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12 Myths of the Science of ACEs

 

The two biggest myths about ACEs science are:

MYTH #1 — That it’s just about the 10 ACEs in the ACE Study— the CDC-Kaiser Permanente Adverse Childhood Experiences Study. It’s about sooooo much more than that.

MYTH #2 — And that it’s just about ACEs…adverse childhood experiences.

These two myths are intertwined. The ACE Study issued the first of its 70+ publications in 1998, and for many people it was the lightning bolt, the grand “aha” moment, the unexpected doorway into a blazing new understanding of the link between childhood adversity and the adult onset of chronic disease, mental illness, violence and being a victim of violence, among many other surprising consequences. Most people don’t realize that the original ACE questionnaires had more than 100 questions, and explored many aspects of a person’s family history. To make things easier to grasp, one of the people working with Drs. Robert Anda and Vincent Felitti, the co-principal investigators, came up with the suggestion for a shortened version, and the 10 ACEs and the ACE score were born. By the way, Anda and Felitti recognized that there were many other ACEs than those they chose to look at — including racism, bullying, a father being abused, and community violence — but they settled on those ten because they were identified as common in a pilot study of about 300 people; several of the adverse experiences — such as sexual abuse and physical abuse — had been individually well studied.

Since the original ACE Study was done, there have been many other surveys and studies, and many of those have expanded the types of ACEs. Based on the other parts of ACEs science, we now know that any experience that results in toxic stress can be regarded as an ACE. So, we put together this infographic to show the three realms of ACEs:

  1. Family
  2. Community
  3. Climate crises

This infographic expands the types of experiences in the original ACE Study and combines them with the “Pair of ACEs” described by Wendy Ellis, director of Building Community Resilience Collaborative and Networks, and adverse experiences from climate crises, which are sure to increase over the next several decades. The truth of the matter is that the experiences listed in the three areas in the infographic can all cause harm to children’s brains and bodies. How they recover — or cope — depends on the supports provided them after the experience.

There’s no doubt that the ACE Study is an easy door to go through to begin to explore the mind-bending, world-changing knowledge of ACEs science, but there was so much more going on before, during and after the ACE Study was first published. The story of that evolution is for another time. For this post, it’s important to grok that around 2012, give or take a couple of years, among leaders of the ACEs movement, ACEs science jelled into what it is today — an interlocking matrix of five areas of complementary research:

  • The ACE Study and subsequent ACE surveys that show how many people experience ACEs, at what levels, and the consequences (epidemiology).
  • How toxic stress from ACEs damages children’s developing brains (neurobiology or brain science).
  • How toxic stress from ACEs affects our short- and long-term health.
  • How we pass ACEs from generation to generation through our genes (epigenetics).
  • And how resilience research shows that our brains are plastic and our bodies can heal through implementing protective factors and resilience-building practices based on ACEs science.


The other 10 myths:

MYTH #3 — The ACE Study findings are just about figuring out your ACE score. It’s more complicated. And eye-opening.

  1. ACEs are surprisingly common — 64% of the 17,000 in the ACE Study had one of the 10 ACEs; 12 percent had four or more.
  2. There’s an unmistakable link between ACEs and adult onset of chronic disease, mental illness, violence, being a victim of violence, and so much more, including more broken bones (from thrill sports).
  3. The more types of childhood adversity, the direr the consequences. An ACE score of 4 increases the risk of alcoholism by 700%, attempted suicide by 1,200%; it doubles heart disease and lung cancer rates.
  4. ACEs contribute to most of our health problems, including chronic disease, financial and social health issues.
  5. One type of ACE is no more damaging than another. An ACE score of 4 that includes divorce, physical abuse, a family member depressed or in prison has the same statistical outcome as four other types of ACEs. This is why focusing on preventing just one type of trauma (stopping sexual abuse) and/or coping mechanism (stopping smoking) won’t ever eliminate that trauma or coping mechanism.

