Let’s not sprinkle ACEs everywhere!

Let’s not sprinkle ACEs everywhere! 150 150 Jane Evans


Professor Mark Bellis, Director of Policy, Research and International Development in Public Health Wales said:

“So many of the health problems we see in adults have their roots in childhood.”

It IS time for ACEs!

Not before time, adversity in childhood is finally being seen as having clear, well-evidenced long-term implications for adult mental and physical health and many other important components of daily life. Talk of ‘ACES’ (Adverse childhood experiences) is becoming more common, it is appearing in the media and on social media, and being discussed and tested around the World.

It was a few years ago that I came across the Adverse Childhood Experiences study which was carried out by Felitti and Anda in America with over 17,000 predominantly white, middle class Americans. These two clinicians decided to ask people about their childhoods and to match the findings with their health records and life style habits and experiences.

“Childhood abuse, neglect, and exposure to other traumatic stressors which we term adverse childhood experiences (ACE) are common. Almost two-thirds of our study participants reported at least one ACE, and more than one of five reported three or more ACE.”

The findings were shocking but not surprising and validate and substantiate what I had seen for nearly 2 decades. Namely, the more stress, unpredictability and fear there is for a child in their own home from the adults they need to have a close relationship with, the more the child is likely to go on to be an adult with complex needs.

The ACE Score is used to assess the total amount of stress during childhood and has demonstrated that as the number of ACE increase, the risk for the following health problems increases in a strong and graded fashion:

  • Alcoholism and alcohol abuse
  • Chronic obstructive pulmonary disease (COPD)
  • Depression
  • Fetal death
  • Health-related quality of life
  • Illicit drug use
  • Ischemic heart disease (IHD)
  • Liver disease
  • Risk for intimate partner violence
  • Multiple sexual partners
  • Sexually transmitted diseases (STDs)
  • Smoking
  • Suicide attempts
  • Unintended pregnancies
  • Early initiation of smoking
  • Early initiation of sexual activity
  • Adolescent pregnancy”

Even without knowledge of the ACE Study, this is what I have seen in my work with families for far too long and this is what the study shows over and over again. I AM glad that this knowledge is becoming mainstream now but, at the same time, I AM concerned that it needs to be seen as part of a raft of complex needs someone will have and will need trauma-informed support with.

UK ACE Studies

In Wales and Blackburn with Darwen, England, there have been Adverse Childhood Experiences Studies and the evidence is clear, “In 2014 the English national ACE study interviewed nearly 4,000 people aged 18 to 69 years from across England and produced comparable results to the US.”

“Results from the first Welsh Adverse Childhood Experience (ACE) study show that suffering four or more harmful experiences in childhood increases the chances of high-risk drinking in adulthood by four times, being a smoker by six times and being involved in violence in the last year by around 14 times.”

Having the evidence replicated is great news, and that is not where my concerns rest.

Why is all this ‘excitement’ over ACES IS making me anxious!

Adversity wastes lives and costs a fortune in terms of health care, incarceration, domestic abuse, additional educational and other services, lost days from work etc. etc. At the same time, the effects of childhood adversity also generate money for the cigarette, alcohol and fast food industries and huge amounts of employment in health and caring services. Sick, immobile people need clinicians and carers.

Findings from the Welsh Adverse Childhood Experiences (ACE) Study, Public Health Wales, show:

Cannabis use

Increased with ACE count, rising from 14.2% of those reporting no ACEs to 64.5% of those with four or more ACEs

High-risk drinking

 Increased with ACEs, with 8.2% of those who had indicated no exposure to ACEs reporting this behaviour compared to 27.9% of individuals who had experienced four or more ACEs

Heroin or crack cocaine

Use increased with ACE count, rising from 1.4% of those with no ACEs to 20.3% of those with four or more ACEs

People are quite rightly alarmed by the links between childhood adversity and poor outcomes in all areas for adults.

However, working with traumatised people for over 2 decades has taught me that asking about their trauma has to be done in the context of what this might do to them, in the moments they are discussing it and very importantly when the session or conversation is over.

What can we do now we know about ACES?

I recently attended a fascinating day in Birmingham where the research and study from Wales and Blackburn with Darwen were presented to a roomful of professionals. Quite rightly everyone was buzzing about the ACE Studies findings.

We spent time in discussion groups with each of the experts. The general theme of the event was that in all areas of life, but especially for Doctors, and the Police there should be a routine questioning of people about their childhood experiences because if early adversity was revealed then their needs would be clearer and more fully understood. There seemed to be a great deal of interest in finding out how and when this could be done. It caused several chills to run down my spine.

On the face of it this may sound reasonable and helpful but I am less sure. The people I have worked with and known who have experienced adversity in their childhoods have taught me one very clear lesson, ‘never to assume they view their childhoods as having been adverse or traumatic.’ If you are the professional with them at the time you need to be able to sense and pay attention to how they are reacting and responding to such information, especially in terms of what is happening to their body and nervous system. Just asking the questions and relating them to a list of health problems, social needs and behaviours is not enough.

