Adverse Childhood Experiences (ACEs) & Developmental Trauma
Adverse Childhood Experiences
Vince Felitti at US Health insurer and provider Kaiser Permanente discovered the relationship between Adverse Childhood Experiences (ACEs) and adult health problems. In following up the drop-out rates from obesity clinics, he discovered a high proportion had been sexually abused as children, and weight gain was a strategy for self-protection1. Kaiser Permanente (a US health insurer and provider) subsequently conducted the ACE Study of > 17,000 participants2.
The current ACE Questionnaire, identifying the experiences defined as ACEs, is replicated here. Caution should be taken by any reader with PTSD as there is risk of re-traumatisation by reading this.
Risk if 0 ACES
|Increased risk with ACEs|
|1 ACE||2 ACEs||3 ACEs||4+ ACEs|
|Severe obesity BMI >35||5.4%||+ 30%||+ 75%||+ 90%||+ 120%|
|Ever attempted suicide||1.2%||+ 100%||+ 250%||+ 700%||+ 1400%|
|Considers self an alcoholic||2.9%||+ 100%||+ 250%||+ 300%||+ 450%|
|Ever injected drugs||0.3%||+ 65%||+ 360%||+ 660%||+ 1000%|
|Heart attack||+ 40%||+ 120%|
|Cancer (any)||+ 90%|
|Chronic bronchitis/ emphysema||+ 60%||+ 60%||+ 120%||+ 290%|
Table 1. Increased Risk of Serious Health Issues compared with Adverse Childhood Experiences1
Similar research has been repeated in other areas, including England3 and Wales4 :
The ACE Pyramid6 illustrates how ACEs can lead to early death, and how the disrupted neurodevelopment that stems from ACEs is the cause of issues developing later in life:
The evidence indicates that it is the cumulative effect of 4+ ACEs that has a multiplying effect on the risks of adverse outcomes.
Looked-after children are more likely to have experienced multiple ACEs, by definition of the Children Act threshold7, that “A court may only make a care order or supervision order if it is satisfied that the child concerned is suffering, or is likely to suffer, significant harm.”
Developmental Trauma is the childhood version of Complex Post Traumatic Stress Disorder (PTSD).
The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5)8 recognises Post Traumatic Stress Disorder (PTSD).
Complex PTSD is not recognised by DSM-5, but is recognised by the NHS9 and Mind10 as a form of PTSD arising from multiple traumatic events. CPTSD often results in additional emotional and physical symptoms such as difficulty regulating emotions, feelings of shame, body pains.
Dr Bessel van der Kolk, founder of the Trauma Center in Boston, has been instrumental in campaigning for Developmental Trauma to be recognised as a diagnosis11.
His criticism of the current PTSD diagnosis is that it “is not developmentally sensitive and does not adequately describe the effect of exposure to trauma on the developing child.”
1Felitti, Vincent J. “Childhood sexual abuse, depression, and family dysfunction in adult obese patients: a case control study.” Southern medical journal 86.7 (1993): 732-736.
2Felitti VJ, et al., “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study.” American Journal of Preventative Medicine 14.4 (1998):245-258.
3Bellis, Mark A., et al. “Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: a national survey.” Journal of public health 37.3 (2014): 445-454.
5Bellis, M. A., et al. “Welsh Adverse Childhood Experiences (ACE) Study.” Adverse childhood experiences and their impact on health-harming behaviours in the Welsh adult population. NHS Wales (2015).
6Retrieved from httpss://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/about.html 25/9/19.
7Children Act 1989, S31 (2)(a).
8American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub, 2013.
11Van der Kolk, Bessel A. “Developmental trauma disorder: toward a rational diagnosis for children with complex trauma histories.” Psychiatric annals 35.5 (2017): 401-408.
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