By Thomson, Paula
Childhood trauma encompasses abuse, neglect, and exposure to violence. A more global term, childhood maltreatment, is often employed to capture a range of negative events that threaten optimal development (D’Arcy and Meng, 2015; Felitti and Anda, (2010). Exposure to maltreatment or adversity may lead to injury and/or damage to multiple systems (neurological, physical, psychological, emotional), and in extreme cases, death. Child maltreatment frequently occurs within the family setting; however, children are also at increased risk for victimization in the community (bullying, assault, robbery, kidnapping, trafficking), and within institutions (i.e., church, military, gangs). Behind closed doors, children are vulnerable to abuse inside and outside the family system. For example, teachers, coaches, and medical care workers all have access to children; the unequal power differential may lead to manipulation, coercion, and abuse of minors who are in their charge (Thomson and Jaque, 2019).
The ACE Study
The Adverse Childhood Experience (ACE) study first began in Kaiser Permanente’s Department of Preventive Medicine in San Diego. Dr. Vincent Felitti joined forces with the US Centers for Disease Control and Prevention (CDC) under the leadership of Robert Anda. In 1998, the early ACE study results demonstrated strong associations between adult medical problems and childhood adversity (Felitti et al., 1998). In this early study, individuals with four or more types of childhood adversity had a four to twelve-fold increase in health risks for alcoholism, drug abuse, depression, smoking, sexually transmitted diseases, ischemic heart disease, cancer, chronic lung diseases, skeletal fractures, liver disease, and suicide (Felitti et al., 1998; Felitti and Anda, 2010). The overarching findings indicate a dose response relationship between ACEs and health-related disorders. Findings from ACE studies indicated that the same child may experience multiple forms of abuse and neglect; this intensifies the complexity of their stress responses (psychological, physiologic, and behavioral). For example, many minors who are exposed to physical or sexual abuse typically experience emotional abuse as well. Domestic violence often increases the likelihood of parental separation or divorce. Children exposed to domestic violence also experience more physical and emotional neglect, higher rates of mentally ill or addicted family members, and incarcerated family members (Felitti and Anda, 2010). Exposure to violence also increases when children are raised in communities or nations that are dominated by events such as ethnic cleansing or war (politically or gang motivated). A factor that further increases morbidity and mortality rates is when children are polyvictimized by multiple perpetrators. All forms of victimization may last a short period of time or extend over years.
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