ACE STUDY OVERVIEW

Understanding

the ACE Study

how it applies to

the future of

Oklahoma children

acestudy.org

“Promoting a Trauma-Informed Child and Family Serving System in Oklahoma Communities”

The ACE Study – the Center of Disease Control’s (CDC) Adverse Childhood Experiences Study – has been showing up everywhere. It hasbecome a catch phrase in social services, public health, education, juvenile justice, mental health, pediatrics, criminal justice and even business. People have said that just like people wanting to know their cholesterol score, so should everyone know their ACE score.

But what is this study? Why should it be so important to Oklahoma?

The ACE Study began in an obesity clinic in San Diego, CA designed for people who were 100 – 600 pounds overweight. It was 1985 and Dr. Vincent Felitti, chief of Kaiser Permanente’s Department of Preventative Medicine was very concerned. People that were doing well and successfully losing 100 to 200 poundswere dropping out.He decided to conduct face-to-face interviews with a few hundred of the dropouts by using a standardized set of questions.

The turning point in his quest came about by accident. He was running through the set list of questions when he misspoke. Instead of asking ‘How old were you when you were first sexually active’ he asked ‘how much did you weigh when you were first sexually active?’

A female patient answered ‘Forty pounds.’ He was confused and asked the question again and she gave the same answer, burst into tears and added ‘It was when I was 4 years old, with my father.’

Another respondent disclosed that she had been raped when she was 23 and in the year after the attack she had gained 105 lbs. ‘To be overweight is to be overlooked and that’s the way I need to be.’

So he and his colleagues began asking questions a bit differently and found that 286 of the drop outs that they interviewed had been sexually abused as children.Through this process they began to grasp that even though the people being interviewed were 100 to 400 pounds overweight they didn’t see their weight as a problem. For many of them being overweight was a solution. The realization sank in that maybe it wasn’t just food that was being utilized as a coping mechanism but the weight itself. For them, the weight provided a sense of safety and a solution.

Dr. Felitti and his colleagues continued their interviews and found many of the dropouts had been abused as children. We now understand that turning to drugs, and other negative coping skills, is a normal response to serious childhood trauma, and that although obesity and drug use,etc.,is conventionally viewed as the problem, it has also been found to be the unconscious solution to other, far deeper and often concealed issues.

Dr. Anda, with the CDC, came onboard and a study was developed to determinehow the influence of Adverse Childhood Experiences and the origins of behaviors underlie the leading causes of death in the U.S.The ACE study was born. Nearly 18,000 people participated in thatdecade long study.

Dr. Felitti and Dr. Anda developed the ACE calculator as a scoring system for ACE; having none of the following experiences results in score of 0; being verbally abused as a child is one point; having experienced verbal abuse AND living with a mentally ill mother AND an alcoholic father would result in an ACE score of three.

Adverse Childhood Experiences

While you were growing up, during the first 18 years of life:

Did a parent or other adult in the household often or very often…

Swear at you, put you down, and humiliate you? Made you afraid you might be physically hurt?

Push, grab, slap or throw things at you?Hit you so hard you had had marks or were injured?

Touch or fondle you, have you touch them in a sexual way? Attempt to have oral, anal or vaginal sex with you?

Did you often or very often feel that…

No one loved you or thought you were important or special? Your family didn’t look out for each other, feel close to or support each other?

You didn’t have enough to eat, had to wear dirty clothesor had no one to protect you? Your parents were too drunk or high to take care of you or take you to the doctor if needed?

Were your parents or caregivers ever separated or divorced?

Was your mother or stepmother sometimes, often or very often pushed, grabbed, slapped, or had something thrown at her? Sometimes, often or very often kicked, bitten, hit with a fist, or hit with something hard? Was she ever repeatedly hit at least a few minutes or threatened with a gun or a knife?

Did you live with anyone who - was a problem drinker, an alcoholic or used street drugs?

Was a household member depressed or mentally ill, or did a household member attempt suicide?

Did a household member go to prison?

Someone with an ACE score of 4 or more could be: Twice as likely to become smokers, seven more times to be an alcoholic, and 10 times more likely to inject street drugs. More likely to be violent, to have more marriages, more broken bones, more drug prescriptions, more depression, more auto-immune diseases, and more work absences.

In Oklahoma for the state fiscal year 2013 it was reported:

  • 11,418 children were neglected or abused (substantiated cases)
  • 6,886 of those children were 0 – 6 years old