Adverse childhood experiences (ACEs) include childhood emotional, physical, or sexual abuse and household dysfunction during childhood. The categories are verbal abuse, physical abuse, contact sexual abuse, a battered mother, household substance abuse, household mental illness, incarcerated household members, and parental separation or divorce. The experiences chosen were based upon prior research that has shown to them to have significant negative health or social implications, and for which substantial efforts are being made in the public and private sector to reduce their frequency of occurrence. Scientific evidence is mounting that such adverse childhood experiences (ACEs) have a profound long-term effect on health. Research shows that exposure to abuse and to serious forms of family dysfunction in the childhood family environment are likely to activate the stress response, thus potentially disrupting the developing nervous, immune, and metabolic systems of children. ACEs are associated with lifelong physical and mental health problems that emerge in adolescence and persist into adulthood, including cardiovascular disease, chronic obstructive pulmonary disease, autoimmune diseases, substance abuse, and depression.
Definition and types
The concept of adverse childhood experiences refers to various traumatic events or circumstances affecting children before the age of 18 and causing mental or physical harm. There are 10 types of ACEs: Physical abuse: Any intentional act that causes physical harm through bodily contact. Sexual abuse: Any forceful, unwanted, or otherwise abusive sexual behavior. Psychological abuse: Any intentional act that causes psychological harm, such as gaslighting, bullying, or guilt-tripping. Physical neglect: Failure to help meet the basic biological needs of a child, such as food, water, and shelter. Psychological neglect: Failure to help meet the basic emotional needs of a child, such as attention and affection. Witnessing domestic abuse: Observing violence occurring between individuals in a domestic setting, such as between parents or other family members. Witnessing drug or alcohol abuse: Having a close family member who misused drugs or alcohol. Mental health problems: Having a close family member or otherwise important individual experience mental health problems. Imprisonment: Having a close family member or otherwise important individual serve time in prison. Parental separation or divorce: Parents or guardians separating or divorcing on account of a relationship breakdown. The different adverse childhood experiences are not isolated and in many cases multiple ACEs impact someone at the same time.
Prevalence
Adverse childhood experiences are common across all parts of societies, in 2009 the CDC started collecting data on the prevalence of ACEs as part of the Behavioral Risk Factor Surveillance System (BRFSS). In the first year data was collected across five US states and included over 24,000 people. The prevalence of each ACE ranged from a high of 29.1% for household substance abuse to a low of having an incarcerated family member (7.2%). Approximately one quarter (25.9%) of respondents reported verbal abuse, 14.8% reported physical abuse, and 12.2% reported sexual abuse. For ACEs measuring family dysfunction, 26.6% reported separated or divorced parents; 19.4% reported that they had lived with someone who was depressed, mentally ill, or suicidal; and 16.3% reported witnessing domestic violence. Men and women reported similar prevalences for each ACE, with the exception of sexual abuse (17.2% for women and 6.7% for men), living with a mentally ill household member (22.0% for women and 16.7% for men), and living with a substance-abusing family member (30.6% for women and 27.5% for men). Younger respondents more often reported living with an incarcerated and/or mentally ill household member. For each ACE, a sharp decrease was observed in prevalence reported by adults aged ≥55 years. For example, the prevalence of reported physical abuse was 16.9% among adults aged 18--24 years compared with 9.6% among those aged ≥55 years.