What Does the Evidence Tell Us?

Some of the strongest evidence to date regarding the importance of the early years comes from a large study of adults.  In contrast to positive, nurturing experiences in early childhood, negative experiences often result in later addictions, poor mental health, and chronic health conditions that are a huge burden on the health care system. In addition to the direct costs of acute care and chronic disease treatment, poor health in adulthood results in reduced capacity to participate in the workplace and in society.

Research conducted by Drs. Felitti and Anda over the past several years has demonstrated that adult health is negatively impacted by traumatic emotional experiences in childhood such as abuse and household dysfunction.

The Adverse Childhood Experiences Study examined biopsychosocial survey data from over 17,000 adults in San Diego, California who were part a private Health Maintenance Organization called Kaiser Permanente.  It represents one of the largest studies ever conducted on the links between childhood maltreatment and health in later life. 

Participants were asked if they had ever experienced any of the following events during their childhood:

   1.Emotional Abuse
   2.Physical Abuse
   3.Sexual Abuse
   4.Emotional Neglect
   5.Physical Neglect
   6.Mother Treated Violently
   7.Household Substance Abuse
   8.Household Mental Illness
   9.Parental Separation or Divorce
  10.Incarcerated Household Member

Each participant was then assigned an ACE Score ranging from 0 to 10 depending on the number of events they reported.  The ACE Score serves as a marker of the total amount of stress experienced during childhood.  Nearly two-thirds of the study participants reported at least one ACE, and more than one in five reported three or more. 

Statistical analysis demonstrated that as ACE Scores for participants increased, so did the risk of health problems such as alcoholism, chronic obstructive pulmonary disease, depression, heart disease, suicide attempts, sexually transmitted diseases and many others.  ACE Scores showed a strong and graded relationship to health-related behaviours and outcomes not only in adulthood, but also in adolescence.

What appears to be demonstrated by this research is that traumatic emotional experiences in childhood are transformed into physical disease in later life. What often occurs in primary care is an attempt to treat the intermediary mechanism rather than the cause of the disease.  For example, patients with liver disease who are alcoholic are treated for alcoholism rather than for the underlying cause of why the patient began or continues to drink excessively.

A number of detailed reports and peer-reviewed articles have been published regarding the main study findings and are available through links on the Centre for Disease Control and Prevention website.

This research has a number of important implications for clinical practice as well as for universal prevention programs in the area of child maltreatment.  Clearly, the medical, social and economic implications of adverse events in childhood are enormous and efforts must be made to prevent abuse and household dysfunction while young children are at their most vulnerable.   One recommendation made by Dr. Felitti in a recent presentation (March 22, 2007, University of Calgary) was to invest in parenting programs to help support parents in this important role as caregivers. This is consistent with recommendations made in both the Early Years Study 2:  Putting Science into Action (2007) and From Neurons to Neighborhoods: The Science of Early Childhood Development (2000). 

The Chair program will be implementing this key recommendation to provide information and support to parents with regard to early childhood development.  Parenting resource centres linked to schools that offer high quality programs for parents of preschoolers are critical to enhancing school readiness for children and reducing social isolation and ineffective parenting practices.  In addition, the Chair will help to facilitate evaluation of current community-based parenting programs to generate and improve outcomes for children and families.