MYTH #4 — If you have ACEs, you’re doomed. If you have no ACEs, you’re fine. The brain is plastic. The body wants to heal. No matter who has ACEs — kids or adults — it’s not too late to heal. Understanding ACEs science is the first step, because that leads to understanding that you weren’t born bad, you had no control over your childhood, the way you coped was appropriate because you weren’t given healthy alternatives, and you can heal. Recent research shows that if you have protective factors in your childhood along with ACEs, you do much better than people who have ACEs and no protective factors. And here’s something interesting: if you have no or low ACEs, that doesn’t mean life is a bed of roses. Without protective factors, you do worse than someone with ACEs and protective factors. Those protective factors are crucial to health and well-being.

MYTH #5 — Screening should be done everywhere. Not necessarily. When you want to know the burden of ACEs and the promise of protective factors in a community, a school, an organization — and it’s extremely useful to know what the ACEs burden is, as well as the level of protective factors — an anonymous ACE and resilience survey is enough.  But in healthcare an individual's score is useful for treating and following patients. In both circumstances an ACE questionnaire should never be done without explaining ACEs science. Some people don’t think ACEs screening should become common, and often say, “What if insurance companies start screening for ACEs to determine insurance rates?” Well, we’re hoping to build enough of a movement so that insurance companies would have to look at the ACEs in their own organization first, before using it in a nefarious manner.

MYTH #6 — Physical and sexual abuse are the worst ACEs. The brain can’t distinguish between different types of ACEs — once the experience goes into the brain, it’s toxic stress. The ACE Study showed that it doesn’t matter what the types of ACEs are. An ACE score of 4 that includes divorce, physical abuse, an incarcerated family member and a depressed family member has the same statistical outcome as an ACE score of 4 that includes living with an alcoholic, verbal abuse, emotional neglect and physical neglect. “We studied a whole range of outcomes — emotional, social, financial, biomedical, etc. If someone had an ACE score of 2 or 4 or 7, it didn’t matter how you made the ACE score up. It didn’t matter.That was unexpected and a surprise,” says Felitti.

MYTH #7 —You don’t need to learn about ACEs science if you’re becoming trauma-informed. We know organizations that skipped over the ACE Study, included a little bit of brain science, and went right to implementing a trauma-informed approach. But that approach is not going to get an organization to be as successful as it could be if it integrated ACEs science.

MYTH #8 —You can’t ask someone about ACEs because you’ll traumatize them. When the ACE Study was going through the design and approval process, the institutional review board that decided if the study could be done turned it down at first because they thought that people would have what is known in layperson’s terms a “nervous breakdown” if they were asked the questions. To receive approval for the study, a person on the research staff was required to wear a pager 24-7 for the dozens, perhaps hundreds of people the review board thought would be needing emergency care. Not one person called this hotline. However, although anyone can do the 10-question ACE survey online — it’s in lots of places (e.g., NPR, here) — it’s NOT a good idea to introduce ACEs science in a staff meeting by requiring everyone to take the survey first. The trauma-informed approach is to educate people about ACEs science, make time for questions and discussion, then do the survey anonymously. And always have someone there available to talk with people who have their lives suddenly altered by the knowledge and want to talk about how it’s affecting them. It happens. Some therapists have been reluctant to ask their patients about ACEs. But what better place to address ACEs than with a therapist?

MYTH #9 — For physicians to start asking about ACEs, they need to have a therapist on staff. When Felitti realized the power of the ACE survey, he integrated it into the Health Appraisal Center at Kaiser Permanente in San Diego. Over the next few years, more than 440,000 patients who came through the center took the survey. He didn’t have a therapist on staff. For a while, a therapist had a temporary office in his clinic, and the nurse-practitioners called on him when necessary. It turns out that just the act of listening and acknowledging can make a difference — in the only study that’s been done on this, of 125,000 people who went through his center, there was a 35% drop in doctor visits and an 11% in visits to emergency rooms.

