The use of the adverse childhood experiences (ACE) framework has become widespread in its use. It consists of a checklist of ten questions which identify some of the key traumatic experiences which may occur in a child’s life (under 18 years) and have longer-term impacts. The obvious risks are that it is reductive and the different experiences being equally weighted can result in a crude understanding or appreciation of the impact of each experience. I have written before in my book for instance, how the experience of domestic violence and abuse in childhood may only constitute one ‘score’, yet the ramifications can be widespread and lifelong.
The ACE questionnaire has become popular because it makes visible the wide-ranging traumatic experiences in a way that enables us to examine the multi-dimensional aspects of children’s lives; acknowledging that many children live with multiple difficulties. A wealth of longitudinal research has arisen since the ACE study which has highlighted that the effects of these traumas can impact on aspects of lives which appear unrelated on the surface. The oft-cited critical number is 4+/10.
Nearly half of people in England experience at least one ACE (52%), with around 9% experiencing four or more ACEs (Bellis et al., 2014).
Research from Montana found that ‘Adults with an ACE score of 4 or more are 1220% more likely to attempt suicide, 1003% more likely to use injected drugs, 460% more likely to have recent depression, and 390% more likely to have lung disease… Adults with an ACE score of 2 or more are 400% more likely to consider themselves an ‘alcoholic.’’ Source here. Studies have established that a higher ACE score ‘is an important predictor of poor behavioural and consequently poor health outcomes over the life course’ (Source).
Source: Young Minds
As a professional within the support service arena, I suspect most of us have sat in on meetings where local statistics around ACEs are discussed, particularly concerning identifying those at risk of harm (or criminality). In professional training sessions, making these links between 4+ and harm is commonplace.
But I wanted to open up the discussion about how we process this as people with ACEs ourselves. Recently I have come to realise that I actually feel a lot of tension around the struggles that I have faced. As someone with the magic 4+ number of ACEs, I have come to split myself apart when I sit in meetings and hear the bleak prognosis of the particular target group of young people who are classified as most in need. I experience myself in two halves; the professional self, sitting in the meeting and offering my research-related perspectives; and the private self which stings at the 4+ claims.
In some ways I want to shout out that not all of us with 4+ end up criminalised, in prison, teenage parents etc. etc. Sometimes I want to claim the success story persona- breaking the cycle, breaking the mould, being the change, bucking the trend. In those moments I want to scoop up those children living through it and tell them ‘Don’t give up hope, you can get through this’. Some of us manage to navigate both survival and the code-switching required to get by in the mainstream. Many of us become very high achievers, seeking to plug the self-worth gap through external merits.
But I am coming to realise I also have the shadow side of shame when I read the research and see the areas where my ACEs continue to impact my life. The reality is that the older I get the less I expect to fully ‘heal’. The ongoing struggle within myself and in addiction recovery endures. I wonder, perhaps opening up with vulnerability will help others too.
We are split between ourselves as living in chaos, or as ‘survivors’.
As the ‘expert’ or the ‘subject’.
Split between the past and the future; desperately trying to deny the messy present.
Because this is where the complexity is.
That when you have grown up with the magic score of 4+ even getting to reach the ‘normal’ is an achievement. But this doesn’t mean that those impacts go away. With the continued rise in recognition for ‘experts-by-experience’ or the importance of wider lived-experience as having a contribution, I think we need to break the taboo around the enduring legacy of harm.
We may still be here, but we may also be struggling.
We may be thriving, but also overcoming.
We live in the messy present of childhoods you can’t grow out of.
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