Child Abuse Prevention Month: What's the significance of an ACE score?

Less than 20 years ago, Vince Felitti, MD, and Rob Anda, MD, published the results of research that showed proof of a strong relationship between painful things that can happen in childhood – adverse childhood experiences, or ACEs - and health as an adult.

This evidence of long term effects on health was striking and the most compelling argument for preventing child abuse since another physician, Henry Kempe, MD, coined the phrase "battered child syndrome" in 1964. But Felitti's work was different -- while Kempe was showing doctors how to diagnose the most serious types of abuse from a child's physical symptoms, Felitti was telling us that experiences that seem to leave no physical scars actually do.

Fellitti's work evolved into what is now known as an ACE score, which is calculated simply by counting the number of these specific experiences. The list includes physical, verbal and sexual abuse; loss of a parent though divorce, death or incarceration; feeling unloved; having a parent with addiction or mental health problems and experiencing hunger. These initial ACE studies found that a higher ACE score is related to a higher probability of poor adult health, including links to heart disease, lung cancer, depression and use of alcohol and tobacco.

Like anyone else who first hears of the ACE studies, I quickly calculated my score and wondered if this meant that my adult health status was sealed. The answer is yes and no – while the correlations are strong, the actual increase in the numbers of cases of these diseases is thankfully still low.

For example, in a study on smoking persistence and ACEs the overall rate of persistent smoking was around 9 percent for the study population, but 10.4 percent for people with higher ACE scores. Adults with higher ACE scores need to monitor their health, treating their ACE score as a warning sign, like high cholesterol.

The decades of research that followed these initial ACE findings coincided with an explosion in medical technology and brain science. We now know that when a child experiences stress, his brain chemistry changes in ways that can affect his physical and mental health. But here's the good news -- loving, safe, and nurturing families and communities can offset the effects! When loved, hugged and cared for, children's brains experience physiological changes that are good for the brain and can counteract some of the effects of the stress-related changes. As educators and others working with children learn how to recognize the signs that child is suffering from toxic stress, unwanted behaviors from the child can be met with effective, specific interventions rather than punishment.

Every child deserves a great childhood, free of adverse childhood experiences, and we all have a role to play in making that happen. While we can't protect our children from every one of life's adverse experiences, we can ensure that they also experience the joy, safety and stability of warm, nurturing, caring relationships. Never underestimate the power of a hug.

Janet Rosenzweig, MS, PhD, MPA, is the Vice President, Research and programs for Prevent Child Abuse America  and the author of The Sex-Wise Parent and The Parent's Guide to Talking About Sex: A Complete Guide to Raising (Sexually) Safe, Smart, and Healthy Children. For more information, read her blog  and follow her @JanetRosenzweig on Twitter. 

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