Felitti wrote:

It turned out that asking, listening, and accepting are a powerful form of doing that appears to provide great relief to patients. A common interchange was for the examiner to remark, "I see on the questionnaire that ...... (your father killed himself / you were raped / you were frequently beaten as a kid). Can you tell me how that has affected you later in your life?"

It took patients only a minute or two to describe how their childhood trauma affected them later in life. Their responses were to the point and usually helpful to understand what might be done.

MYTH #10 — There’s no difference in being trauma-informed or ACEs-science informed. Being ACEs-science informed is the bedrock, the foundation of becoming trauma-informed. You need both. ACEs science is the WHAT and WHY. Trauma-informed is the HOW. If we do only the how, becoming trauma-informed risks becoming a fad, especially if implementing trauma-informed practices without ACEs science shows only slight improvement.

MYTH #11 — Since ACEs only happen during childhood, we only have to focus all our resources on kids and we’ll solve our problems. Research shows that parents pass their ACEs on to kids, so you have to involve parents. If parents address their ACEs, learn about ACEs science, and get help, they get healthier, and, as a result, their kids get healthier. What causes ACEs? Toxic stress. And since toxic stress appears in the community and the environment, parents won’t get as healthy as their kids need them to be until the organizations and systems they work for and interact with, the communities they live in, and the nations they’re part of stop traumatizing already traumatized people, and start healing. The early ACEs science pioneers have shown that we can solve our most intractable problems, but we won’t solve our most intractable problems unless all organizations, systems in all sectors, all communities and nations integrate trauma-informed practices based on ACEs science.

MYTH #12 — We need to address ACEs only in poor people of color who live in urban areas, because they’re the demographic with the highest burden of ACEs. This just further exacerbates the them-us culture we’re all living in now, and is remarkably short-sighted. ACEs are everywhere, in all demographics. And people with ACEs in power — which in the United States are mostly white men who come from middle-class and upper middle-class backgrounds — can and do act out their ACEs by abusing people individually and by the policies that they create, either in the organizations they lead or the positions they hold in public service. You can find many examples of leaders in the business, faith-based, healthcare, entertainment, political and other arenas who have done so, and are doing so, due to their own ACEs. So it's just as important to educate kids and their parents in Palo Alto High School in Palo Alto, CA., about ACEs science as it is kids and their parents in McClymonds High School in Oakland, CA.

ACEs are everywhere, but, generally speaking the people with the least burden of ACEs are those who have the most power, because they have the most resources. Those with the greatest burden of ACEs are those with the least power and the fewest resources, no matter what country you're talking about. Traditionally, the people in power create a social structure that keeps those without the power as powerless as possible by instituting racism, sexism, classism, etc.

The promise of ACEs science is that we humans finally understand that these "isms" harm everyone — the powerful and the powerless — and that it's better for everyone to institutionalize sharing. Yeah, I know — much easier said than done. But now we have — and are accumulating more — scientific evidence, and, just like the increasing evidence for climate disruption, that genie won't be put back in the bottle.

_______________

Gail Kennedy of our ACEs Connection team came up with the idea for the 3 realms of ACEs while talking with Elaine Miller-Karas of the Trauma Resource Institute and Bob Doppelt of the Resource Innovation Group.

She brought in the rest of our ACEs Connection team to come up with the approach and content, and handed it over to graphic designer Mindy Atwood to make it look gorgeous.

Thank you all for creating this very useful infographic!

A two-sided PDF is attached: infographic on one side, facts about ACEs on the other. For more information about ACEs science, go to ACEs Science 101.

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Hi Jane - I noticed the PDF that is attached here on this post as well as the one Morgan Vien attached to THIS post: https://www.pacesconnection.com...alms-of-aces-handout, don't include PANDEMIC as seen in the image at the top of your post. Would you be able to link the latest version of the 3 Realms infographic that includes PANDEMIC here and on Morgan's blog post? Thanks so much! Hope you are well!