If I had a golden coin for every time someone has told me about their earliest childhood memories and experiences, and has been genuinely been surprised when I have gently explored or suggested that this could lie behind their life experiences and high anxiety, I would be living on a private island with glitter coated unicorns.

In fact, for most people uncovering links between how they were raised and their current illnesses, anxiety, children’s behaviours, or events throughout their lives can come as a surprise and cause a big reaction. I am NOT A THERAPIST, so I go carefully and spend a great deal of time holding them emotionally through any new revelations and tracking how it is presenting in them physiologically as well as psychologically. I spend time reassuring them that childhood adversity is never acceptable but more of a shared experience than is commonly believed. Sadly many people have had harsh or emotionally distant parenting, or grown up with violence and sexual abuse from someone in the family or a close family friend. None of which is OK but does not make them ‘wrong’ or at fault in any way!

These are some of the ACE Study questions:

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

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

Swear at you, insult you, put you down, or humiliate you?


Act in a way that made you afraid that you might be physically hurt?

Yes No If yes enter 1 ________

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

Push, grab, slap, or throw something at you?


Ever hit you so hard that you had marks or were injured?

Yes No If yes enter 1 ________

  1. Did you often or very often feel that …

No one in your family loved you or thought you were important or special?


Your family didn’t look out for each other, feel close to each other, or support each other?

Yes No If yes enter 1 ________


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

Yes No If yes enter 1 ________

With knowledge of ACEs comes responsibility to be trauma-aware too

I would strongly advocate that asking such questions should be done slowly, carefully and by someone who is able to recognise trauma, or else the person being questioned may discover that their childhood was traumatic, may feel completely overwhelmed and then the consultation or questionnaire ends or carries on without recognition and attention to this which could do a great deal of harm! I have studied childhood trauma for 12 years and only ever consider myself as a ‘beginner’ in it as the people I support are always showing and teaching me new aspects of it, as does the latest research which has taught me not to fear it but to be very respectful of everyone’s childhood adversity ‘journey’.

Knowledge is a powerful thing!

Knowing that your health, your coping mechanisms, being in repeated abusive relationships, having an ongoing sense that life is full of disappointment and stress has an explanation which links with the environment you were raised in takes some adjusting too. Finding out that the adversity of your childhood increases your risk of heart disease, diabetes, high blood pressure, liver disease and suicidality can be shattering so it needs to be delivered carefully and with emotional support and help to adjust life style and habits accordingly to offset the increased ongoing risks to health, relationships and social behaviours.

I recently heard someone say, “we know that asking someone the ACE questions helps them as it doesn’t increase the uptake of services, in fact they often don’t come back” as if that was proof of it being a good thing to do this in a short consultation. May be we should be concerned that discovering adversity in your childhood may mean a very real emotional journey has only just begun and the questioner may never know the impact this has on an already vulnerable person as they never see them again!

People have a right to know in the most compassionate trauma-informed way

With my accumulated knowledge and understanding of childhood adversity it took me a long time to decide to answer the ACE questionnaire. I have often imagined what it is like for someone without any previous insight in the effects of childhood trauma to ‘happen upon it’ or to be asked the questions unexpectedly. It takes practitioners who do understand what trauma does to a person for life and what to watch for and how to ensure they are not floored by discovering they have increased risks of things we all fear.

Finding out my ACE score has been helpful in understanding my coping strategies and ongoing relationship with anxiety, but, my initial reaction was an increased sense of real dread and sadness. My 12 years of studying childhood trauma has been helpful in coming to terms with things that have happened in my adult life and what I need to pay attention to in my life now to be mentally and physically well.

I want people to know about ACEs so they can make informed choices but careful trauma-aware and informed planning and training needs to go in to ‘skilling up’ anyone who is going to be using the ACE Questionnaires or more harm than good could be the end results.

Recommendations moving forward with ACEs

  1. We MUST use the ACE Study findings to prevent adversity in childhood as a priority beyond all others.
  2. ALL professionals MUST be trained to a working knowledge level of being able to see children’s behaviour through the lens of possible adversity and their attachment needs.
  3. Early intervention is VITAL.
  4. Services offering advice, information and support on the child’s developing body and brain for all expectant parents are a must.
  5. Sharing knowledge about how easily a child experiences fear and threat from those around them must be widely known too.

We have the knowledge – we don’t need MORE research – we need grass-roots ACTION!!!


To learn more about childhood adversity and how to recognise and support children and young people impacted by it book your place on:

Unique Masterclass in Working with Children, Young People, Parents and Carers Impacted by Trauma

Jane Evans & Mike Armiger

9.30 – 4:30           13th May 2106

The Clayton Hotel, St Mary Street, Cardiff



Jane Evans

Jane is a ‘learn the hard way’ person. She has learnt from her personal experiences and her direct work with people who have often been in really bad places emotionally, relationally, practically and sometimes professionally.

All stories by: Jane Evans

Leave a Reply

Your email address will not be published.