What are Adverse Childhood Experiences (ACEs)?

An introduction to a series.

By Joseph Zanga, M.D., FAAP, FCP

You have likely heard the term. Perhaps you’ve used it in speaking about a patient. It may even be part of your childhood. Whatever the connection, I ask that you now pause and reflect as we move through this Introduction, which will include an ACEs Survey. We’ll consider in the next article the short and long-term associated health risks, then Resilience and its meaning, and finally how to promote it, even moving beyond your practice to the community, especially the schools and Faith community, in order to prevent and ameliorate ACEs.

Stress comes in many forms, and I’ll start with a simple example:

You’re having a peaceful walk through a coastal nature preserve and suddenly coming toward you is a hungry-looking alligator. You’re frightened, and your heart begins to race, blood pressure rises, respiratory rate increases, you’re sweating profusely. Acute stress! But the alligator turns away into the water, and you relax. Distressing, but no harm is done.

On the other hand, you’re a child who daily faces an angry and physically punitive parent who never seems to turn away from causing you to fear for your safety. Chronic stress produces the same physiologic responses as did the alligator but the effect may linger for a lifetime. Parental abuse is an Adverse Childhood Experience (ACE) but just one of many possible.

Look no further than the year 2020s headlines. Covid-19, schools closed, no friends with whom to interact, distressed parents, never-ending conflicting reports of what was happening and what to do. And all this impossible for the average child, with his/her underdeveloped intellectual capacity, to interpret. More unremitting, chronic stress!

Need to know more? While there are many, below is the most commonly employed ACEs Survey. Please review it and answer how it might apply to you:

ACEs Survey

Prior to your 18th birthday: 

  1. Did a parent or other adult in the household often or very often... Swear at you, insult you, put you down, or humiliate you? Or act in a way that made you afraid that you might be physically hurt? Yes/No

  1. Did a parent or other adult in the household often or very often... Push, grab, slap, or throw something at you? Or ever hit you so hard that you had marks or were injured? Yes/No

  1. Did an adult or person at least 5 years older than you ever...Touch or fondle you or have you touch their body in a sexual way? Or attempt or actually have oral, anal, or vaginal intercourse with you? Yes/No

  1. Did you often or very often feel that ... No one in your family loved you or thought you were important or special? Or your family didn’t look out for each other, feel close to each other, or support each other? Yes/No

  1. Did you often or very often feel that ... You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? Or your parents were too drunk or high to take care of you or take you to the doctor if you needed it? Yes/No

  1. Were your parents ever separated or divorced? Yes/No

  1. Was your mother or stepmother:
    Often or very often pushed, grabbed, slapped, or had something thrown at her, or sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? Or ever repeatedly hit over at least a few minutes or threatened with a gun or knife? Yes/No

  1. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs? Yes/No

  1. Was a household member depressed or mentally ill, or did a household member attempt suicide? Yes/No

  2. Did a household member go to prison? Yes/No

Now add up your “Yes” answers. This is your ACE Score 

Most people have at least one ACE. Some have 4 or more. Next week, we’ll explore the medical meaning of the score and the danger of ACEs.

Learn about the meaning of your ACEs score in part two of the Adverse Childhood Experiences Series.

Want to learn more about ACEs?

Exclusive to ACPeds Members and Physicians, join us this summer for a CME accredited series on Adverse Childhood Experiences.

By Joseph Zanga, M.D., FAAP, FCP

Joseph Zanga, M.D., a past president of the American Academy of Pediatrics (AAP) and the American College of Pediatricians, is a specialist in pediatrics, and the retired Chief of Pediatrics for Columbus Regional Health/Columbus Children’s Hospital in Columbus, Georgia. He was a member of the Board of the Medical Institute for Sexual Health and served an extended term on the National Advisory Council of the National Center for Primary Care at Morehouse Medical School. His most recent completed appointment outside the Columbus community was to the National Advisory Council of the National Institutes of Child Health and Human Development of the NIH. Dr. Zanga has focused on several major issues, including preprofessional education, workforce, child abuse and other violence prevention, substance abuse prevention, children and the media, sexually transmitted infections/adolescent health, and financial access to health care for all children. He also promotes the importance of family for the health and well-being of children. Continue reading...

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