 

This ...... this ..... is a huge part of the solution. We hear the experts state that we avoid passing on our trauma to our kids by resolving our own childhood trauma.... but what does that look like?  How do we know we’ve done that successfully?

I think it looks like changing our Dispositional Representations (A6 here) - ie our Neurons that are wired together and fire together, and some are wired and fire implicitly, to be  closer to sets of neurons wired and firing together that don’t have exaggerated emotion or compulsive denial of negative emotion with warped information processing.    The exaggerated A and C strategies are all great survival strategies for a kid who could otherwise be killed at any moment by their own parents’ hands, but they aren’t  so great for an adult not living in that dangerous situation anymore. 

This author’s work is essential reading for everyone who wants to get to the bottom of how trauma affects us (and I’d read ‘The Haunted Self’ too, I don’t think many of us understand how fragmented and state-dependent our personalities are and how much and how often they switch. Certainly for anyone who feels like they are dealing with a war within, you might be experiencing a lot of dissociation).

The childhood that leads to 6, 8, 10 ACEs..... is intense and most of us were effectively devoid of healthy parenting. It’s not simple to overcome that.  I want to know what it looks like when a parent heals their trauma to the extent that authorities like BVK state and not be presented with an ambiguous statement Like “Heal your trauma so you don’t pass it on to your kids” .... What does that even mean?!?!?!?... Don’t we need to know what that looks like before we can know if we’re there? .. Anyway, Love and Light to Everyone!!! I pray everyone gets close to A1, C1, and B strategies!!  

I’m somewhat socially inept.... and feel massive amounts of fear and shame for being kind of pushy but I’m really convinced it’s important...... so I hope I don’t upset anyone.   We’re all on the same page. We all want the same thing. So awesome.... It’s all good...... (No one needs to kill me - as I talk through my fear and shame. I’m not out to hurt anyone........) 3F088660-BF65-4163-A569-7B0176F5368924297C12-A85C-41A4-B464-746030B8C926

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Hi Jane, thank you for this article. I so agree with all you’ve written.

When I talk to groups about ACEs, I use the 10 experiences as examples of things that can chronically trigger FFF.

My interpretation of the Study findings, based on personal and professional experiential research, is that the underlying issue of critical importance is helping children and adults feel emotionally and physically safe- in actuality or in perception. (Wow, that was some run on sentence!)

Since I last posted here, I’ve learned a great deal about Chronic Toxic Stress and what experiences bring it on.  From what I’ve seen and this is much bigger than childhood adversity.

Last year, my 27 year old health and fit child went into DKA and was subsequently diagnosed with late onset Type 1 DM. I asked his endocrinologist at HUP if this diagnosis was on the rise in millennials; she responded that in her practice it’s at epidemic proportions. 

I love pulling of pieces of a puzzle together so I began to question the nurses on the various units about what they’ve seen. Not only did they concur with endocrinologist but I was told that colon cancer was also being diagnosed at alarmingly high rates amongst millennials.

My theory is that this was the first generation to have access at a young age to the internet;  and the violence and hatred that occurs worldwide. They watched 9/11, mass shootings, bombings, genecides and even our own government ripping children from their parents and caging them like animals.

Talk about feeling unsafe! Not only have millennials and younger grown up watching adversity daily, they have less one on one human interaction with the world. I’m pretty sure that posting on social media and texting instead of calling doesn’t trigger the release of Oxytocin!

Milleninials also have a disadvantage in that we, their parents, have significant ACE scores! What I mean is that in an effort to be nothing like our parents- we stole the opportunity to develop resilience from our now millennial children. We did the best we could- we didn’t realize that attempting to keep them safe from hurt would actually cause them to feel so unsafe, not only in the world but with themselves!

A few months back, I was able to bring CTS to an internationally known and respected Retina specialists who noticed he was seeing a lot damage not consistent with Diabetes (the bulk of his patients). I asked him if he was seeing damage consistent with an inflammatory process. He was perplexed as to how I knew this!

it took a few months of educating him an the endocrinologist he was working with, but I made these two old school doctors to understand how “ feeling safe” impacts physical health and well-being! 

