Do you know what your child’s ACE score is? Many parents can rattle off their teenager’s SAT or ACT score along with GPA, but few to none probably know their child’s ACE score.  ACE stands for adverse childhood experiences.  Children experience trauma in many ways.  It is our responsibility as adults, parents and health care providers to identify and intervene when a child is suffering from traumatic events.

Adverse childhood experiences can be grouped into 3 types: Abuse, Neglect and Household Dysfunction.  The subcategory of abuse includes physical, emotional and sexual abuse.  The subcategory of neglect includes physical and emotional neglect.  The subcategory of household dysfunction includes family member with mental illness or substance abuse, mother treated violently, incarcerated relative, and divorce.   The question, what’s your child’s ACE score, really isn’t fair.  Currently, there isn’t a standardized questionnaire for pediatricians to assess ACEs.  The Center for Youth Wellness in Northern California has developed the CYW Adverse Childhood Experiences Questionnaire and uses it in daily pediatric practice.  At the American Academy of Pediatrics’ National Conference and Exhibition ( AAP NCE) 2015, Dr. Nadine Burke Harris challenged pediatricians to become engaged in the work of screening for ACEs, counseling and referring patients for appropriate interventions.  The general concept is for every ACE that an individual experiences she receives 1 point.  For example, if a teen reports that her mother was diagnosed with depression and her parents recently divorced, that would be an ACE of 2.  Even though the medical community hasn’t developed a universal screen for ACEs, there are compelling findings to suggest that healthcare providers should be cognizant of ACEs in order to prevent negative health outcomes.

Dr. Burke Harris presented at the AAP NCE 2015  that an ACE score of 4 or greater is associated with ischemic heart disease, cancer, COPD, stroke, alzheimer’s, diabetes and suicidality.  Individuals with ACEs greater than 4 are more likely to smoke as an adult, experience alcoholism, become a teen parent or have learning problems.

Children experience a range of stressful events; positive, tolerable and toxic stress.  The body is designed to respond to a stressful situation with the release of hormones, catecholamines and neurotransmitters in order to get the body to respond appropriately to a short-term stressful situation.  This would be considered “positive stress”, which is apart of normal development.  Tolerable Stress, causes a greater reaction from the body, the organs and brain recover from the event with the buffering of a caring adult.  Finally, Toxic stress is the result of prolonged negative experience, which disrupts brain and organ development.  Children that experience toxic stress do not have emotional buffering from healthy adults.

A child that has several ACEs is existing in a state of toxic stress.  The mind and body are constantly in a state of high alert.  One can think of this as a child whose mind and body are trapped in the fight or flight response.   This constant state of high alert has been shown to impact the brain, the immune system, the endocrine system, and the circulatory system.  Children that have toxic stress may benefit from trauma counseling, exercise and mindfulness based awareness training.

Maybe the better question is, do you know what ACEs are?  Hopefully, you can now answer in the affirmative and work to limit their impact on your child’s wellness.