Adverse Childhood Experiences: A Public Health Crisis

Adverse Childhood Experiences: A Public Health Crisis

Adverse Childhood Experience’s (ACEs) are classified as stressful or traumatic events happening in a child’s life including, but not limited to: physical abuse, emotional abuse, neglect, mental illness present in the household, divorce, or substance use disorders. There is a strong, direct relationship between ACEs and poor health outcomes. People with ACEs are notable more likely to contract conditions such as cancer or heart disease, and are a disturbing twelve times more likely to attempt suicide. In addition, risk for adverse health outcomes increases with each additional ACE. Considering that nearly half of all children in the United States have experienced at least one ACE in their life, it appears that Adverse Childhood Experiences are a public health crisis. This raises a question—why are health professionals not paying more attention to the non-physical things going on with their young patients? If ACEs put patients at higher risk for heart disease, cancer, suicide, substance abuse, and risky sexual behaviors, why is this not a primary concern in healthcare?

The Center for Disease Control launched a groundbreaking study aimed at exploring possible links between childhood trauma and health problems in adulthood. They found a direct relationship between ACEs and adult onset of chronic disease, violence and being a victim of violence.  With the national rate of ACEs coming out at 47.9%, this indicates that almost half of the childhood population in the United States is at an increased risk of adverse health outcomes. There are several possible reasons that this issue is not being appropriately addressed.

Initially, one may think that people are choosing to ignore the problem because they think it only affects populations who are already high risk: minorities, immigrants, and low SES families. However, when you look at the data, it shows that ACEs happen across all SES classes and all races. This then shifts the perspective.  What if people are choosing to ignore this issue precisely because it hits so close to home? This is not a problem that can be fixed with vaccinations or medication. It is an epidemic that requires consistent, long-term care from families and healthcare providers. Children are at risk because of their environments and their experiences, and there is no one place to point a finger. In order for people to start making changes to stop these ACEs, they must first take responsibility for being a contributor. That is where you run into obstinacy.

In addition, there may be push-back from healthcare workers claiming that there is not a true causal relationship between ACEs and negative health outcomes. Rather, they believe these kids have behavioral problems that cause them to make poor choices in their adult life which results in these poor outcomes. However, there is data to backup the theory that there is a directional relationship. When a stressful event occurs, especially at a young age when the brain is still developing, a fight-or-flight response is induced and causes heart rate and blood pressure to increase, lungs to expand, pupils to dilate, and excess amounts of cortisol hormone to be released. When children experience a chronic adverse event in their life, their body is constantly thrown into this defensive response. Having this constant stress reaction can cause problems with brain development, immune system development, and hormonal development. These stress reactions are literally changing how a child’s body and brain develops, and is the root of the many problems that can occur later in life.

Children who have experiences ACEs have shown abnormalities in brain regions involved in memory, negative emotions, and attention regulation. The implications of abnormalities in these structures are vast, ranging from attention problems such as ADD or ADHD, all the way to suicidal behaviors.

It’s time to care for patients with holistic respect, and treat problems at their root versus tending to the symptoms. Adverse Childhood Experiences are a public health crisis affecting half of the United States’ youth. Fortunately, the treatment can begin at an individual level, and it is our job to look out for the well being of the children in our lives and intervening when we see them in a dangerous situation.

If you have more questions about Adverse Childhood Experiences, you can check out Nadine Burke Harris's TED Talk on Childhood Trauma and Health or read the CDC study on ACEs