Not all ACEs created equal

Hi, Eric: This very much depends on the individual. The ACE Study, and subsequent population surveys such as the state BRFSS ACE surveys and the Philadelphia Urban ACE Study, look at the effect of ACEs on a population level. In the ACE Study, they found that no one type of ACE has any more deleterious effect than any other.

But on an individual basis, someone's experience of divorce may be much more profound than their physical abuse. It may take people decades of peeling the onion to realize that neglect had a much more profound effect on their lives than sexual abuse.

So, trying to determine which of the ACEs does more damage than any of the others is counter-productive in that it takes us to the place that our society is stuck in now -- the Whac-a-Mole approach to childhood maltreatment.

There's more on that here -- Childhood violence and the Whac-a-Mole effect.

Thanks Jane. I appreciate that consideration, and agree that on an individual basis, there is little merit to try and make assumptions that one experience is potentially less averse than another simply because we think it ought to be. 

Nevertheless, I also recognize, as you said, that as a science we are studying populations, and the study of ACEs is used often to help determine risk. If it was found that some of those risk factors were, for the population as a whole, more significant than others, than it would potentially require refining that process. To me, it would identify a need to revisit the process of identifying an "ACE score" - though I plan to look for the research you reference. If you have any links at the ready, please share.

Thanks for the speedy reply

Yep, to Felitti & Anda's surprise, the ACE Study found that no one ACE was more damaging than any other, population-wise. And, more important, it was the increasing number of types of ACEs....the ACE score....that resulted in the increasing risk for chronic disease, mental illness, violence, being a victim of violence, prescription drug use, and a host of other consequences. So...having one ACE is less risky than having four. And if you have four, it doesn't matter which four. 

Of course, since the ACE Study measured the original 10 ACEs, other surveys have added racism, bullying, witnessing violence outside the home, living in an unsafe neighborhood, and involvement with the foster care system as other ACEs.

And then there's the added consideration of resilience factors -- early data suggests that a high ACE score can be ameliorated by a high resilience score.

But the message I take from all of this is: let's change our systems so that we're responding and assisting earlier, at the first warning signs, until waiting for serious damage to be done to children and adults! And let's make sure the organizations, systems and communities that we work, play, pray and live in aren't toxic, but resilient and self-healing.

Jane (& Eric), Has any significant (correlative) data come out of the World Health Organization's (WHO) 2013 Assessment of the world's healthiest children using their expanded list of ACEs on the WHO ACE International Questionaire [found on their website] ? ? ?

Not that I know of, Bob, but I will pursue!!

Eric, I tell the story this way. My girl friend and I have 7 children between us. ACE scores run from 2 to 6. There are 4 with auto immune disease and 2 with addictions. All symptomatic during their teens.   My girl friend and I are part of 11 siblings. ACE scores run from 0 and up. There is one auto immune disease and one addiction. Symptomatic in their 30s.  The difference between the family sets are our parents were married until the day they died. 

We live in different times. I suggest reading Alice Miller's book "The Body Doesn't Lie" if you plan on assisting people through ACEs awareness.  That's what my children are getting for Christmas this year.

Divorce puts children at risk for many more adversities of new sorts.  How do we support parents to reduce adversity when our institutions created to help in fact have outdated practices stuck in a rut with harmful outcomes to children: ACEs.  The Duluth Model's new "Post Separation Power and Control Wheel" documents what mothers are up against when they ask for help.  Also, some schools and therapists are screening for some adverse childhood experiences, but tests vary and the results might do more harm than good as they keep powers and institutions less traumatized than individual children. 

Thanks for the comments, everyone. I think I erred in how I phrased my question, leading some to believe that I was implying that divorce is somehow less of a stressor. My point, however, was instead that experiencing parental divorce may be "qualitatively different for many than continued physical abuse" and was using that as an example - you could say the same for all of the ACEs.  The idea that was that we are considering every stressor within the ACE survey as having equal weight in a risk formula, so I thought it would be good to discuss that from a scientific perspective. 

