Issue Brief 1 Scanning the Horizons: Impact of Adverse Childhood Experiences on Health

Scanning the Horizons:
Issue Brief 1
Impact of Adverse Childhood
Experiences on Health
March 2012
Key Message: Advances in neurosciences and research point to a strong relationship between childhood exposure to abuse
and trauma and lifelong negative health outcomes. Investments in child abuse prevention can yield long-term savings in health
care costs associated with depression, addiction, heart disease, and teen pregnancy.
The Adverse Childhood Experiences (ACE) study has revealed
important findings that link early childhood traumas to lifelong
negative physical and mental outcomes, such as addictive behavior
and chronic disease. There are more than 3 million reports of child
maltreatment received by state and local agencies each year. 1
In 2010, researchers estimated that the average lifetime cost per
victim of nonfatal child maltreatment is $210,012. Of this total,
$43,178 comes from child and adult medical costs. 2
Brain Development
There also is a growing understanding of how early childhood
trauma affects brain development:
There is now scientific evidence that shows brain function can be
altered through early abuse and neglect. Studies analyze how babies’
brains develop through interactions with their environments. When
crying results in food or comfort, their neuron pathways that allow
them to know how to get their needs met are strengthened. However,
when crying is neglected or results in abuse, the baby learns different
lessons. The strengthening of neuronal pathways under negative
conditions prepares children to cope in negative environments,
and their abilities to respond to nurturing and kindness may be
impaired. 3
Whole Life Perspective
Details about the
ACE Study
The ACE study is a
large-scale population
study that examines the
Adverse Childhood Experiences
association of traumatic
childhood experiences
The ACE Pyramid represents the conceptual
and serious household
framework for the study. Centers for Disease
dysfunction to multiple
Control and Prevention website4
health behaviors that
impact later life physical and mental health. The study has examined
more than 17,000 patients who participate in routine health
The study is run through a collaboration between the Centers for
Disease Control and Prevention in Atlanta and Kaiser Permanente in
Disease, Disability
and social Problems
Adoption of
Health-risk Behaviors
Social, Emotional, &
Cognitive Impairment
San Diego.
The ACE study continues to reveal staggering information related
to the health, social, and economic risks that result from childhood
ACE Categories
There are seven categories of childhood exposure to trauma that
are asked about in the study:
1.Psychological abuse
2.Physical abuse
3.Sexual abuse
4.Mother treated violently
5.Living in a household with someone who was a substance abuser
6.Living in a household with someone with mental illness
7.Living in a household with someone who was imprisoned
More than half of those participating in the ACE study reported
at least one exposure, and 27 percent reported more than two
categories of childhood exposures. People who experienced several
types of adverse childhood experiences were more likely to have
multiple health risk factors leading to unhealthy lives causing early
ACE Results
Compared to people who had no history of ACEs, those with
histories of exposure to four or more were7:
• Twice as likely to smoke
• Seven times more likely to be alcoholics
• Six times more likely to have had sex before the age of 15
• Twice as likely to have been diagnosed with cancer
• Twice as likely to have heart disease
• Four times as likely to suffer from emphysema or chronic
• Twelve times as likely to have attempted suicide
• Ten times more likely to have injected street drugs
Therefore, people with increased exposure to ACEs were more
likely to experience the following health-related issues later in life8:
• Smoking
• Suicide attempts
• Alcoholism
• Depression
• Fetal death
• Illicit drug use
• Ischemic heart disease
• Liver disease
• Intimate partner violence
• Multiple sexual partners
• Sexually transmitted diseases
• Unintended pregnancies
• Early initiation of smoking
• Early initiation of sexual activity and adolescent pregnancy
Strategies for Addressing ACE Study Findings
• Using trauma-informed care therapy
• Screening for childhood trauma when health services accessed
• Providing support and stabilization services to prevent child abuse
• Providing parenting classes for fathers and mothers to prevent
child abuse
• Promoting neighborhood revitalization to promote safety
• Collaboration between human service agencies and health
professionals to deliver a comprehensive continuum of care
1. U.S. Department of Health and Human Services, Administration for
Children and Families, Administration on Children, Youth and Families,
Children’s Bureau. (2011). Child maltreatment 2010. Retrieved from
2. Fang, X., Brown, D. S., Florence, C. S., & Mercy J. A. (2012). The economic
burden of child maltreatment in the United States and implications
for prevention. Child Abuse & Neglect, (36)2, 156–165. Retrieved from
3. Child Welfare Information Gateway. (2009, November). Understanding
the effects of maltreatment on brain development. Retrieved from http://
4. Center for Disease Control and Prevention. (2010, October 5). Adverse
childhood experiences (ACE) study: Pyramid [Web page]. Retrieved
5. Redding, C. (2012). The Adverse childhood experiences study [Web page].
Retrieved from
6. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M.,
Edwards, V., … Marks, J. S. (1998). 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), 245–258. Retrieved from http://www.
7. Anda, R. F., & Felitti, V. J. (2003, April). Origins and essence of the study.
ACE Reporter, 1(1). Retrieved from
8. Center for Disease Control and Prevention. (2010, September). Adverse
childhood experiences (ACE) study: Major findings [Web page].
Retrieved from
Additional Resources
1.Center on the Developing Child, Harvard University
The Center on the Developing Child was founded in 2006. The
Center views healthy child development as the foundation of
economic prosperity, strong communities, and a just society,
and their mission is to advance that vision by leveraging science
to enhance child well-being through innovations in policy and
2.Alliance for Children and Families Neuroscience Project
The Alliance for Children and Families neuroscience project
explores how advancements in neuroscience will impact the ability
of nonprofit human service providers to organize and deliver
behavioral health services in the future. This site features three
companion reports produced as part of the project.
About the Alliance For Children and Families
The Alliance for Children and Families is a nonprofit national membership association of
private, nonprofit human service providers in the United States and Canada. The more
than 350 members of the Alliance provide an array of community-based programs and
services to all generations, serving close to 3.4 million people each year. The Alliance is
accredited by the Council on Accreditation.
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