Adverse Childhood Experiences is a hot topic today as cutting edge research clearly shows how childhood trauma influences health and well-being throughout the lifespan. The affects are progressive and work by first disrupting a child’s neurodevelopment which leads to impaired social, emotional and cognitive development, which is followed by the adoption of health risk behaviors that lead to disease, disability and social problems. This is a recipe for disaster and causes a tremendous amount of suffering. And for many, the result is early death. (See Figure 1)
Before we dive into the what, why and how of ACE’s, I will share a true story – the true and sad story about a little boy I will call “Joey.”
The story of Joey
Joey was born in 1960 to a loving mother and a violent father. He was a beautiful baby boy with soft brown eyes and a cute smile. He was very small: only five pounds at birth. Joey’s mother worked graveyard to allow her husband, Joey’s father, to attend trade school during the day. One night Joey’s mother received an angry call at work from her husband demanding that she, “…come home immediately and get this (expletive) baby to stop crying!” She could hear in the background her precious baby screaming as though in pain. Her heart was pounding as she left work and frantically drove home.
When she arrived home, she found her precious and innocent little baby Joey on his stomach … his butt was bright red and oozing he had been spanked so hard. The wounds were so severe that she couldn’t put a diaper on him for three days. Unfortunately, this was the first of MANY beatings suffered by the wife and his three siblings that followed at the hand of the violent and drunken father. But little Joey, the oldest child, suffered the most.
By the age of five he had suffered so much devastating trauma that he rarely smiled. He had trouble focusing in school even though he was incredibly intelligent. And he was in trouble emotionally and socially – he had little self-control and couldn’t get along with his classmates. By the age of 10 he was sent to the Principals’ office regularly for behavior issues. He was severely punished for at school as he sought out the attention he so desperately craved at home. By the age of 13 he couldn’t take it any longer; when his father was violently beating his mother, Joey attacked his father and screamed for him to leave his mother alone.
The following year, when Joey was 14, his parents divorced. He began skipping school and using drugs and alcohol to numb his pain. When he was 17, Joey was arrested for petty crimes and sent to the juvenile detention center for six months. He then dropped out of high school. When Joey reached the age of 20 he was arrested and jailed for drugs, domestic violence, and brandishing a weapon. He served 20 years and at the age of 40 he was released. But two years later, Joey was back in jail for similar crimes.
Joey is now 57 years of age and once again on parole. He is homeless, suffers from severe mental illness & drug addiction. This man was once a cute little brown-eyed baby boy who is a living example of how adverse childhood experiences have serious and negative long term consequences.
What exactly are ACE’s and why should be concerned?
“According to ACES too high”, Adverse childhood experiences are stressful or traumatic events suffered before the age of 18. Researchers developed a questionnaire based on 10 events including childhood abuse and neglect, as well as household dysfunction like parental substance use, mental illness, domestic violence and parental loss. According to the “ACE’s too high” website, ACEs are adverse childhood experiences that, “… harm children’s developing brains and lead to changing how they respond to stress and damaging their immune systems so profoundly that the effects show up decades later. ACEs cause much of our burden of chronic disease, most mental illness, and are at the root of most violence.”
And the ACE score is important. Scoring a three or higher, there is a strong likelihood the person will have risky health behaviors, chronic health conditions, low life potential, and early death. And the risks go up exponentially from there: scoring a four or higher means a person is 2.5 times more likely to develop hepatitis or COPD; 4.5 times more likely to become depressed; and 12 times more likely to attempt suicide than a person with a score of 0!
Landmark ACE study 1995-1997
According to the SAMSHA website (Substance Abuse and Mental Health Services Administration …many studies have examined the relationship between ACEs and a variety of known risk factors for disease, disability, and early mortality. The Division of Violence Prevention at the Centers for Disease Control and Prevention (CDC), in partnership with Kaiser Permanente, conducted a landmark ACE study from 1995 to 1997 with more than 17,000 participants. The study found:
1. ACEs are common. For example, 28% of study participants reported physical abuse and 21% reported sexual abuse. Many also reported experiencing a divorce or parental separation, or having a parent with a mental and/or substance use disorder.
2. ACEs cluster. Almost 40% of the Kaiser sample reported two or more ACEs and 12.5% experienced four or more. Because ACEs cluster, many subsequent studies now look at the cumulative effects of ACEs rather than the individual effects of each.
3. ACEs have a dose-response relationship with many health problems. As researchers followed participants over time, they discovered that a person’s cumulative ACEs score has a strong, graded relationship to numerous health, social, and behavioral problems throughout their lifespan, including substance abuse.
What is you ACE score?
To find out, follow this link and take the ACE Questionnaire.
WHAT can we do?
According to ACE expert Dr. Nadine Burke Harris, a pediatrician in San Franciso, the ACE questionnaire should be used as a tool by EVERY single doctor to determine a child’s risk for future health consequences. She believes if the questionnaire is used as a screening for EVERY kid, the information gleaned can be used for prevention and treatment. Harris recommends using a multidisciplinary team approach. She adds that this approach is critical so that after the proper diagnosis, the team can get busy by increasing home visits and educating the parents as to the health consequences of ACE’s. Harris believes that just as we teach parents the dangers of lead based paint or the importance of covering electrical outlets, parents should be warned about the devastating effects that family violence and other negative behaviors in the family home have on a child’s health and success.
The good news
The good news is … people are very resilient. Cutting edge research shows that yoga plays a significant role in healing. Those who practice yoga frequently and consistently experience great long-term benefits such as resiliency. Participants feel safe, empowered, and establish greater self-regulation. Feelings of stability, improved self-esteem and healthy relationships are also positive benefits from participating in a regular yoga practice. And many yoga practitioners are learning about trauma informed care and specialize in restorative yoga classes to help those who have been traumatized—regardless of age.
Children need safe, stable and nurturing relationships and environments to thrive and develop skills to reach their full potential. Adults who are suffering from post-traumatic stress disorder (PTSD) need the same.
Spread the word
We should heed Dr. Block’s warning: “Adverse Childhood Experiences are the single greatest unaddressed public health threat facing our nation.” And we should follow Dr. Harris’ advice. She says the number one thing we can do is, “…spread the word and share with others the devastating cost spiritually and financially to each and every one of us.” We can make a difference by getting involved. We could save a life.
Every time I see a homeless person on the street, I think of Joey. And I ask myself, “What happened to that poor soul?”
Below are a list of websites to investigate to see how you can help. Thank you.
2. disrupted neurodevelopment
3. social, emotional and cognitive impairment
4. disease, disability and social problems
5. early death/20 yrs younger