The Connection Between Trauma, Adverse Childhood Experiences (ACEs) and Violence

Between 1995 and 1997, the Center for Disease Control (CDC) and Kaiser Permanente (a large HMO) surveyed over 17,000 mostly white, mostly college-educated, middle class adults with good health insurance and measured how many people had experienced abuse, neglect, or household challenges in childhood – Adverse Childhood Experiences, or ACEs. They found that the higher the ACEs score, the higher the risk of experiencing negative health consequences later in life.

To see the original ACE questionnaire and find out your own score, click here.

Here are some examples of the relationships the original study found between childhood ACE scores and the risk of health problems in adulthood.

The pyramid below sketches the life-span process for ACEs.

It’s important to stress that a high ACE score is not a sentence of doom. For example, the chart above shows 16% of people with 4 or more ACEs becoming alcoholics, but 84% do not. “The brain is plastic; the body wants to heal”. Supportive teachers and family, good nutrition, rest and exercise can all help people build resilience in the face of adversity.

Disadvantaged populations of color often carry a higher burden of ACEs than the mostly college-educated, middle-class people with good health insurance in the original study. For example, in the table below (lower right-hand corner), 49% of the patients at Drexel’s 11th St. Family Health Services clinic had 4 or more ACES, compared with 12% of the Kaiser Permanente study. 

(The table is from Waite, R, and Gerrity, P, “Childhood Adversity and Trauma:  A Life Course Perspective for Prevention and Healing”.  Collaborative Family Healthcare Association 13th Annual Conference, Oct. 27-29, 2011.  Philadelphia, PA)