They just submitted an article and research to get Type 2 DM to also be classified as an autoimmune disorder and to classify Chronic Toxic Stress as a disorder!

There is truly only one way to help children and adults feel safe and that’s to teach them how to feel safe within their own skin.

I’ve learned how to do this myself and just recently created The H.E.A.R.T. Model, a Train the Trainer program which will improve physical outcomes by improving emotional well-being and changing behaviors that contribute to not feeling safe with ourselves.

The beauty of this Model is in its simplicity. It also can be implemented with any population; parents/ children,  teachers/students; addicts/ codependents and providers/patients! A grant I just submitted would implement The H.E.A.R.T. Model simultaneously with low income pregnant women and the providers who serve them. If any organizations are interested in possible collaboration let me know!

Some things in my world never change(- the essence of The H.E.A.R.T. Model lies in validating humanness not brokenness. H.E.A.R.T. provides participants with an unapologetic yes in regards to the following three questions...

Do you See Me? Do You Hear Me? Do I Matter?

Thank you, I realize that was a novel 🙄

With love, gratitude and heart💕

Leslie

 

I very much appreciated the 12 Myths of the Science of Aces. They identify many key misperceptions, and the new graphic is especially good in highlighting community and environmental sources of adversity as well as household sources. Thank you, Jane, for that.

But, as you would expect, I have some comments and serious reservations as well.  I will explain those in relation to excerpts from Myths 2, 6, and 12!

MYTH #2. ….ACEs science jelled into what it is today — an interlocking matrix of five areas of complementary research:

  •             The ACE Study and subsequent ACE surveys that show how many people experience ACEs, at what levels, and the consequences (epidemiology).
  •              How toxic stress from ACEs damages children’s developing brains (neurobiology or brain science).
  •              How toxic stress from ACEs affects our short- and long-term health.
  •              How we pass ACEs from generation to generation through our genes (epigenetics).
  •             And how resilience research shows that our brains are plastic and our bodies can heal through implementing protective factors and resilience-building practices based on ACEs science.

 

Here you miss noting explicitly the large and relatively independent body of neuroscience research that looks at childhood adversity.  That is the major source of what has come to be ACEs science. Much of the voluminous research using the ACE measure focuses on how ACE scores are related to various problems such as depression or delinquency -- your first bullet.  The understanding of the toxic stress and how it works biologically come from this other research tradition, which rarely uses the ACE survey as a measure of adversity and rather frequently uses early childhood family poverty.  I realize that in this excerpt you may be presuming a broad definition of ACE, but the narrow view of ACE shapes the reading of this section.

I know that you believe that the field takes a broad view of ACEs.  However, i

 

t does inconsistently, and too often as a 'by the way' -- here is the ACE and ACE score but there are other measures and some people include other items.  Unhappily, I regularly see ACE used to mean simply the ACE survey items.  A case in point, the just published CDC booklet on Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidence.  Other cases are legislative initiatives about adversity and trauma. And the Got Your ACE and Resilience Scores? link on ACEsConnection reinforces that view. For too many practitioners, ACE means the ACE survey and the ACE score, so the widened view of adversity is limited. People latch onto something tangible and nifty and the ACE score is both.

 

MYTH #6 ….In healthcare for treating and following patients, then an individual’s score is useful. In both circumstances an ACE questionnaire should never be done without explaining ACEs science. Some people don’t think ACEs screening should become common, and often say, “What if insurance companies start screening for ACEs to determine insurance rates?” Well, we’re hoping to build enough of a movement so that insurance companies would have to look at the ACEs in their own organization first, before using it in a nefarious manner.

