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trauma, abuse, adverse childhood experiences (ACE) 

If you've read my past threads, buckle up. This may be a similarly challenging one. But I want to start by pulling together a lot of what we now know about the ways toxic stress alters the development throughout childhood of the central nervous system, immune system, endocrine system, and other bodily systems with lifelong effects.

This field of research and public health uses the umbrella term Adverse Childhood Experiences or ACEs.

trauma, abuse, adverse childhood experiences (ACE) 

If you aren't already familiar with the term, I invite you to jump into it the way I did, by taking a quick online test. It only takes a couple of minutes. Just start the quiz and run through it. We'll discuss the what the number means next.

npr.org/sections/health-shots/

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trauma, abuse, adverse childhood experiences (ACE) 

That number on the screen represents how many of the 10 identified adverse childhood experience categories impacted your development. If your score was not 0, you are in the majority. The research shows that roughly two-thirds of us have at least one of the listed categories of adverse experiences.

Go ahead and read the article with the quiz now if you like. but I'll continue exploring it in more depth in this thread with additional resources.

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trauma, abuse, adverse childhood experiences (ACE) 

Was your score higher than 0, 1, or 2? I believe roughly 12.5% of adults experienced 4+ ACEs in childhood.

Hello, my name is Scott. My ACE score is 9.

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trauma, abuse, adverse childhood experiences (ACE) 

Why does that matter? Extensive research at this point has demonstrated a dose related increase in risk across 40+ adult health outcomes and that number keeps growing.

For each ACE you experienced your risk of ischemic heart disease, stroke, autoimmune diseases, and a host of other outcomes increases, often by hundreds of percentages points at higher ACE scores over those with lower or zero ACE scores.

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trauma, abuse, adverse childhood experiences (ACE) 

Now you need to stop and watch the amazing TED talk by Nadine Burke Harris, MD. She gives the best short form presentation of this public health crisis that I've ever seen.

Seriously. Listen to what she has to say if you can or read the transcript.

ted.com/talks/nadine_burke_har

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trauma, abuse, adverse childhood experiences (ACE) 

The research into ACEs goes back to 1995. The original study included more than 17K participants at Kaiser. These were mostly middle class, white, college-educated adults. ACEs are not a problem of poverty or location, though obviously poverty can make children even more vulnerable. Here is the Centers for Disease Control (CDC) site on ACEs. It includes the original research.

cdc.gov/violenceprevention/chi

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trauma, abuse, adverse childhood experiences (ACE) 

I highly recommend Dr. Nadine Burke Harris' book, The Deepest Well. It provides depth with a human face and without too many of the data details I love.

panmacmillan.com/authors/dr-na

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trauma, abuse, adverse childhood experiences (ACE) 

This is one of many of her videos that dig more deeply into the data.

youtube.com/watch?v=vEoCmjrUjX

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trauma, abuse, adverse childhood experiences (ACE) 

I also like this video by Dr. Vince Felitti, the person who along with Dr. Robert Anda at the CDC conducted the original study. Remember this isn't new, was a very large-scale study and has been confirmed and expanded by many subsequent studies.

youtube.com/watch?v=KEFfThbAYn

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trauma, abuse, adverse childhood experiences (ACE) 

Multiple states are working to identify, heal, and prevent ACEs across multiple spheres. Again, it's a public health crisis. The developmental changes can't be undone but their ongoing harm can be mitigated and even adult risks can be reduced.

Obviously, though, it's a situation where it is much, much easier to prevent the harm or mitigate the neurodevelopmental and systemic damage in childhood as the bodily systems are still developing.

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trauma, abuse, adverse childhood experiences (ACE) 

Subsequent studies remain primarily focused on the core identified elements to remain consistent with the existing body of research.

However, as Dr. Nadine Burke Harris herself has found with secondary research, Dr. Felitti's focus on core personal integrity and caregiver environment appears to have been a key insight.

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trauma, abuse, adverse childhood experiences (ACE) 

Even extreme poverty, neighborhood gun violence, racism and other environmental sources of stress appear to be mitigated and are less likely to be bodily experienced as toxic stress by a child if their primary ACE score is low. For a developing child, *that* is both the most damaging type of stress and the greatest buffer against external sources stress.

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trauma, abuse, adverse childhood experiences (ACE), child sexual abuse 

Other studies have shown that children with ACEs are at a higher risk of experiencing more as they grow up. When they check groups of children at different ages, that's what they've found.

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trauma, abuse, adverse childhood experiences (ACE), child sexual abuse 

And, of course, it's what I experienced. I acquired my 9th and final ACE when I was 14-15 and was groomed and sexually abused by an adult female family friend.

On the one hand it was the cherry on top of a childhood so chaotic it's hard to capture in words.

At the same time, it shattered me. No other words describe my inner experience.

