Editor’s Note: This is the first of a two-part series on adverse childhood experiences (ACEs) and what individuals working with these individuals need to know. The first article focuses on background information regarding ACEs and the second article in the October issue will identify practical strategies for coaches.
What are Adverse Childhood Experiences?
Adverse childhood experiences, or ACEs, are potentially traumatizing events that take place during childhood. Traditionally, ACEs, according to the Centers for Disease Control and Prevention (CDC), have been grouped into three categories:
Abuse is separated into emotional, physical and sexual abuse. Emotional and physical abuse are specific to adults living in the household, (i.e., parent, step-parent or other adults living in the house), whereas sexual abuse can be committed by family members, relatives, friends or strangers. Household challenges are comprised of substance abuse inside the household, mental illness in the household, an incarcerated family member, parental separation or divorce, and violence against one’s mother or stepmother. Neglect is comprised of physical and emotional neglect and are specific to one’s immediate family. More recently, researchers have also begun to examine community and social factors – rates of community violence, poverty and racial discrimination – as sources of ACEs.
Despite a growing body of research around ACEs, there remain issues around understanding and diagnosing trauma in children1. As researchers have pointed out, “child victims of physical, sexual, and emotional abuse, or indirect witnesses of domestic violence often experience multiple forms of abuse on frequent occasions,” despite this, children who report multiple ACEs may not meet criteria for diagnosis of post-traumatic stress disorder2. Thus, it might not be obvious that a child is suffering from the effects of ongoing, chronic, toxic stress. The problem is that coaches and others may confuse what are symptoms of ongoing ACEs with a lack of focus, a lack of motivation or willfully ignoring expectations of player conduct.
How common are ACEs?
Unfortunately, ACEs are very common. Over the past few decades, research has shown that nearly two-thirds of adults have reported experiencing at least one ACE and one in every six adults has experienced four or more ACEs3. In considering specific traumas, global estimates suggest that 150 million girls and 73 million boys are victims of sexual assault worldwide4, with U.S. reports showing sexual assault prevalence rates of 25 percent for females and 16 percent for males. The CDC reports physical abuse rates at 28.3 percent, household substance abuse rates at 26.9 percent, household mental illness rates at 19.4 percent, and emotional abuse and neglect at 10.6 and 14.8 percent, respectively (See Figure 1).
Limited data exists on the prevalence of ACEs in athletes, but a recent study reported similar rates of ACEs for college athletes and the general population. In a study of 477 Division I, II, and III collegiate athletes, 64.5 percent of participants reported at least one ACE. The most common reported ACEs were physical abuse (24.2%), household mental illness (21.9%), parental separation (21.2%), and household substance abuse (16.0%). Similar to general population data, 38.7 percent of participants reported at least two ACEs and 25.1 percent of participants reported at least three.
What are the effects of ACEs?
Research has consistently shown a detrimental effect of ACEs on a range of health and well-being indicators. A dose-response effect has been established in that the more ACEs one endures, the more likely negative outcomes occur. Individuals with at least four ACEs represent the most at-risk group6. These individuals are more likely to be depressed, have difficulty controlling their anger, use illicit drugs, engage in domestic violence, and to suffer from alcoholism, than those without a past trauma history. Additionally, more ACEs increases the risk of physical injury, poor mental health (e.g., depression, anxiety, suicide), chronic disease (e.g., cancer, diabetes) and educational attainment. These findings have also been replicated in athlete samples, with ACEs being related to anxiety, depression, physical health and injury, stress, and substance use in college athletes.
Further, early ACEs affect brain development and can change the way immune system functions7. Children who have experienced or are experiencing ACEs:
How does sports participation impact ACEs?
While limited, data has suggested sport participation can be beneficial for those impacted by ACEs. A recent study reported that children who experienced ACEs and participated in team sports in grades 7-12 had a lower likelihood of a diagnosis of depression or anxiety and depression symptoms when they were 24-32 years old. This study was the first to look at the benefits of sports participation and ACEs and adds to the growing evidence that sports provides both physical and mental health benefits to children. However, it is essential that the environment and culture of the team and the sport allows for those positive benefits, as sports participation in a toxic environment can negatively impact health.
1. D’Andrea, et al. (2012). Understanding interpersonal trauma in children: Why we need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry, 82, 187–200. doi:10.1111/j.1939- 0025.2012.01154.x
2. Denton, R., et al. (2017). The assessment of developmental trauma in children and adolescents: A systematic review. Clinical Child Psychology and Psychiatry, 22, 260–287. doi:10.1177/1359104516631607
3. Felitti, V. J., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14, 245–258. doi:10.1016/ S0749-3797(98)00017-8
4. United Nations General Assembly. (2006). Report of the independent expert for the United Nations study on violenceagainst children. Retrieved from https://www.unicef.org/violencestudy/reports/SG_violencestudy_en.pdf
5. Brown, B.J. et al. (2020, winter). Beyond the lines: Exploring the impact of adverse childhood experiences on NCAA student-athlete health. Journal of Issues in Intercollegiate Athletics, 8-38.
6. Anda, R. F et al. (2006). The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 56, 174–186. doi:10.1111/j.1365- 2214.2006.00614_2.x
7. Shern, D. L et al. (2016). Toxic stress, behavioral health, and the next major era in public health. American Journal of Orthopsychiatry, 86(2), 109-123. doi:10.1037/ort0000120
8. Easterlin et al. (2019). Association of team sports participation with longterm mental health outcomes among individuals exposed to adverse childhood experiences. JAMA Pediatrics, 173, 681-688. doi:10.1001/jamapediatrics. 2019.1212
9. Massey and Whitley (2016). The role of sport for youth amidst trauma and chaos. Qualitative Research in Sport, Exercise, and Health, 8, 487- 504. https://doi.org/10.1080/2159676X.2016.1204351
William Massey is an assistant professor in the College of Public Health and Human Sciences at Oregon State University. His research focuses on the intersection of play, physical activity, and youth development, with a focus on children from under-served or vulnerable backgrounds. Sam Johnson is a clinical associate professor in the College of Public Health and Human Sciences at Oregon State University. He is Past-President of the Oregon Athletic Trainers’ Society and is a member of the Oregon School Activities Association Sports Medicine Advisory Committee.