ADVERSE CHILDHOOD EXPERIENCES SURVEY: EFFECTS ON PARENTING

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1 ADVERSE CHILDHOOD EXPERIENCES SURVEY: EFFECTS ON PARENTING Amy Dickson, Psy.D. LSU Health Sciences Center Department of Psychiatry

2 THE ADVERSE CHILDHOOD EXPERIENCES (ACE) STUDY A COLLABORATIVE EFFORT BETWEEN KAISER PERMANENTE AND THE CENTER FOR DISEASE CONTROL VINCENT FELITTI, M.D.-KAISER & ROBERT ANDA, M.D., M.S.-CDC The largest study of its kind ever done to examine the health and social effects of adverse childhood experiences over the lifespan. Over 17,000 participants filling out a routine health screener volunteered to participate in this survey.

3 ACE STUDY The ACE Study began in 1985 when, as a specialist in Preventive Medicine, Dr. Felitti initially set out to help obese people lose weight through the Positive Choice programs. Surprisingly, those people most likely to drop out of the weight loss program were those who were successfully losing weight. An initial study of 286 such patients revealed that many had been unconsciously using obesity as a shield against unwanted sexual attention, or as a form of defense against physical attack, and that many of them had been sexually and/or physically abused as children.

4 ACE STUDY The prevalence and severity of these problems was totally unexpected. Many had never discussed these issues with anyone, let alone their doctor. It also became evident that many obese patients had also previously used tobacco, alcohol, and street drugs to moderate stress and feelings of despair before turning to food. Dr. Felitti joined with Dr. Anda who was studying these issues for the CDC.

5 ACES The study asked about adverse childhood experiences. Based on the report, an ACE score was computed for each person. The ACE Score attributes one point for each category of exposure to child abuse and/or neglect. The points are added for a resultant score of 0 to 10. The higher the score, the greater the exposure to negative events, and therefore the greater the risk of negative consequences.

6 ACE STUDY 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? or Act in a way that made you afraid that you might be physically hurt? Yes No If yes enter 1 2. Did a parent or other adult in the household often or very often Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured? Yes No If yes enter 1

7 ACE STUDY 3. Did an adult or person at least 5 years older than you ever Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you? Yes No If yes enter 1 4. Did you often or very often feel that No one in your family loved you or thought you were important or special? or Your family didn t look out for each other, feel close to each other, or support each other? Yes No If yes enter 1

8 ACE STUDY 5. Did you often or very often feel that You didn t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it? Yes No If yes enter 1 6. Were your parents ever separated or divorced? Yes No If yes enter 1

9 ACE STUDY 7. Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit at least a few minutes or threatened with a gun or knife? Yes No If yes enter 1 8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs? Yes No If yes enter 1

10 ACE STUDY 9. Was a household member depressed or mentally ill, or did a household member attempt suicide? Yes No If yes enter Did a household member go to prison? Yes No If yes enter 1 Now add up your Yes answers: This is your ACE Score.

11 ACE STUDY Abuse: Emotional 10-11% Physical 26-28% Sexual 21% Neglect: Emotional 15% Physical 10% Household Dysfunction Mother treated violently 13% Mental illness 19-20% Substance abuse 27-28% Parental separation or divorce 23-24% Household member imprisoned 5-6%

12 SCORES The percentage of Kaiser members with each ACE score is shown below. Note that only 1/3 of persons reported no ACEs with 2/3 reporting at least one ACE. Of those who had one ACE, 87% had at least another ACE, 70% had 2 or more and greater that 50% had 3 or more. ACE score: 0 33% 4 6% 1 26% 5 5% 2 16% 6 6% 3 10%

13 RESULTS ACEs were not only unexpectedly common, but their effects were found to be cumulative. As the ACE score increased the number of risk factors for the leading causes of death increased. Compared to persons with an ACE score of 0, those with an ACE score of 4 or more were: Twice as likely to be smokers 12 times more likely to have attempted suicide 7 times more likely to be alcoholic 10 times more likely to have injected street drugs

14 Adverse Childhood Experiences Abuse and Neglect (e.g., psychological, physical, sexual) Household Dysfunction (e.g., domestic violence, substance abuse, mental illness) Impact on Child Development Neurobiologic Effects (e.g., brain abnormalities, stress hormone dysregulation) Psychosocial Effects (e.g., poor attachment, poor socialization, poor self-efficacy) Health Risk Behaviors (e.g., smoking, obesity, substance abuse, promiscuity) Disease and Disability Major Depression, Suicide, PTSD Drug and Alcohol Abuse Heart Disease Cancer Chronic Lung Disease Sexually Transmitted Diseases Intergenerational transmission of abuse Data: Long-Term Consequences Social Problems Homelessness Prostitution Criminal Behavior Unemployment Parenting problems Family violence High utilization of health and social services

15 % Alcoholic CHILDHOOD EXPERIENCES VS. ADULT ALCOHOLISM ACE Score Vincent J. Felitti, M.D. Robert F. Anda, M.D.