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trauma, abuse, adverse childhood experiences (ACE), child sexual abuse 

It's important to recognize ACEs count *categories* not individual experiences. The accumulation of multiple categories is what strongly correlates to the dose related increase in risk across health outcomes. Anyone who experienced 6+ ACEs likely had a childhood experience that is difficult for them to express to others or even grasp themselves. I know that's true for me.

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trauma, abuse, adverse childhood experiences (ACE), child sexual abuse 

One of the sites where I track news on this topic is ACES Connection. If you're interested in the subject, I recommend it.

acesconnection.com/

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trauma, abuse, adverse childhood experiences (ACE) 

And the risks across multiple health outcomes goes up starting with the first ACE score. It really is dose related. The only "safe" ACE score is a 0 score. If you have a non-zero ACE score, you should be seeking ways to mitigate the bodily impact of toxic stress.

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trauma, abuse, adverse childhood experiences (ACE) 

As Dr. Felitti mentions in his talk, part of the pushback he and Dr. Anda got from the medical community was an attempt to dismiss the health outcome risks as purely behavioral. (Never mind that the neurodevelopmental damage contributes to adult behavior.)

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trauma, abuse, adverse childhood experiences (ACE) 

As he says, behavior is something they can control for. So they did. They found that across *all* health outcome categories, the increased risk was only reduced by about one-third. And things like pancreatic cancer or lupus have no obvious behavioral linkage at all.

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trauma, abuse, adverse childhood experiences (ACE) 

@tmorizot I feel concerned that I'm as traumatized as I am with a low ACE score. I feel like they should have a question about religious "family" too. "Did your church terrify you weekly?" Yes? Ok, have a point.

trauma, abuse, adverse childhood experiences (ACE) 

@abigail Even one ACE or traumatic experiences that aren't included in that core, primary list can be deeply traumatizing. They focus on counting categories instead of traumatic events because that correlates to the developmental environment the child experienced. That's where the dose related systemic effect comes into play.

But *any* trauma can still be experienced and felt deeply with lifelong effects.

trauma, abuse, adverse childhood experiences (ACE) 

@tmorizot Also, poverty: Did you have food but heat and shoes were difficult to obtain? Did your parents love you a lot but also have some mental health problems? Honestly, I think it's a miracle so many of us function on a semi-healthy level at all.

trauma, abuse, adverse childhood experiences (ACE) 

@abigail Caregiver suffering from mental illness is one of the categories. Poverty and other systemic issues *are* a source of stress, but a low ACE score tends to make them a tolerable stress for a child. That's something Dr. Nadine Burke Harris mentions being surprised to discover in some secondary research data collection she did. Of course, they amplify a higher ACE score.

re: trauma, abuse, adverse childhood experiences (ACE) 

@tmorizot I got an ACE score of 3, counting losing a parent to cancer. I answered no to one item on a technicality, so let's call that 3.5

re: trauma, abuse, adverse childhood experiences (ACE) 

@DJWalnut Definitely in the higher risk zone. I mean the risks across health outcomes increase with each ACE, but around 4, the odds that the body and brain have been significantly impacted by toxic stress responses begin to approach certainty. Good news is there are always things we can do to manage our stress response and improve those health outcome risks.

re: trauma, abuse, adverse childhood experiences (ACE) 

@tmorizot yeah, I know that I'm a mental health disaster, but I've only been coming to terms with that recently. I should look into ACEs and how I can heal

re: trauma, abuse, adverse childhood experiences (ACE) 

@DJWalnut
Good luck! I hope you find the things that help you.

re: trauma, abuse, adverse childhood experiences (ACE) 

@tmorizot thank you

trauma, abuse, adverse childhood experiences (ACE) 

@tmorizot wow. Your knowledge of the ACES is amazing. Thank you for sharing it! This is such an important conversation to have as a society. I teach a class to parents about the intergenerational transmission of toxic stress that centers heavily on the ACES. My favorite piece, is that social determinants of health don't have to be the end of the story and with knowledge much can be repaired.

trauma, abuse, adverse childhood experiences (ACE) 

@Joy_concepcion
That sounds like a really good class. Absorbing and processing information is what I do. And yes, breaking the generational cycle is critical.

trauma, abuse, adverse childhood experiences (ACE) 

@tmorizot coming from a family with high ACE scores, this is important to me. What has been most beneficial is meditation and other practices that mitigate stress and are linked to the natural production of telomerase and the regrowth of telomeres. Every time I take ti.e for meditation I envision happy DNA 😊. But I'm a need like that. Thatnks for bringing in the conversation.

trauma, abuse, adverse childhood experiences (ACE) 

@Joy_concepcion
Yeah, I'm working on ways to mitigate the effects of toxic stress. I'm still early in that process, mostly just trying to deal with trauma and ptsd right now.

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