ACE-study

In 1998, Robert Anda and Vincent Felitti did a piece of groundbreaking research resulting in what was later called ‘The ACE-study’, a study into Adverse Childhood Experiences (ACEs) and their correlation with adult health and wellbeing (Felitti et al. 1998). The crucial finding was that the level of toxic stress in early life (defined as abuse, neglect or household dysfunction) was strongly linked to health outcomes and health risk behaviors later in life. To score the number of ACEs, ten main ones were identified, but there are more and the defining characteristic is that, without (enough) buffering protection from a stable adult, adverse experiences create toxic stress for the child. Ever since, insights have been further increasing that childhood offers a ‘window of opportunity’ when it comes to creating healthy setpoints for interrelated processes like brain development, stress regulation, gut function, and immune competence (Burke Harris 2018; Roseboom 2018).

More than twenty years later, however, the ACEs-perspective and the harmful effects of toxic stress offer a lens that is too rarely used to look at socioemotional pathology such as anxiety, aggression, addiction, depression, suicide, social dysfunctioning, burn-out, and school drop-out (Van der Kolk 2015). Neither is it a standard tool to investigate serious health issues such as cardiovascular disease, cancer, infection, and (auto)immune diseases (Shonkoff et al. 2012; Shonkoff & Garner 2012). In general, the ACEs-science is still conspicuously lacking from policies and practices throughout society (e.g. pre- and perinatal care, education, childcare, mental health care, addiction treatment, police and juridical and judicial systems), despite the severe loss of health and happiness caused by childhood trauma, the difficulties it can cause for social competence, and the drastic increases in costs due to pathology, low productivity, dysfunction, and various types of interpersonal and intergenerational relationship issues (Bellis et al. 2019; Bowlby 2005a, 2005b; Independent Care Review 2020).

Nurturing relationships with close others support a healthy neurological, physiological, immunological, and socioemotional development, so that children can grow into joyful, vigorous adults (Grille 2008; Lancet 2016; Narvaez et al. 2013; UN OHCHR 1989). Such relationships also help to break the cycle of intergenerational trauma, that can easily persist when trauma is not acknowledged. The more thorough adults address and deal with the trauma they may have suffered themselves, the better equipped they are to offer the young ones a solid foundation for life. By asking ‘What happened to you?’ instead of ‘What is wrong with you?’, people are invited to share their life narratives in a safe, non-judgmental environment (Maté 2010, 2011). When the listener understands the science behind ACEs, the listening process allows for more empathy and compassion towards health-related practices. Seeing behavior as a consequence of emotions that in turn reflect underlying needs can help to take away the moral judgment and address the root causes of risk behavior and pathology, both in professional and in private settings.

Depoliticization and decontextualisation of many health issues and relegating them to the lifestyle domain does not do justice to the highly contextual character of ACEs (Hoke & McDade 2015; Huber 2011, 2015; Meloni 2014). Approaching health issues from an ACEs-perspective provides a framework that identifies biopsychosocial and intersectional aspects of trauma, which changes the paradigm and thus the direction chosen for healing, both at a personal and at a societal level (Engel 1977; United Nations 2015).

Through a nation-wide discussion and by connecting lay and professional communities, this project aims to raise societal awareness about the ACEs-science. By getting ACEs on the radar of all sectors of society that are in any form responsible for the care provided to babies, infants and children, young people will have the chance for either a better start in life, or better healing once trauma is present.