ACEs: Adverse Childhood Experiences -- and Problems for a Lifetime
By Lloyd I. Sederer, MD; 11/13/2013
The Born This Way Foundation is opening doors for many youth to have the full life they are born to live. Many youth experience events in their early life, through no choice of their own, which can be deeply stressful to a developing mind and brain -- both highly sensitive to beneficial and detrimental influences.
ACEs are "adverse childhood experiences" that can usher in a lifetime of misfortune -- and frequently then pass troubles on to succeeding generations. These are events beyond a young person's control.
The principal types of ACEs are abuse, neglect and seriously troubled households. More specifically, ACEs are emotional, physical and sexual abuse; emotional and physical neglect; and homes that have domestic violence, or mental and/or substance (alcohol or drug) disorders, or parental separation or divorce, or a family member who is incarcerated. While ACEs occur before the age of 18, their effects can endure.
Doreen, for example, was born of a teenage mother who was herself physically abused and suffered severe traumatic stress disorder. By the time Doreen was 14 she was markedly obese with pre-diabetes and using synthetic marijuana on a daily basis. She lived with her grandmother, who was physically disabled and unable to care for herself, no less Doreen.
Alberto, for example, was 15 and had behavioral problems in school dating back almost a decade. His father was in prison and had been a drug addict. His mother had divorced his father and her search for a stable male partner and father figure for her two sons yielded a series of unstable, volatile and sometimes exploitative relationships. Alberto had multiple school suspensions and was at risk for expulsion because of fights and truancy. He started using tobacco, alcohol and drugs when he was eleven.
The stories of these two teenagers are as tragic as they are common. They are the faces of the impact of ACEs -- in this or any other country. ACES put our youth, and the generations they spawn, at risk for developing many of the following conditions and problems:
- Alcohol and drug abuse
- Heart, lung or liver disease
- Sexually transmitted diseases (STDs)
- Intimate partner violence
- Smoking, including at an early age
- Suicide attempts
- Unintended pregnancies
As the number of ACEs a youth experiences increase, so too does his or her risk for these health and mental health problems -- often before they depart their teen years! In fact, the greater the number of ACEs a youth experiences -- and the presence of one ACE usually means there are others -- the greater the likelihood of multiple problems.
The initial study that identified ACEs was done almost 20 years ago, involving over 17,000 people, by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente Health Plan.
We can appreciate how a progression of consequences begins with one or more ACEs. These unwelcome and unavoidable (to the youth) experiences adversely impact that youth's social, emotional and cognitive (intellectual) development and foster increased rates of unhealthy behaviors including smoking, alcohol and drug use, indiscriminate and unprotected sex, a sedentary life style and a diet rich in sugar and fats.
ACEs seem to do their damage in two principal ways: First, by inducing a chronic stress response in the brain (and thus body), which lowers immunity to disease and is instrumental to the development of a variety of mental and physical illnesses -- as well as our capacity to recover from them.
Second, by the long-term disease-producing effects of behavioral and habit disorders. The combined effects of chronic stress and risky behaviors and habits induce a host of disease states and social problems, often by adolescence and, if not, by young adulthood. In short order, disease and disorder mount, limit functioning and quality of life, and go on to produce disability and early death.
With this degree of scientific information on the profound impact of adverse experiences on youth (and their later lives) it remains a puzzle that so few people know about this work. But lack of appreciation of ACEs is only one element in limiting the development of interventions to reduce their awful impact.
Preventing abuse, neglect and seriously troubled households are among the most daunting of social challenges to try to tackle. Yet their prevalence, and the suffering and cost these problems produce, are the measure of the necessity for our families and societies to find ways to intervene -- and spare youth from a life marred by pain and dysfunction.
The Born This Way Foundation, and its message to be brave and to be kind, is not daunted by challenges of this magnitude. Lady Gaga and Cynthia Germanotta, co-founders of the Foundation and daughter and mother, recognize social-emotional development as a crucial building block in the lives of youth, and have made this and what impacts it, negatively and positively, a focus of their work. In the future, I will report further on what they are doing to change the world for and through young people.
Dr. Sederer's new book for families who have a member with a mental illness, The Family Guide to Mental Health Care, published by WW Norton, is now available.
The opinions expressed here are solely mine as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company.