Prevalence and Long-Term Effects of Adverse Childhood Experiences on Adult Functioning

Research group: Metka Kuhar, Helena Jeriček Klanšček, Gaja Zager Kocjan, Ada Hočevar Grom, Zalka Drglin, Nina Mešl

 
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An increasing number of studies show that adverse experiences in childhood are related to poorer physical and mental health, health-risk behaviours in childhood and adulthood and other unfavourable outcomes (e.g. lower educational attainment and lower material status in adulthood). There even exist financial calculations of the expensive consequences of adverse experiences – in terms of taxes collected from individuals, as well as healthcare and social security expenditures. Awareness of early adverse experiences and their consequences and the recognition of these phenomena, while ensuring support aimed at reducing the risk factors and damage, are among the key social and public health tasks. 

The bulk of the data on the prevalence of adverse experiences in childhood and research evidence about correlations between them and various outcomes in adulthood stem from the globally recognised Adverse Childhood Experience Study, also known as the ACE study. This study was conducted for the first time between 1995 and 1997 in the USA, and from 2009, it has been conducted yearly in all US states. It was also conducted in many other countries. 

These studies typically measure 10 categories of adverse childhood experiences (ACEs). There are five categories of personal experience: physical, emotional or sexual violence/ abuse, and emotional or material neglect. The other five categories (called household dysfunctions) relate to other family or household members. These include adult domestic violence, addiction, mental health problems and criminal acts by an adult household member, as well as the separation of parents or interruption of contact between a child and his or her parents due to parental death, separation or abandonment. 

In these studies, more than two-thirds of the participants usually report at least one ACE, and one-tenth to one-sixth of the subjects report four or more such experiences. These rates are higher in marginalised groups of the population and in populations with a lower socioeconomic status. The probability that a person develops poor physical or mental health and/or other unfavourable outcomes is highest for those who have four or more ACEs. 

The purpose of our research was, first, to obtain data on the prevalence of ACEs among Slovenes and on the association of ACEs with various health and psychosocial outcomes in adulthood, as well as on risk factors and protective factors in childhood and adulthood. The first Slovenian ACE study was conducted in 2019 via an online survey. The final sample included 4,940 Slovenian adults aged between 18 and 75 years. 76.5% of survey participants reported at least one ACE, and 27.2% reported four or more ACEs. The results showed that different ACEs often occur in combination and are more common in families with low socioeconomic status. With higher ACEs score the risk of physical illness and mental disorders increases, as well as the risk of health risk behaviors and lower life satisfaction. Protective factors in childhood mitigate the negative effect of ACEs, especially on mental health. Based on research work and a review of foreign good practices, we highlighted the importance of appropriate and systematic treatment of ACEs at all levels and in all relevant sectors. We have developed six strategies for addressing ACEs and strengthening resilience.

In the second part of the project, we reviewed selected foreign models of good practices in the context of kindergartens and schools. These are considered to be the key institutions that can act as a protective factor in the lives of children and adolescents by developing safe and stimulating environments. In six focus groups with a total of 43 educators, primary school teachers and counselors, we explored: how kindergartens and schools in Slovenia understand and recognize traumatic experiences, the extent to which they are aware of the connections between these experiences and various difficult behaviors (e.g. emotional-behavioral problems) and other signs, how they act in cases where they recognize the traumatic experiences or their consequences, and what they would need to better respond (e.g. within one's own institution, at the level of systemic change). According to the results, professionals in Slovenian kindergartens and schools often face challenges related to working with children with symptoms of trauma. They expressed the need for more frequent and systematic addressing of issues related to traumatic experiences in the context of kindergartens and schools as well as the wider society. We have developed the initial guidelines for explicit and systematic addressing of this topic in kindergartens and schools.

With this research, we want to contribute to the development of appropriate models of preventive action and systematic early interventions in Slovenia, both in the identification and prevention of ACEs, as well as by reducing their negative consequences and strengthening protective factors.

Scientific publications in English

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