What are Adverse Childhood Experiences (ACEs)?
Trauma is a word that you have probably heard before – but what about adverse childhood experiences (ACEs)? A growing area of research is distinguishing ACEs from the more general term trauma and examines why this type of trauma may be particularly important. This article will outline what ACEs are and why they matter for military families.
A landmark study was published in 1998 that described ACEs as exposure to seven types of abuse and household dysfunction (i.e., physical, sexual, and psychological abuse, parental substance misuse, parental mental illness, mother treated violently, and parental incarceration) prior to age 18 (Felitti et al., 1998). Since then, others have called for the expansion of ACEs to include experiences such as neglect, socioeconomic status challenges, parental absence or separation, and removal from the family home (Bruskas & Tessin, 2013; Tyler & Schmitz, 2013; Wade et al., 2014).
Unfortunately, ACEs are quite prevalent. When using the originally defined ACE categories, around half of the adults in the U.S. report at least one ACE (Bethel et al., 2014; Campbell et al., 2016; Felitti et al., 1998). This number is likely higher when you start to consider more expanded definitions of ACEs. The researchers who originally introduced ACEs also demonstrated that experiencing four or more ACEs puts individuals at risk for several leading causes of death (Felitti et al., 1998). ACEs have also been linked to myriad negative outcomes across the lifespan that are more common among military members, such as substance misuse, depression, and posttraumatic stress disorder (PTSD) (Campbell et al., 2016; Felitti et al., 1998; Hovens et al., 2017; Huges et al., 2017).
What does this mean for military families?
There is evidence that ACEs are more prevalent among military Service Members (Blonich et al., 2014; Kanton et al., 2015). Further, emerging research demonstrates approximately one in five Service Members have experienced moderate to high levels of ACEs (Reed-Fitzke et al., 2022; Reed-Fitzke et al., under review). Some suggest these higher levels exist because volunteering for military service may be seen as an opportunity to leave an adverse childhood environment and improve one’s circumstances (Blosnich et al., 2014; Kanton et al., 2015). Although that may be true, those who enter service with a history of ACEs may be at-risk for health concerns if exposed to military-related trauma. There is a growing body of evidence indicating that Service Members who report ACEs are more likely to report postdeployment mental health concerns compared to Service Members with similar military-related trauma without childhood adversity (LeardMann et al., 2010; Morgan et al., 2022; Sareen et al., 2013; Reed-Fitzke et al., under review).
As you might expect, ACEs have been connected to various difficulties within interpersonal relationships, although much of this research has been conducted within the broader population. Most notably, ACEs have been connected to both intimate partner violence victimization and perpetration, relationship distress and instability, and lower relationship satisfaction (Friesen et al., 2010; Hughes et al., 2017; Wheeler et al., 2019). Among military couples, there is some evidence to suggest a similar pattern of ACEs and relationship challenges exists, as well as a possible connection between Service Member ACEs history and partner mental health (Khalifian et al., 2022; Miller et al., 2013). Additionally, active-duty Service Members with higher ACEs have been found to be more likely to report family characteristics that are indicative of problematic functioning (Oshri et al., 2015).
Unfortunately, the majority of what we know regarding the impact of ACEs on military families is limited to how ACEs impact the Service Member, particularly in regard to their mental health. Since this area of study is relatively new, that means there is still a lot we do not know. Given what we do know about ACEs, there may be a connection between ACEs and challenges in separation and reintegration, as well as relocation. Despite the challenges that ACEs may cause, individuals and families can be adaptive. It may be that certain individuals and families have learned to be flexible and face challenges head-on due to their past experiences of adversity and may handle military related stressors with ease. We still have much to learn about how ACEs might impact the nature of military family life.
So is it all bad news?
Fortunately, the answer to that question is no! Although there is certainly an impact of childhood adversity that persists into adulthood, Service Members with ACEs and their families can be resilient – and resilience is something that can be fostered (Lamson et al., 2020; Oshri et al., 2015; Reed-Fitzke et al., 2022. Service Members with ACEs may benefit from engaging in resilience training, such as the Master Resilience Training Course offered by the Army. Additionally, bolstering social support may be a way to protect individuals and families against the negative impact of future military trauma, as strong support systems have been shown to help buffer against military stressors (Han et al., 2014; Reed-Fitzke & Lucier-Greer, 2020; Zalta et al., 2020). Families with a history of ACEs, just like all military families, may benefit from getting connected to their local Family Readiness Systems.
A SALUTE TO OUR WOMEN SERVICE MEMBERS FOR WOMEN’S HISTORY MONTH
THEORY SERIES: FAMILY SYSTEMS THEORY IN A MILITARY CONTEXT
THERAPY: WHERE DO I EVEN BEGIN?