The ACE survey was intended to be a population level tool as you suggest, not a diagnostic instrument for individuals.  ACE screening typically uses a version of the original survey or adds a few additional items.  No survey provides a comprehensive view of individual circumstances.  Nor do a survey and score reflect the odds (often low) of health or behavioral issues with a certain ACE score, even a higher one.  It does not take into account protective factors which are crucial in understanding individual trajectories in the face of adversity. (there are serious questions about the validity of the resilience survey that you post in What’s your ACEs Score. There is a developing resilience science that provides many options, but again no resilience score reflects individual circumstances).  What makes much more sense than
ACE screening in a medical setting is to screen for the symptoms or indicators of toxic stress which medical practitioners can do rather than very rough overpredictions of toxic stress that ACE measures provide. 

MYTH #12 — We only need to address ACEs in poor people of color, because they’re the demographic with the highest burden of ACEs. This just further exacerbates the them-us situation we’re all in and is remarkably short-sighted. ACEs are everywhere, in all demographics. And people in power — which in the United States are mostly white men who come from middle-class and upper middle-class backgrounds — can and do act out their ACEs by abusing people individually and by policies that they create, either in the organizations they lead or the positions they hold in public service. You can find many examples of leaders in the business, faith-based, healthcare, entertainment, political and other arenas who have done so, and are doing so, due to their own ACEs.

As you can imagine, I have some serious concerns about your framing here. Perhaps, there are those who believe this myth and, if so, it needs to be questioned.  But a much more problematic Myth is that ACEs are everywhere in equal measure. The definition of adversity (using your graphic) makes clear that adversity is differentially distributed and that if we are to prevent or reduce adversity and toxic stress, we need to understand that, be explicit about that, and act on that awareness. It is possible to hold the two observations together – ACEs are everywhere AND they are not everywhere equally.  Without that recognition, we focus entirely on the important steps of helping people facing toxic stress through awareness, therapy and trauma-informed institutions.But there it stops.  

By holding both views together, we can also focus on social policies that exacerbate adversity (such as child separation!), on policies that may reduce adversity (poverty reduction, neighborhood violence reduction, provision of affordable housing…..) and on policies that increase resources in communities and households for protection against toxic stress. Right now, this policy approach that recognizes inequality and social determinants of health is poorly developed in the ACEs movement, and advocates for the poor and marginalized recognize it.  That needs to change!

Once again, thanks for your good efforts helping lead this important movement. 

 

I absolutely love this graphic. Thanks so much for producing and making available. I love Wendy's Pair of ACEs but we definitely need to include climate change impacts, as they are increasing.

Thanks so much for this article and the resources attached to it. I will most certainly be sharing this broadly and referring back to it frequently. 

Could someone please post it to our Canadian ACEs and TI Network please for easy reference?

Thanks so much Jane and Team. 

Oops I fumbled the quote below.  First line is what was quoted that Jane said; next lines are my comment. 

ACEs we don't name or think about are numerous and rampant in babyhood, and many are neglect based/ missing important inputs:  Lack of words, lack of eye contact, lack of responsiveness, lack of carrying.  Lack of joy in the face of the primary caregiver.   

Also there are bad overt practices: Cry it out.  Scheduled feedings.  Early/ too much use of daycare.  I can go on....  To me, all of these are Baby ACEs.  When mental health problems hit in grade school and toddlerhood now, we really need to consider Baby ACEs.

Primal parenting is a lot closer to what our brains are wired to receive.... all departures from "paleo" parenting are possible ACEs.

Look at the film clip of the  "still face experiment" and you will see how injurious SUBTLE things can be to a baby.

I'd say lack of attachment is an ACE.

Lack of attachment is THE biggest ACE problem we have.  Lack of attachment = lack of emotional self regulation.  It sets the right brain to " I am alone, I am unworthy."  It's the root problem of mental distress and it means there is no safe haven for the child for any of the other ACES (death, bullying, racism, etc)  that may come their way.