For example, check out this study, particularly Table 2 http://jamanetwork.com/journal...a/fullarticle/194504

Very interesting study-especially Table 2.  Since I work in corrections, I have always been interested in the incarcerated family member ACE.  What I have found, at least here in MN, is that particular ACE rarely stands alone.  So when I look at a group of students who identify incarcerated family member as their experience, I am almost always going to find numerous other adverse childhood experiences listed also.  Not true with the separation/divorce question.  That one often stands alone.  So, while I am not surprised to see the high connection to prevalence to attempted suicide, I also wonder if those who list parental incarceration also list numerous other ACES. 

How have you found that it stands alone, Lori?

I've found that if there's divorce, there are other ACEs, but many people don't think that living with a parent who drinks too much or who's depressed are ACEs. And that it sometimes takes a while before people understand that the times that their mother was sleeping off another "secret" (i.e., we don't talk about mom's drinking) bout with booze and dad was at work, and they were going hungry and hadn't had a bath and didn't have clean clothes and were left to take care of themselves in the back yard, that that was neglect.

Jane,

Just my experience here in MN talking about the original 10 ACES and discussing our experiences in class and the many collaborative groups I am involved in. I have had many-including myself, have 1 ACE and divorce or separation of a parent be it, although certainly no research to back that up; strictly antidotal.  I do see your point, although the ACE study didn't really delve into collateral contact regarding the test taker's own answer to the 10 questions. So part of the study I guess really is the test taker's perception as to what they were or were not exposed to as a child. Kind of brings a whole new aspect to the study! Like, do those of us who truly believe our parent's divorce was NOT based on drug or alcohol use, depression or mental illness, or domestic violence deluding ourselves? Do we truly have multiple ACES and bury it? Or is it a form of resiliency that we don't or didn't observe those issues?  More to think about.

In MN, a group I work with Strengthening Families Affected by Incarceration were able to get 2 questions added to our MN Student Survey, which is given to almost every student in the state, unless they opt out, that asks numerous questions, many related to ACES and also poses questions that are suppose to measure "well being" factors.  Anyway, we had the question of "Do you now have a parent or guardian incarcerated?" and "in the past, have you had a parent or guardian incarcerated" and used that information to measure school  consecutiveness, mental health and chemical health.  There are info graphs on our website done by Wilder research, who were a partner in the project. www.familiesaffectedbyincarceration.org

Anyway,  this is where my perception that incarceration of a family member generally comes with multiple yes answers in the ACE questions.

Thank you for giving me even more to think about!!

Lori

Those graphs are really interesting. Thanks for the link, Lori. Did the MN Student Survey publish the ACE results separately?

Also, I think it's really valuable to show the link between incarceration and other consequences. However, the solution that's often proposed after looking at a particular ACE is to focus on eradicating or reducing that ACE, when the ACE Study showed that any combination of ACEs results in health consequences. That's why focusing on violence prevention only won't stop violence. Here's an article that addresses that:
https://acestoohigh.com/2016/0...-childhood-violence/

I know many state entities such as public health and Dept of Education use the survey information, but I am honestly not sure what has been published or by whom.

Thank you for the link!  I didn't mean to imply that isolating an ACE to focus on was a good strategy.  I think it is difficult for those of us who work in an ACE entity such as corrections, to be able to figure out how to contribute to the overall cure without giving more focus to the symptom we are surrounded with every day.  The world of government silos.

Thanks, Lori.

And, yep, the silo issue is a big one if we're going to prevent ACEs!

Why does it not seem to matter which of the ACEs a person has?  The adverse experiences do not cause the illness and lifetime medical and mental health issues that were reported outcomes. The reported ACE score is an indirect measure of exposure to adrenaline and cortisol in the developing brain of children age 0 to 18 years.  Children with areas of their brain without solid connections are more at risk for a variety of harm.  The logic is:  the more different trauma a child experiences the more their brain has elevated levels of adrenaline and cortisol.  Resilience as the experience of  comforting, valuing adults reduces the duration and amount of adrenaline and cortisol levels.  Lower adrenaline and cortisol allow the brain to get a more complete set of neural connections. The more neural connections the more likely the adult will make healthier choices and engage in less risky behavior. It is still possible for a child with large numbers of ACEs to obtain resiliency but a high ACE score could make it less likely the child will obtain resiliency.