Maine Association for Infant Mental Health

What Does the ACE Study Mean for Maine Children?

The Adverse Childhood Experiences (ACE) Study correlated self-reported presence of seven categories of stressful childhood experiences (psychological, physical or sexual abuse; violence against mother; living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned) with a variety of measures of adult risk behavior, health status, and disease in over 9,500 adult members of the Kaiser Health Plan in San Diego, CA. (Felitti, et al., 1998). This study found strong relationships between the number of ACE categories experienced in childhood and the presence in adulthood of health risk behaviors and diseases, such as alcoholism, drug abuse, depression, suicide attempt, smoking, promiscuity, obesity, heart disease, cancer, job-related problems, and unwanted pregnancies, etc.

The ACE Study led to recommendations for primary prevention of adverse childhood experiences, for secondary prevention to ameliorate or heal the bio-pyscho-social impairments associated with ACEs before they lead to adoption of health-risk behaviors, and tertiary intervention with ACE-related health-risk behaviors, disease, and social problems (e.g. before they produce adversities in the next generation of children).

Closer to home, over 900 children entered foster care in the mid-Maine region over the past six years and received triage pediatric and psychosocial assessment through MaineGeneral Medical Center’s Pediatric Rapid Evaluation Program. Of that group approximately 28% experienced sexual abuse, 48% were physically abused, 64% had a parent with a substance abuse problem, and over 67% were exposed to domestic violence in their family. About 8% experienced neglect, without any of the preceding adverse childhood experiences. About 23% experienced just one factor, 32% had two factors, and 37% experienced three or more.

The strong dose response relationship identified between the number of ACE categories experienced and the prevalence or percentage of a variety of health behavior problems in adulthood enabled the Study to estimate the odds ratio, or risk, that a person would develop the negative adult outcomes. When these adult health risk outcome percentages from the retrospective ACE Study are applied to children entering foster care each year in Maine, they predict that unresolved adverse childhood experiences will lead annually to an additional (above baseline expectations without adversity) 20 children who become obese, 38 who attempt suicide, 42 who have job-related pregnancies, and over 100 who develop depression; as adults. Missing in these numbers are the outcomes who also experienced adversities, but did not enter foster care.

These behavioral and physical health outcomes may be preventable, if children are provided with opportunities to recover from adversity before they develop unhealthy or risky alternatives for coping with their experience. This will require identifying adverse childhood experiences early, providing safety, supporting families and service providers in helping children to develop healthy emotional and behavioral coping skills and resources, and collaborating among agencies, disciplines and the State of Maine to coordinate and sustain services, as well as a focus on their outcomes.

Not only should such efforts reduce the personal health risks in the children noted above, they should ultimately reduce health costs and interrupt the transgenerational transfer of adversity to future children. Whereas the ACE Study in California pioneered a retrospective look at the adversities adults experienced as children, Maine has an opportunity to lead the nation in a prospective view of how supporting recoverery and resilience in childhood reduces the prevalence of negative health outcomes in adulthood.


Felitti, VJ; Anda, RF; Nordenbergm D; Williamson, DG; Spitz, AM; Edwards, V; Koss, MP; Mars, JS. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of dealth in adults; The Adverse Childhood Experiences (ACE) Study, American Journal of Preventive Medicine, 14(4), 245-258

(From Child Abuse Action Network, Fall 2005 Newsletter. The Maine Child Abuse Action Network (CAAN) is the entity designed by the Governor to receive Children’s Justice Act funds which are provided by the Administration for Children and Families of the Department of Health and Human Services On the Web at www.childabuseactionnetwork.com.

Maine Resilience Building Network (MRBN)

(Adapted from 2005 CAAN Conference Panel Presentation by Mark Rains, Ph.D.)