By Bryan Amaro, Photo: Unsplash, University of San Diego, Digital USD, May 28, 2022
Background and Significance
Adverse Childhood Experiences (ACEs) have been well-studied for over 20 years, with the seminal research performed in San Diego, CA, through Kaiser Permanente and MD internist Vince Felitti in 1998. ACEs are potentially traumatic events that occur during childhood before 18 years of age (Felitti et al., 1998). The stress response is a normal part of life, and is the bodies response to a threat, challenge, physical or psychological obstruction (Hustedde, 2021). The stress response physiologically starts in the brain via the amygdala, hypothalamus and pituitary gland. Outside of the brain it involves the adrenal glands releasing epinephrine and cortisol. This process results in elevated blood pressure, blood sugar, and suppresses the immune system (Johnson et al., 2021). A colloquial phrase termed for this phenomenon is the “fight or flight” response. All people experience various levels of stress at different durations and intensities (Beal, 2019). ACEs are strongly associated, in dose-response fashion with many of the most common, serious, and costly health conditions our society is facing today, including nine of the ten leading causes of death in the United States, and earlier mortality expectancy due to its chronic unrelieved duration and intensity (Merrick et al., 2018). One of the principal reasons ACEs can cause extensive damage involves their relationship to the toxic stress response which develops when one is chronically experiencing unrelieved stressed (National Scientific Council, 2014). The toxic stress response leads to lasting and serious stress, which is exacerbated without support from a loved one or caregiver (Johnson et al., 2021). Some doses of stress are healthy and expected during childhood; however, the chronic exposure to high doses of adversity during sensitive and critical times of early development without caregiver support create an environment for long term damage to occur (Beal, 2019). Increased doses of cumulative adversity lived through childhood years during early development create long term disruptions in the brain, immune, hormonal, and metabolic systems usually through genetic functions (Bucci et al., 2016). Research has demonstrated that children experiencing severe and long-term abuse have smaller brain sizes (Brown et al., 2009).
Over the years the original study has been replicated and repeated on various socioeconomic demographics given that the first study was done on mainly White, middle class, college educated adults, with private insurance. Subsequent studies have found even higher prevalence of ACEs with groups who are typically marginalized such as Black, Hispanic and Native Americans (Liu et al., 2020). Because ACEs have been linked to many detriments and impediments to living a healthy long life, especially with minorities, over 37 states and the District of Colombia have adopted or passed legislation related to ACE screening and interventions (National Conference of State Legislatures, 2022).
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