(ACE) Study: Implications for Mothers - National Association of ...

I S S U ESpringM A Y2 0 1 3PracticePerspectivesThe NationalAssociation ofSocial Workers750 First Street NERita Webb, MSWSenior Practice Associater webb@naswdc.orgSuite 700Washington, DC 20002-4241SocialWorkers.orgThe Adverse Childhood Experiences (ACE) Study:Implications for Mothers’ & Children’s Exposure to Domestic Violence©2013 National Association ofSocial Workers. All Rights Reserved.IntroductionOf the 76 million children living in the UnitedStates, it is estimated that 46 million canexpect to have their lives affected by violence,abuse, crime, and psychological trauma (U.S.Department of Justice, 2012). Approximately15 million children witness domestic violenceeach year (Futures Without Violence, 2008).Even as bystanders to domestic and familyviolence, children may experience psychologicaltraumatization as if abused themselves. Bothchildren and adults exposed to violence mayfind it difficult to talk about their traumaticexperiences. Some children may evenexperience severe to moderate posttraumaticstress disorder (PTSD) (Groves, 2012).The Adverse Childhood Experiences (ACE)Study is one of the largest retrospective studiesto examine the links between traumaticchildhood experiences and current adult healthand well-being (Centers for Disease Controland Prevention [CDC], 2012). Over 17,000adult patients receiving health care at a majorhealth care organization completed confidentialACE surveys. The study sample was a crosssectionof middle class, ethnically diverse,women and men, ranging in age from 19 toover 60 years (CDC, 2012). According tothe CDC, the ACE Study provides detailedinformation about past history of abuse,neglect, and family dysfunction, as well aslinks to risk factors and current adult healthstatus, mental health, quality of life, anddeaths (CDC, 2012). Furthermore, theresearch draws awareness to a noticeablecogent relationship between ACEs, health riskbehaviors, mental health, and substanceabuse conditions (Larkin & Records, 2007).Adverse Childhood ExperiencesThe ACE Study examined the occurrence ofadverse childhood experiences that includedchild and household exposures:• Child- Emotional/physical abuse- Sexual abuse- Emotional/physical neglect• Household- Domestic violence/battered mother- Single-parent homes—due toseparation/divorce/death- Substance abuse—one or both parents- Incarcerated parent(s)- Parent(s) suffering from mentalhealth illnessThe ACE ScoreThe ACE Study score is a reported total ofstudy participants’ experiences that includehealth, mental health, addiction, criminal, andsocial welfare problems. Nearly two-thirds of

The ACE researchdemonstrates thatexposure todomestic violencecan increase riskfor physical,mental health,and substanceabuse conditions.the ACE Study respondents reported a minimum ofone ACE related to personal and family stressors,such as witnessing their mother being battered;parent(s) with substance abuse, mental illness,criminal behavior; or being incarcerated (Felitti, etal., 1998). These childhood experiences occurbefore the age of 18 years, when adverseexperiences can disrupt early psychosocial andneurodevelopmental stages (Larkin, 2013). TheACE Study score demonstrates experiences ofchildhood abuse, neglect and exposure to othertraumatic violence and family stressors aspredictive of adolescent and adult long-termhealth, behavioral, and social problems.The higher the ACE score, the greater prevalenceof co-occurring physical, mental health, andsubstance abuse conditions such as depression,illicit drug use, alcohol abuse, smoking, suicideattempts, intimate partner abuse (domesticviolence), sexually transmitted disease, unintendedpregnancy, high-risk sexual activity, fetal death,liver disease, heart disease, obesity, and chronicobstructive pulmonary disease (CDC, 2012). TheACE score revealed that ACEs are common, oftenoccur in groups, and contribute to high lifetimecosts and economic toll.ACE Findings of ChildhoodExposure to Domestic Violenceand Behavioral ConditionsThe ACE Study found that many respondentsreported at least one adverse experience duringchildhood. However, those adult participantswho reported four or more ACEs were atsignificantly increased risk for suicide attempts,depression, drug abuse, and alcoholism (FuturesWithout Violence, 2008). For those participantswho reported witnessing their mother’s abuse,there was a substantial increase and graded riskduring adolescence for alcohol use, drug use,and depression (Dube et al., 2006).The ACE research demonstrates that exposure todomestic violence can increase risk for physical,mental health, and substance abuse conditions.Furthermore, research on children who witnessdomestic violence found that they face anincreased risk for mental health issues related tojuvenile delinquency, antisocial behavior, andescalated rates of depression, anxiety, and PTSD(Alpert, 2010). The impact of chronic domesticviolence exposure in childhood was found tohave long-term effects throughout the life span.Implications of ACEs for Resiliencyin ChildhoodThe study findings provide insight into identifyingfactors for consideration and understanding ofthe effects of ACEs related to domestic violenceand family dysfunction over the life span. Manylessons continue to be learned from the ACEstudy related to prevention and intervention in theareas of health, mental health, addictions,criminal justice, and social welfare.In early childhood development, a mother’sinfluence on resilience in children and exposureto traumatic, stressful, and violent situations hasbeen examined. In particular, research suggeststhat mothers’ exposure to domestic violence anddepression can influence early childhood coping,adaptation, and resilience. Still, the effects ofdomestic violence on children vary widely (Groves,2012). Despite witnessing domestic violence,many children have adequate behavioral andemotional functioning (U.S. Department of Healthand Human Services, 2009). Generally, protectivefactors and less maternal exposure to domesticviolence are thought to promote better adaptationcharacteristics in children. Factors that are likelyto have affective influences for resilient childreninclude the following: positive parental/partnerrelationships, effective parenting when under stress,and family/support networks. Subsequently, whenmothers are able to model effective coping andconvey a sense of security and confidence to theirchildren, there is an increase likelihood of betterfunctioning and managing of stress by the child.(Groves, 2012)ACE Study Implications forSocial WorkersThe ACE Study affirms the interrelationship ofadverse childhood experience of abuse, neglect,and family dysfunction on adult health andwell-being. Social workers can use the studyfindings to explore how childhood traumaticexposure to violence and other ACEs are linkedto medical, mental health, and substance abuseconditions throughout the life span. The data,factors, and findings gathered from the ACE studycan guide social workers and support them inaddressing policies and practices that promoteearly childhood prevention and treatmentintervention. The study findings draw attention toimproving adult physical, mental health, andsubstance abuse conditions by focusing onprimary prevention of childhood physical and

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