It triggers the all-or-nothing chemical response that begins in the brain and ends in the adrenal glands, and it triggers it continually, day by day, week by week. The problem is, the human physiology knows only one way to deal with a stressful situation and, with chronic non-life threatening stressors, it is overkill, like sending the Marines to rescue a kitten in a tree.
It is precisely the way this chronic stress is managed that creates wear and tear and can cause harm to the body, mind and brain. The process of stimulating the acute stress response causes an elevation of blood pressure to provide blood flow to the muscles of the limbs for fight or flight, a rise in blood glucose levels to supply fuel for the reaction and inflammatory proteins to help respond to potential bodily injury. Triggering this process over and over again, day after day, can result in serious long-term consequences, including atherosclerosis, insulin resistance and diabetes, and the myriad of diseases associated with chronic inflammation – including cancers.
Adverse childhood experiences trigger these stress responses at a young age and allow the negative effects to accumulate over time – “It’s not the years, it’s the mileage.” Young children are especially vulnerable to pre-frontal cortex damage in the brain, which leads to executive function loss, which is seen as reduced cognitive functioning and poor emotional control. Thankfully, the pre-frontal cortex responds to intervention. Improving the environment to reduce stress and teaching stress management will lead to better executive functioning.
When I first read about this study and the results I immediately assigned this risk to lower income, high-risk community children. I was surprised to learn that the average age of respondents to the study was 57. The respondents were middle and upper middle class, 75% white and 75% attended college. This is clearly a condition that does not discriminate.
Much of what I discussed is worst case scenario and many children will not experience events of the magnitude that create the extreme stressors discussed in this article. But, it is important to understand that most children these days do experience some level of stress and must learn how to properly cope with it in order to grow and prosper healthfully. Meditation, prayer, journaling and having a confidante are some of the recommended ways to teach your child to deal with stress. Of course, as always, I believe good, whole food nutrition and vigorous exercise should play an important role in this process as well.
Lastly, as a parent, I realize that my child is sensitive to my behavior and will absorb some of the stress I have in my life if I am not diligent to protect him from that. He will also learn how to deal with his stress by watching me. I owe it to him to learn to manage my stress healthfully. It will be good for my heart and his.
* I learned of the ACE study while reading How Children Succeed by Paul Tough. This is a marvelous book that I recommend to any parent with school-age children or younger.
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