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Michael Abrahams | What is your ACE score [Part 2]

Published:Monday | March 18, 2019 | 12:00 AM

Last week I discussed the landmark ACE (Adverse Childhood Experience) study and the correlation between childhood trauma and poor health.

To summarize, the study examined ten adverse childhood experiences under three categories: abuse, neglect and exposure to household dysfunction.

The ten experiences were:


- Emotional abuse

- Physical abuse

- Sexual abuse



- Emotional neglect

- Physical neglect



- Mother treated violently

- Household substance abuse

- Mental illness in household

- Parental separation or divorce

- Criminal household member


A score of one is assigned to each positive answer, so scores range from a minimum of zero to a maximum of ten.

The study found that ACEs are common, and that most respondents (64 per cent) had at least one.

It was also discovered that ACEs usually do not occur alone, and that if a participant had one, there was an 87 per cent chance that they would have two or more.

As the ACE score increases, so do the risks of developing a host of maladies and dysfunctional and destructive behavioural patterns. In other words, the study found a graded dose-response relationship between ACEs and negative health and well-being outcomes.

For example, compared with those with an ACE score of zero, persons having four adverse childhood experiences (an ACE score of four) are twice as likely to be smokers or to be diagnosed with cancer, four times as likely to develop emphysema or chronic bronchitis, seven times more likely to be alcoholic and twelve times more likely to attempt suicide (an increase of 1,200 per cent).

 An ACE score above six was associated with a 30-fold (3,000 per cent) increase in attempted suicide, and people assigned these scores were found to be at risk of their lifespan being shortened by 20 years.

ACEs were found to be associated not only with adult onset of chronic disease, such as cancer, heart disease and mental illness, but also with violence and being a victim of violence, and the higher the score, the higher the risks.

People with high ACE scores were found more likely to be violent, to have more marriages, more broken bones, more drug prescriptions, more depression, and more autoimmune diseases.

By leading to many major chronic health, mental health, economic health and social health issues, high ACE scores also contribute to workplace absenteeism, increased health care costs, and an increased burden on mental health and criminal justice systems.


These findings were from the original ACE study conducted in San Diego in the United States of America between 1995 and 1997. Since then, hundreds of ACE studies have been performed worldwide, and among other populations in the USA, and a consistent finding is the correlation of ACEs and dysfunction in childhood and adulthood.

For example, one study found that a child with four or more ACEs was 32 times more likely to be labelled with a behavioural or cognitive problem than a child with no ACEs.

Another found that students with at least three ACEs are three times as likely to experience academic failure, five times as likely to have attendance problems and six times as likely to have behavioural problems.

Several have found a significant correlation between elevated ACE scores and the development of diabetes mellitus and autoimmune diseases such as rheumatoid arthritis.

What this all boils down to is that chronic toxic stress takes a toll on us, making us unhealthy and adversely affecting our quality of life. The revelation of this phenomenon is a call for us to revisit people we tend to label and dismiss, and approach them with love, compassion and empathy.

Children who are branded as being rude, disruptive, dunce, lazy or slow may be traumatized and deserving of attention and intervention, rather than marginalization.

Likewise, adults who are dysfunctional, angry, aggressive and have multiple health complaints, should also be approached in a similar fashion.

Unfortunately, some are so toxic that, for your own health, you should keep them out of your space, and avoid being in theirs. But, reaching out to dysfunctional adults and children may be of much help, especially if they can be guided to resources and professionals who can help them.

We know that childhood trauma can cause disease. The correlation between ACEs and poor mental heath is a no-brainer, but the association with physical disease may be less obvious.

Next week I will delve into the mechanisms through which chronic toxic stress affects our minds and bodies.


- Michael Abrahams is a gynaecologist and obstetrician, comedian and poet. Email feedback to and, or tweet @mikeyabrahams.