Daun Kauffman posted:
Tina Cain posted:

We’d get a lot more done that moved the needle if we found a way to look at the attachment system -w/o alienating adults- and not just ACEs... Because it’s the lack of a secure attachment that does all the damage, not an ACE Score. It’s the attachment relationships that are the resilience we look to build.  I can tell at 6 months with my Ages and Stages - SE, which babies are on a path to develop Developmental Trauma and adult Personality Disorders. 

Avoidant, Anxious and Disorganized Attachment would have antecedent(s).  The antecedent would be the ACE, correct?  The flawed attachment is ("only") a symptom of the ACE, similar to the many other behavioral symptoms.

I want to think a bit about my response but what I can say is that the “safe, stable, nurturing relationship” as noted on the CDC’s website on violence prevention, Essentials for Childhood, well 

A safe, stable, nurturing relationship is a secure attachment. 

https://www.cdc.gov/violencepr...lect/essentials.html

Tina Cain posted:

We’d get a lot more done that moved the needle if we found a way to look at the attachment system -w/o alienating adults- and not just ACEs... Because it’s the lack of a secure attachment that does all the damage, not an ACE Score. It’s the attachment relationships that are the resilience we look to build.  I can tell at 6 months with my Ages and Stages - SE, which babies are on a path to develop Developmental Trauma and adult Personality Disorders. 

Avoidant, Anxious and Disorganized Attachment would have antecedent(s).  The antecedent would be the ACE, correct?  The flawed attachment is ("only") a symptom of the ACE, similar to the many other behavioral symptoms.

We’d get a lot more done that moved the needle if we found a way to look at the attachment system -w/o alienating adults- and not just ACEs... Because it’s the lack of a secure attachment that does all the damage, not an ACE Score. It’s the attachment relationships that are the resilience we look to build.  I can tell at 6 months with my Ages and Stages - SE, which babies are on a path to develop Developmental Trauma and adult Personality Disorders. 

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Thank you for this, Jane and ACEs Connection team. I think most of us on this site are excited and hopeful that ACEs science and all things related are beginning to get a lot more attention and acceptance in the media and in our communities, but with this influx of information can come a lot of confusion and misunderstanding -- for ANY of us, not just those for whom ACEs science is new. We must continue to hone our message and understanding of how this information may be received and misconstrued. This post and infographic provide a substantive and thoughtful response to the to-be-expected (though desirable, because it often arises from critical thinking about the topic) questioning and skepticism when encountering ACEs science and the concept of trauma-informed approaches in our institutions.

Last edited by Laura Pinhey

Jane, I was one of those who was struck by the lighting bolt when I first read of the ACE study. I thank you for your work and this current post  which is most enlightening for me. As I write my second book on my life of chronic adversity which started in my childhood,I always thought that there were some hereditary factors which I illustrate in my story. For me it spans three generations and luckily for me there were some protective factors which probably saved me from total destruction of self. Still, my ACEs have had terrible consequences in my life which so far have resulted ,I think,in my cirrhosis of the liver and now liver cancer due to my alcoholism and other self medications. As you pointed out ,just the knowledge of ACEs has been healing as it has taken away the guilt of my life's failures as a father now realizing that I really did not have a chance avoiding these failures having  my ACEs occurring right from the start of my life. The persons who provided my protective factors enabled me to stay on the right path in life and caused me to avoid other worsening factors and eventually led to my sobriety and change of life at age 35. In my first book I do not mention ACEs because at that time I did not know about them. Now as I write my second book on my life of chronic adversity,ACEs will have  a prominent place as I illustrate the effects of having lived a life with multiple ACEs . My mission  is to reach individuals and families plagued with adversities of life and give inspiration,hope,and to educate them on the fact that there are paths to healing themselves and their family members. I appreciate your studies on this subject, your articles and you and your organization's mission. 

I LOVE this new infographic!! I'm already making copies and incorporating it into a presentation I'm doing with Emory University in a few weeks! Great job to the ENTIRE ACEs Connection Team. This is great. 