16 % Have Injected Drugs ACE SCORE VS. INTRAVENOUS DRUG USE or more ACE Score Vincent J. Felitti, M.D. Robert F. Anda, M.D.

17 % With a Lifetime History of Depression CHILDHOOD EXPERIENCES UNDERLIE CHRONIC DEPRESSION >=4 ACE Score Women Men Vincent J. Felitti, M.D. Robert F. Anda, M.D.

18 EVIDENCE FROM ACE STUDY SUGGESTS: Adverse Childhood Experiences determine the likelihood of the ten most common causes of death in the United States. Top 10 Risk Factors: smoking, severe obesity, physical inactivity, depression, suicide attempt, alcoholism, illicit drug use, injected drug use, 50+ sexual partners, h/o STD. ACEs seem to account for one-half to two-thirds of the serious problems with drug use. They increase the likelihood that girls will have sex before reaching 15 years of age, and that boys or young men will be more likely to impregnate a teenage girl. The fallout from various forms of child abuse and household dysfunction is monumental, costing Americans untold sums of money. Vincent J. Felitti, M.D. Robert F. Anda, M.D.

19 THE MORE CATEGORIES OF TRAUMA EXPERIENCED IN CHILDHOOD, THE GREATER THE LIKELIHOOD OF EXPERIENCING: alcoholism and alcohol abuse chronic obstructive pulmonary disease (COPD) depression fetal death poor health-related quality of life illicit drug use ischemic heart disease liver disease risk for intimate partner violence multiple sexual partners sexually transmitted diseases (STDs) smoking obesity suicide attempts unintended pregnancies

20 WITH AN ACE SCORE OF 0, THE MAJORITY OF ADULTS HAVE FEW, IF ANY, RISK FACTORS FOR THESE DISEASES.

21 HOWEVER, WITH AN ACE SCORE OF 4 OR MORE, THE MAJORITY OF ADULTS HAVE MULTIPLE RISK FACTORS FOR THESE DISEASES OR THE DISEASES THEMSELVES.

22 Death Early Death Disease, Disability Adoption of Health-risk Behaviors Social, Emotional, & Cognitive Impairment Adverse Childhood Experiences Birth The Influence of Adverse Childhood Experiences Throughout Life

23 EVIDENCE FROM ACE STUDY SUGGESTS: Adverse childhood experiences are the most basic cause of health risk behaviors, morbidity, disability, mortality, and healthcare costs. Web site: pdf Vincent J. Felitti, M.D. Robert F. Anda, M.D.

24 LEARN MORE Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, et al JS. The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine. 1998;14: Journal of Preventive Medicine. 1998;14: Dong M, Anda RF, Felitti VJ, Dube SR, Giles WH. The Relationship of Exposure to Childhood Sexual Abuse to Other Forms of Abuse, Neglect and Household Dysfunction during Childhood. (In press, Child Abuse and Neglect).

25 LEARN MORE Hillis SD, Anda RF, Felitti VJ, Nordenberg D, Marchbanks PA. Adverse childhood experiences and sexually transmitted diseases in men and women: a retrospective study. Pediatrics (1):E11. Dube SR, Anda RF, Felitti VJ, Chapman D, Williamson DF, Giles WH. Childhood abuse, household dysfunction and the risk of attempted suicide throughout the life span: Findings from Adverse Childhood Experiences Study. Journal of the American Medical Association. 2001: 286,

26 LEARN MORE Dietz PM, Spitz AM, Anda RF, Williamson DF, McMahon PM, Santelli JS, Nordenberg DF, Felitti VJ, Kendrick JS. Unintended pregnancy among adult women exposed to abuse or household dysfunction during their childhood. Journal of the American Medical Association. 1999;282: Whitfield CL, Anda RF, Dube SR, Felitti VJ. Violent Childhood Experiences and the Risk of Intimate Partner Violence in Adults: Assessment in a Large Health Maintenance Organization. Journal of Interpersonal Violence 2003; 18(2):

27 IMPACT ON FAMILIES Parents who have been: Sexually Abused Physically Abused Emotionally Abused Felt unloved/not cared for Did not have basic physical needs met Exposed to Domestic Violence Whose parents divorced/separated Whose parent(s) were mentally ill Whose parent(s) were jailed Whose parent(s) were substance abusers How does this impact their ability to parent?

28 WHAT DOES THIS MEAN FOR THE PARENTS Our team works with children ages 0-5 years involved in the Orleans Parish foster care system. Here s what we know about our parents: N = 266 children served by LSUHSC Infant Team between May March 2014 N = 183 families 183 mothers 215 fathers

29 OUR DATA

30 THE GOOD NEWS? We know the etiology of many of these problems and we can break the cycle. Children who were sexually abused can grow up to have children and protect them from harm. Parents can address their substance use and raise children who do not become addicted.

31 HOW? Prevention and Early Intervention Understanding the connections Learning new coping skills Being cared for themselves and hence learning what their children need and how to protect them. Building a greater sense of self.

32 WHAT CAN OUR COMMUNITY DO?