Afifi - ACEs research

The field of ACEs really developed from one paper in 1998, from Flaherty and colleagues. So that was 25 years ago. And the one paper was really influential in that it really connected ACEs to health outcomes. And that was a really important thing for individuals to understand, is that adverse childhood experiences can have an impact on your health, not only as a child, but in adolescence and into adulthood. So that was, I think, the most critical piece of understanding from that work. 

So, ACEs have been associated with many poor outcomes. So, it includes injury, traumatic brain injury, unintended pregnancy, complications with pregnancy, sexually transmitted infections, also physical health, mental health, such as anxiety, depression, thinking about suicide and substance use. 

So, the field has been vast and in looking at many different outcomes. Consistently what the ACEs field has shown us is that trauma equals bad outcomes and many outcomes have been looked at. That’s been robust and consistent. The other really great contribution that the ACEs field has made is it’s shown that the more adversity one experiences, the greater the impact that that has on these negative outcomes. 

The field of ACEs has been very important to make those connections from adversity to health. I think moving forward, though, one thing that hasn’t changed very much in the past 25 years with ACEs is how we measure and think about ACEs. It’s really interesting to me that 25 years ago, one paper came out with these ten ACEs and really people sort of just continued to study these ten ACEs. So I’ve done a little bit of work to empirically determine should we remove some of the ACEs, which the data shows that we shouldn’t. Those are, for example, parental divorce was one I was thinking that might no longer be considered an adverse childhood experience. But empirically, with data, it seems to still fit. We’ve also looked empirically to see if other things have, could be considered an ACE. And so things like bullying or peer victimization or parental gambling problems, those could be added. There’s other things such as environmental or neighborhood violence or things that have been looked at in terms of being added as an ACE. So those are concepts to consider. I think when where we’re thinking about ACEs is that we don’t have to think of it as just this restricted ten. And it’s interesting to me that that hasn’t evolved as much as one would think.