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November 27, 2015

From childhood suffering to adult problems

Reuel S. Amdur

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The Adverse Childhood Experiences (ACE) research project is clearly one of the most significant studies of its kind in identifying the impact of childhood experiences on later dysfunctions.

The study, begun in 1995, enrolled over 17,000 patients of the Kaiser-Permanente health plan in San Diego, California, gathering self-reported childhood experiences and then looking at adult health and social difficulties.  Analysis of the data was carried out by the U.S. Centers for Disease Control and Prevention in Atlanta, Georgia.

On March 13, 2015, the Ottawa Community Committee on Child Abuse held a session at a Salvation Army program centre to view and discuss a video presentation on ACE. 

Dr. Vincent Felitti narrated the video, and it was he whose observations led to ACE’s inception. 

It all began with a patient he was treating for obesity.  She began with a weight of 408 pounds and was able to reduce to 132.  This is an impressive accomplishment, as the rule of thumb in weight reduction is that a 10% reduction is what is hoped for. 

But things went rapidly wrong.  In three weeks, she regained 37 pounds.  Felitti needed to find out why, so he interviewed her.  She related that she had been sexually abused as a child.  Overeating served two functions.  It helped to reduce tension, depression, and anxiety, and it made her physically unattractive, thereby making her less likely to be of sexual interest to men.  The trigger for the recent weight gain was the interest that a man had shown in her.  Felitti found this same pattern in other failed weight-loss patients.  Thus he has begun his interest in childhood factors in adult dysfunction.

In the research that followed, the impact of ACE was found not to be just psychological. 

ACE actually affects the developing brain.  The video showed the CAT scans of the brains of two children, one a normal child and the other a child from a Romanian orphanage.  (Under the dictator Nicolae Ceausescu, orphans and other abandoned children were stuck in warehouse-type orphanages with virtually no stimulation.) 

The Romanian child’s brain had a large empty space in the middle, where the normal child had large amounts of white matter.  Neural networks of the Romanian child were compromised, as was the biochemistry of neuroendocrine systems.

ACE foresee an order of conditions: from adverse childhood experiences; to disrupted neurological development; to social, emotional, and cognitive impairment; to adoption of health-risky behavior; to disease, disability, and social problems; and finally to early death.  Not everyone with ACE goes through all of these steps, but this is a common sequence.

In the interview with the Kaiser-Permanente volunteers, ten items of childhood mishap were listed, as follows: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, violence directed at the mother, substance abuse in the home, mental illness in the home, parental separation, and incarceration of someone in the home. 

Close to 90% of respondents had experienced at least one of these factors, and almost as many had experienced another one or more.  Those items with 20% or more included physical abuse, sexual abuse, substance abuse in the home, and parental separation.  Mental illness in the home came in at just under 20%. 

While people who had lived with no or just one negative childhood experience had a low frequency of any particular dysfunction, the frequency tended to increase with the number of negative experiences.  Generally, four and more items meant a phenomenal leap in frequency, of an off-the chart nature.

Here is a list of outcome factors identified: alcohol and/or drug abuse, chronic obstructive pulmonary disease, depression, loss of fetus, poor health-related quality of life, ischemic heart disease, liver disease, partner violence, promiscuity, venereal disease, smoking, obesity, attempted suicide, unwanted pregnancy, and presentation to the doctor of unexplained symptoms.

While it is difficult to move from ACE identification to developing a therapeutic approach to, for example, ischemic heart disease, social and psychological measures lend themselves more readily to development of approaches.

For example, school systems which have employed approaches involving an awareness of ACE have, in a number of instances, dramatically reduced suspensions and expulsions.  Perhaps for ischemic heart disease an awareness of ACE might lead to testing to see if there is a need for treatment to lower cholesterol, so even there we might find useful applications.

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