In the Adverse Childhood Experiences (ACEs) Study, the Kaiser-Permanente (KP) Health Maintenance Organization (HMO) and the US Centers for Disease Control and Prevention (CDCP) collaborated in surveying over 17,000 HMO members about their experience of a variety of adversities as 0-18 year olds and their subsequent health histories.

They found a strong relationship between the number of ten categories of adversities experienced ((physical abuse, emotional abuse, sexual abuse, physical and emotional neglect and experience of parental domestic violence, substance abuse, incarceration, mental illness, and separation/ bereavement) and risk of a variety of negative behavior and health outcomes, including “the leading causes of morbidity, mortality and disability in the USA: cardiovascular disease, chronic lung disease, chronic liver disease, depression and other forms of mental illness, obesity, smoking and alcohol and drug abuse.”

Initially eight, and then ten, categories of adversity were included in the study because of their high prevalence in the KP weight reduction program: five directed toward children (physical abuse, emotional abuse, sexual abuse, and, later, physical neglect, emotional neglect) and five household issues (domestic violence to mother, separation, substance abuse, incarceration, significant psychiatric illness).

Although other risk factors such as poverty, political and cultural trauma, etc. also affect illness and wellness, they were not analyzed in the ACE Study of KP members. The number of adversity categories experienced in childhood significantly predicted negative health and behavior outcomes, but it did not appear to matter much which categories were involved. The number of experiences within categories was not counted. 

Inside the ACE Score Strengths Limitations and Misapplications with Dr. Robert Anda

Dr. Robert Anda, Co-Principal Investigator and designer of the ACE Study, explains strengths and limitations of the ACE Score. He explains why the growing popular movement to use the ACE Score for screening patients, assigning risk, and making clinical decisions for individual patients is a misapplication of the ACE Study findings. 

Watch video: https://youtu.be/Kfx5vOHFfxs

 

Other resources:

https://www.ajpmonline.org/article/S0749-3797%2820%2930058-1/fulltext

https://www.aceinterface.com/