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Adverse Childhood Events (ACEs)

Adam Schickedanz, MD and Solomon Behar, MD
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Sol sits down with UCLA pediatrician and researcher Adam Schickedanz to discuss the impact of Adverse Childhood Experiences on the physical and mental health of children.

  • An adverse childhood experience or event is a stressful or traumatic experience before age 18.  ACEs fall into three categories: 1) abuse, 2) neglect and 3) household dysfunction. ACEs disrupt social connections early in life.  

  • Screeners for ACEs exist.

  • ACEs have long term health implications; the more ACEs, the worse the health outcomes.

    • In toddlerhood, there may be developmental delays.  Unfortunately, there are not that many sensitive indicators of early stressors.

    • Early in life, behavioral health is the major category affected.  Children in middle childhood/adolescence who have experienced more ACEs have higher rates of mental illness.

      • Riskier behaviors with substance abuse may ensue.

    • In early adulthood, the stress response can be altered (that is, the cortisol “thermostat” is set at a higher setting and if you have been stressed your whole life, it is almost hard to know what a normal level would be) with resultant hypertension, obesity and diabetes.

  • 60% of US adults have experienced one or more ACEs, 10% have experienced 4 or more ACEs.

  • The abuse category includes: physical, sexual and emotional.  Neglect includes: physical and emotional. Household dysfunction includes: exposure to mental illness in a first degree relative, exposure to substance abuse at home, death, separation and/or incarceration of a parent.

  • A 1998 paper by Felitti laid the groundwork for ACEs research and screening; specifically noting that there was a dose response between the number of ACEs experienced and health outcomes.  It does not necessarily appear to be that one ACE is more impactful than another; how the child experiences the ACE appears to be more significant.

  • If a child is removed from an environment of adversity, that child may have normal health outcomes.

  • The caregiver may be reluctant to disclose any ACEs the child may be experiencing as he/she may feel responsible and/or worried about DCFS involvement.  Asking about what has been stressful or difficult as a parent may aid in this discussion.

  • Intergenerational manifestations of the parent's own ACEs changes parenting behaviors and child outcomes.

    • Additionally, in the above cited study, parents who experienced 4 or more ACEs, had children whose ADHD likelihood was two-fold higher and risk of early mental illness was four-fold higher than those children of parents who had no ACEs.

  • As a pediatrician, helping the parent become aware of how their own early adversity might be influencing their parenting may be helpful and an opportunity for intervention.  Raising public awareness for the public health implications of ACEs is also powerful.

    • Action steps include: linkage with mental health services, community resources (SNAP, WIC) and parent coaching.

  • Here is the AAP statement on ACEs and ultimately states that childhood health should be thought of in the context of the eco-bio-developmental model.

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Take Off that Red Skin! Full episode audio for MD edition 203:24 min - 95 MB - M4APeds RAP March 2019 Written Summary 323 KB - PDF

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