I am a huge fan of the Showtime series Ray Donovan. It’s a rather dark drama about a violent but charismatic Hollywood “fixer” with questionable morals and a deeply dysfunctional family. In a recent episode, Ray has been ordered by a judge to attend anger management therapy. His therapist asks Ray a series of questions about his experiences as a child: Was he ever physically hurt by an adult? Did adults in his family abuse alcohol or drugs? Did anyone in his family commit suicide? Did he ever witness his father abuse his mother? Was he ever sexually abused by an adult? Ray silently nods yes to all of these questions and a few more. The therapist then explains that people who experience these things as children are more likely to have serious health and psychological problems as adults: addiction, mood disorders, heart disease, cancer, etc. Ray storms out of the office. Cut.
ACEs
As anyone in the world of children’s policy or services knows, these questions are about adverse childhood experiences, or ACEs, which were the subject of a groundbreaking research study conducted by the American health maintenance organization Kaiser Permanente and the Centers for Disease Control and Prevention. About 15,000 adult participants were recruited to the study between 1995 and 1997 and have since been in long-term follow up for health outcomes. The researchers were interested in the correlations between selected early experiences that produced toxic stress and later health outcomes. And what they found was astonishing, even to the researchers. Dr. Robert Anda, one of the research principals, noted that when he first saw the data showing how much harm these early experiences created, he cried. And his conclusion was that in order to improve the health of all Americans, we need to pay much more attention to protecting children from these traumatic experiences by shoring up their families and treating parents’ addictions, mental illnesses and other problems.
More than four=much higher risk
At the same time, I wish all pediatricians were asking the parents of their patients about these ACEs, because the stress is multi-generational. Stress is passed down through learned behaviors and epigenetic changes in the parents’ chromosomes.I wish Ray’s therapist had used the label of “Adverse Childhood Experiences” so that more of us can be aware of their impact and start using common language to talk about them. Wouldn’t it be great if every primary care doc used the list of ACEs as a screening tool to find out if their patients were at higher risk for these bad outcomes? The patients wouldn’t even have to disclose the details of the experiences, just count up how many experiences they had had and tell the doctor the number. People with more than four are at much higher risk.
It’s important to raise awareness of ACEs and their impact because we can’t fix what we don’t see. I’m not sure if Ray is ready to see, or to change, but the rest of us can do both to make sure our children are protected from ACEs in the future.
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