Thank you all for your kind words and input. We already have some good feedback, and we'll incorporate that on revisions and additions that we do. Then we'll park the infographic in an easily accessible and prominent place for our continually growing community.

Thanks for your comment and for your kind words!! There are MANY ACEs that are missing, Adrienne! We didn't have room for them all, and we note that*. We also encourage people who use this infographic to point that out and to invite others to add more ACEs! Then we can create a poster version of this!

*I think we could note it more clearly, so we'll work on that.

Last edited by Jane Stevens

Jane,

Love love LOVE this infographic.  One edit - it's missing food insecurity and other food traumas!  This could be added at either the household level or the community level - but we think it's super important to keep it top of mind.

Adrienne Markworth

Leah's Pantry

 

Thank you Jane for this excellent post and the very useful infographic.  You make beautifully clear how the science and the advocacy that are based in the ACE Study are both evolving and growing.  Well done!  

Thank you for this new infographic! I added climate change as a third source of trauma to my ACEs presentation at the beginning of this year, but I am grateful for a great visual that connects all three types/sources of ACEs.

I like the myth-busting, too.

Thank you Jane. 

Hope everyone who reads this shares it to FB, Twitter, LinkedIn, Insta - any and ever social media platform and emailing list they have.

Send it to members of Congress, elected officials in your state, people in your community in a position to help you make changes to help prevent and heal ACEs, foster personal, family, community, worldwide resilience. 

Policy makers need to see this again and again and people running for office need to see ACEs Science as the driver for the changes most of us hope to see. Voters need to read it to help us make the requests and demands of candidates and elected officials.  Journalists need this to help spread the word. 

Share and share widely! 

Excellent post! The three realms of ACEs illustrate well the pervasiveness of toxic stress experiences. In my view, increasing generalized awareness of the impacts of ACEs is a critical step toward helping individuals to recover from them and to become resilient. During the course of my hairdressing appointment recently, I introduced the topic of ACEs and, in particular, Dr. Felitti's study. My hairdresser quickly related to me her grandmother's story which began with sexual abuse in childhood by a family member and culminated in lifelong morbid obesity and related chronic physical and behavioral health conditions. Her grandmother's poor eating habits were transferred to her children and were passed along to their children, resulting in obesity across those generations. As we know, trauma's adverse effects need not equate to destiny, but certainly awareness and understanding of the adversities are necessary so that genuine healing from those harms can occur.             

This is a wonderful infographic, and the breakdown of the myths is going to be helpful as we share this work. Are there plans to translate the graphic into other languages? Thank you so much for the incredible work you are doing!

Good write up. Thanks...

My 2 cents  - 

ACEs aren’t transmitted generationally just by epigenetics but also by learned behaviors - Dr. Putnam - his longitudinal work on Child Sexual Abuse and Dissociation shows clearly that parents who have their own dissociation that has not been addressed will pass on their traumatic dissociation and disorganized attachment to their kids - and the ACEs in the next generation begin to stack up.  (These are the families with the generations of diagnosed or undiagnosed personality disorders particularly “Borderline” but not exclusively).  Knowledge of Maternal Dissociation and how it relates to Infant Attachment and Stress and ultimately Infant Brain Development, Regulation of the Body’s Stress and Immune Systems, I believe will be critical to ACEs prevention in the future. 

There are critical periods of brain development - with Infancy as very, very important. Neglect in the first 2 months of childhood can have such a profound effect on child development that it alone can result in a worse outcome than all kinds of horrific abuse and neglect and 10 ACEs that begins after age 1. 

Early Intervention During Pregnancy and Infancy are key for ACEs Prevention and a healthy society. 

Thanks. 

Last edited by Former Member

Jane, Thank you!  You are doing a wonderful job of disseminating around the world important human information that has too long been hidden by silence and by the belief that nice people don't talk about certain things, and surely don't ask.  I am continually impressed by what you are doing and by your effectiveness in doing it.  I can hardly wait to read the book you are writing about the ACE Study!  

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