Do you know your ACE score?

Do you know your blood pressure or your cholesterol score?  Do you know your own ACE score?  Adverse childhood experiences (ACEs) are stressful or traumatic experiences, including abuse, neglect, and a range of household dysfunction such as witnessing domestic violence, or growing up with substance abuse, mental illness, parental discord, or crime in the home. ACEs are strongly related to disruptions in development and have been linked to a range of adverse health outcomes in adulthood.  The ACEs questionnaire is available in 7 languages and can be found here.

So why should psychologists measure ACEs across the age span and why is something that happened in childhood important in my work with adults? 

The Center for Disease Control’s Adverse Childhood Experience Study – The ACE Study – suggests that adverse childhood experiences (ACEs) are associated with a number of long-term negative health outcomes and risky behaviors.  ACEs are associated with cancer, diabetes, depression, suicide, ischemic heart disease, smoking, drug abuse, obesity, sexually transmitted infections, and adolescent pregnancy.  In a time where treating the health of our population is getting a lot of emphasis, the recognition that a higher ACEs score is associated with a higher risk of negative health consequences is likely to improve efforts towards prevention and recovery.

More recently, studies link chronic maternal stress as one of the contributing risk factors for preterm birth, and a recent article in the journal BMC Medicine found that women who had two or more stressful events during childhood had double the risk of preterm birth [1].  Preterm birth is the leading cause of death for children under the age of five, and babies who survive are at much higher risk of developing a number of health conditions as well as cognitive and behavioral issues.  The authors conclude that if we know who is at risk, interventions before the end of their pregnancy could improve pregnancy outcomes.

Another recent study found that people who have inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis, are twice as likely to have a generalized anxiety disorder at some point in their lives when compared to people without IBD, and of particular interest was the six-fold odds of anxiety disorders among those with IBD who had a history of childhood sexual abuse [2] .  While this study does not draw conclusions on cause and effect, it draws attention to the need for routine screening and targeted interventions for anxiety disorders.  It also highlights the important connection between physical and mental health. The authors note that adverse life experiences and chronic anxiety can hijack the stress response system, potentially effecting a whole host of bodily processes.

Early research on the impact of adverse childhood experiences was published in the American Journal of Preventive Medicine in 1998 [3], and at that time the authors concluded that primary prevention of adverse childhood experiences requires societal changes that improve the quality of family and household environments during childhood.  Secondary prevention of ACEs requires a recognition and acknowledgement of their occurrence and an effective understanding of behavioral and cognitive coping skills that reduce the emotional impact of these experiences.  These efforts require coordination and collaboration with physical and mental health care providers, public health, human services, the criminal justice system, schools, and even communities.

The Centers for Disease Control and Prevention (CDC) has a helpful website that can direct you toward a number of evidence-based prevention programs that help mitigate the impact of child abuse and neglect, sexual violence, elder abuse, suicide, global violence, youth violence, and intimate partner violence.  This webpage can be found here.

The Minnesota Psychological Association (MPA) recognizes that transformation is happening in the delivery of our health care.  Psychologists in private practice, health care organizations, education, industry, and research recognize that we are uniquely qualified to measure and mitigate the negative consequences of ACEs so that people can reduce the chronic stress and lead happier and healthier lives.

The 2015 MPA President’s Conference is dedicated to learning more about the ACEs study as presented to us by co-principal investigator, Vincent J. Felitti, M.D.  Anna Lynn, M.P.P., from the Minnesota Department of Health, will also share what Minnesota is doing in research, policy, and practice in preventing ACEs.  Abigail Gewirtz, Ph.D., will provide an overview of long-term findings from programs aimed at promoting resilience in at-risk children. Finally, a panel of experts will share what they are doing to mitigate adverse childhood experiences and trauma in our communities, schools, law enforcement centers, hospitals, medical clinics, and mental health clinics.  This panel includes Glenace Edwall, Ph.D., BraVada Garrett-Akinsanya, Ph.D., Paige McConkey, MHP, and Mark Sanders, Psy.D.

The 2015 MPA President’s Conference, Building Resilience and Mitigating the Lifelong Effects of Adverse Childhood Experiences (ACE), will be held on Friday, August 14, at the Rivers Edge Convention Center in St. Cloud.  Please join us.  Walk-in registrations are welcome.  Information and registration on the President’s Conference can be found here.  Come attend the conference and stay Friday night to enjoy the area microbreweries and an Art Crawl in downtown St. Cloud.  You can take advantage of discounted hotel rates that can be found at the previously noted link to information and registration.

Scott Palmer, Ph.D., L.P., is the Director of the Behavioral Health Clinic at St. Cloud Hospital, an assistant adjunct professor at the College of St. Benedict/St. John’s University, and is President of the Minnesota Psychological Association.  He is a volunteer member of the Red Cross, where he provides psychological first aid to survivors of local or national disasters.  He is a member of the Motivational Interviewing Network of Trainers (MINT) and uses MI in his practice to help people move toward positive change.

References

    1. Christiaens, I., Hegadoren, K., Olson, D.  Adverse Childhood Experiences are Associated with Spontaneous Preterm Birth: A Case-Control Study. BMC Medicine, 2015, 13:124.
    2. Fuller-Thomson, E., Lateef, R., Sulman, J.  Robust Association Between Inflammatory Bowel Disease and Generalized Anxiety Disorder: Findings from a Nationally Representative Canadian Study.  Inflammatory Bowel Diseases.  2015 (July).
    3. Felitti, V., Anda, R., Nordenberg, D., Williamson, D., Spitz, A., Edwards, V., Koss, M., Marks, J.  Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Deaths in Adults.  The Adverse Childhood Experiences (ACE) Study.  American Journal of Preventive Medicine.  1998; 14 (4), 245-258.
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