Wednesday, 27 October 2010

ACE Study : health outcomes and child abuse

The Adverse Childhood Experiences (ACE) Study is a major research study that compares current adult health status to childhood experiences decades earlier.

It is one of the largest studies of it's kind, and it has brought new startling evidence to the table, with regard to a number of inter-related issues. 

This is the core of the fire underneath a large smoke cloud. This is about root causes.

The study reveals, as it is ongoing, that there is a direct linkage between the number of incidences of adverse early childhood experiences and the development of health related issues, risk behaviours and pathologies that emerge over 50 years later. The data is so clear, as to be able to show that much risk behaviour (smoking, addiction, obesity, self-harm, suicide) could be described as a form of self-medication, albeit ones with serious risks in the future, that seeks to manage unresolved the feelings associated with adverse childhood experiences.

"A striking finding was that adverse childhood experiences are vastly more common than recognized or acknowledged. Of equal importance was our observation that they had a powerful correlation to adult health a half-century later. It is this combination that makes them so important."

The study found that within middle class society, fromwhich it drew it's first data from, the incidence of child abuse is at least one in four. The study demonstrates that the more abuse is encountered in a childs life, the more the risks of disease and risk behaviour will manifest, and that there is a perfect curve in all the comparisons that described this relationship  throughout.

Figure1. Graph shows relation between Adverse Childhood Experiences (ACE) Score and smoking status.

The ACE score is based on zero adverse childhood experiences, 1 adverse childhood experiences,2 etc etc... Thus the relationship between the levels of ACE's and health outcome are clear.

Figure 3. Graph shows relation between ACE Score and illicit use of injected drugs.

This has very serious implications, for Health Services, Social Services and Society in general.

"Intravenous drug use is a major public health problem. In spite of massive efforts to curtail it, little progress has been made. We found that IV drug use may properly be viewed as a personal solution to problems that are well concealed by social niceties and convention. For example, a male child with an ACE score of 6 has a 4600% increase in the likelihood of later using intravenous drugs. This relation to adverse childhood experiences is powerful and is graded at every step; it provides a perfect dose-response curve; and epidemiologically, these outcomes are nearly unique in magnitude."


"Beyond these few illustrations, we found many other measures of adult health to have a strong, graded relation to what happened in childhood: hepatitis, heart disease, fractures, diabetes, obesity, alcoholism, occupational health, and job performance. These findings are detailed in the original and subsequent articles and will further be reported in publications of the yet-to-be-analyzed prospective arm of the ACE Study. " 


"The findings ........ provide remarkable insight into how we become what we are as individuals and as a nation. The ACE Study reveals a powerful relation between our emotional experiences as children and our adult emotional health, physical health, and major causes of mortality in the United States. Moreover, the time factors in the study make it clear that time does not heal some of the adverse experiences we found so common in the childhoods of a large population of middle-aged, middle-class Americans. One doesn't 'just get over' some things."

The ACE Study shows clearly that a number of key issues must be addressed.

1. The current paradigm set out for Health Care needs to undergo a rapid transformation, in that it must address the roots of disease, and not merely the emergent symptoms. All those working within Health Care must actively enhage within Society as a powerful lobby for that change, and not wait for instructions on the matter, advice from 'think-tanks' or any other consultative 'Authority'. Get on with it!

2. Social Services and Politcans, Media and others with voices in Society must address their current overtly judgemental and hopelessly aggressive approach to 'management' of risk behaviours that emerge from within any given population or community. It's not the individuals fault. And it's not that there is something intrinsically wrong with the distressed indivdual. There are issues with the Society itself, with regard to illegitimate power of many operators to influence the situation of peoples lives at a distance, and adversely, and they must be dealt with.

3. Society must address the incidence, that is to say, the frequency of Adverse Childhood Experiences across the entire Society, and identify all those social factors that give rise to intergenerational trauma patterning such as deprivation, poverty, institutional racism, war and so on.

4. Survivors must be respected, and given the space to talk about their experiences. It is the silence, and the discomfort of those who find it 'difficult' to face the truths, that traps survivors, far more than their own discomfort at their own lived experiences. This respect must be visible throughout Society. 

5. Survivors, by telling their stories, release themselves from the binds of silence, and are free to grow again - though that said, it has to be recognised that 'getting over it' is about the practicality of living or of being cared for as best one can by Society, Community, Family. And it's not always easy.

"This is not a comfortable diagnostic formulation; it points out that our attention is comfortably focused on tertiary consequences far downstream. The diagnosis shows that the primary issues are well protected by social convention and taboo and points out that we have limited ourselves to the smallest part of the problem: the part where we are comfortable as mere prescribers of medication. Which diagnostic choice shall we make? Who shall make it? And if not now, when?" 

That taboo must be utterly broken.  The matter must be addressed in public, and in private, where appropriate, at all levels. 

Kindest regards


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1 comment:

w.sutton said...

Thank you Cornelius for your site and this ACE study, of which there are many more.

Thank you for your music..........
please check out my blog and feel free to post..............

I look forward to keeping in touch