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What are ACEs?

ACEs are adverse childhood experiences that harm children's developing brains so profoundly that the effects show up decades later; they cause much of chronic disease, most mental illness, and are at the root of most violence.


“ACEs” comes from the CDC-Kaiser Adverse Childhood Experiences Study, a groundbreaking public health study that discovered that childhood trauma leads to the adult onset of chronic diseases, depression and other mental illness, violence and being a victim of violence. The ACE Study has published about 70 research papers since 1998. Hundreds of additional research papers based on the ACE Study have also been published.


The 10 ACEs the researchers measured:


-- Physical, sexual and verbal abuse.

-- Physical and emotional neglect.

-- A family member who is:

  • depressed or diagnosed with other mental illness;
  • addicted to alcohol or another substance;
  • in prison.

-- Witnessing a mother being abused.

-- Losing a parent to separation, divorce or other reason.


People have an ACE score of 0 to 10. Each type of trauma counts as one. Each ACE counts as one, no matter how many times it occurs. 


You can think of an ACE score as a cholesterol score for childhood trauma.


Of course, there are many other types of childhood trauma -- such as witnessing a sibling being abused, witnessing violence outside the home, witnessing a father being abused by a mother, being bullied by a classmate or teacher – but only 10 types were measured. They provide a useful marker for the severity of trauma experienced. Other types of trauma may have a similar impact.



CDC ACE Study site

Wikipedia -- Adverse Childhood Experiences Study

The 10 ACE Questions (and 14 resilience survey questions)


Why are ACEs significant?

There are two main reasons:


1. The ACE Study revealed four main discoveries:

  •  ACEs are common…nearly two-thirds (64%) of adults have at least one.
  •  They cause adult onset of chronic disease, such as cancer and heart disease, as well as mental illness, violence and being a victim of violence
  • ACEs don’t occur alone….if you have one, there’s an 87% chance that you have two or more.
  • The more ACEs you have, the greater the risk for chronic disease, mental illness, violence and being a victim of violence. For example, people with an ACE score of 4 are twice as likely to be smokers and seven times more likely to be alcoholic. Having an ACE score of 4 increases the risk of emphysema or chronic bronchitis by nearly 400 percent, and suicide by 1200 percent. People with high ACE scores are more likely to be violent, to have more marriages, more broken bones, more drug prescriptions, more depression, more autoimmune diseases, and more work absences. People with an ACE score of 6 or higher are at risk of their lifespan being shortened by 20 years.    

2. The 17,000 ACE Study participants were mostly white, middle- and upper-middle class, college-educated, and all had jobs and great health care (they were all members of Kaiser Permanente).



ACE Study video (three minute trailer)

The Adverse Childhood Experiences Study – the largest public health study you never heard of – started in an obesity clinic


Has anyone else done an ACE Study?

Twenty-six states and Washington, D.C. (infographic) have done one or more ACE surveys. Here are links to their reports.


There are numerous other ACE surveys, including cities, such as Philadelphia; organizations, including the Crittenton Foundation; schools, including Spokane elementary schools; by pediatricians, including Dr. Nadine Burke Harris and Dr. Victor Carrion (2011 and 2013); several countries, including EnglandSaudi Arabia, and a World Health Organization ACE survey of university students in Romania,; and 64,000 juvenile offenders in the Florida juvenile justice system.


What other research explains the results of the ACE Study?

Researchers who are studying the short- and long-term consequences of childhood adversity say that a “unified science” of human development has emerged that includes the:

  • epidemiology of childhood trauma (the CDC-Kaiser ACE Study),
  • neurobiology of toxic stress,
  • long-term biomedical consequences of toxic stress,
  • epigenetic consequences of toxic stress,
  • and resilience research.


What’s the neurobiology of toxic stress?

Brain science shows that, in the absence of protective factors, toxic stress damages children’s developing brains. Stress is the body’s normal response to challenging events or environments. Positive stress -- the first day of school, a big exam, a sports challenge -- is part of growing up, and parents or caregivers help children prepare for and learn how to handle positive stress, which is moderate and doesn't last long. It increases heart rate and the amount of stress hormones in the body, but they return to normal levels quickly.  


But when events or the environment are threatening or harmful – we stumble across a bear in the woods – our brains instantly zap into fight, flight or freeze mode and bypass our thinking brains, which can be way too analytical to save us (Is the bear really mean? Is it more interested in berries or killing me? Should I wait until I see it charge?). With help from caring adults, children also recover from this tolerable stress. 


Too much stress – toxic stress – occurs when that raging bear comes home from the bar every night, says pediatrician Nadine Burke Harris. Then a child’s brain and body will produce an overload of stress hormones -- such as cortisol and adrenaline -- that harm the function and structure of the brain. This can be particularly devastating in children, whose brains are developing at a galloping pace from before they are born to age three. Toxic stress is the kind of stress that can come in response to living for months or years with a screaming alcoholic father, a severely depressed and neglectful mother or a parent who takes out life’s frustrations by whipping a belt across a child’s body.



Harvard University Center on the Developing Child

Video: Toxic Stress Derails Healthy Development (2 min)

An Unhealthy Dose of Stress (Center for Youth Wellness white paper)


What are the biomedical effects of toxic stress?

Chronic toxic stress—living in a red alert mode for months or years—can also damage our bodies. In a red alert state, the body pumps out adrenaline and cortisol continuously. Over time, the constant presence of adrenaline and cortisol keep blood pressure high, which weakens the heart and circulatory system. They also keep glucose levels high to provide enough energy for the heart and muscles to act quickly; this can lead to type 2 diabetes. Too much adrenaline and cortisol can also increase cholesterol.


Too much cortisol can lead to osteoporosis, arthritis, gastrointestinal disease, depression, anorexia nervosa, Cushing’s syndrome, hyperthyroidism and the shrinkage of lymph nodes, leading to the inability to ward off infections.


If the red alert system is always on, eventually the adrenal glands give out, and the body can’t produce enough cortisol to keep up with the demand. This may cause the immune system to attack parts of the body, which can lead to lupus, multiple sclerosis, rheumatoid arthritis, and fibromyalgia.


Cortisol is also extremely important in maintaining the body’s appropriate inflammation response. In a normal response to a bee sting or infection, the body rushes antibodies, white blood cells and other cell fighters to the site and the tissues swell while the battle rages. But too much swelling damages tissue. Cortisol controls this fine balance. So without the mediating effects of cortisol, the inflammatory response runs amok and can cause a host of diseases.


If you’re chronically stressed and then experience an additional traumatic event, your body will have trouble returning to a normal state. Over time, you will become more sensitive to trauma or stress, developing a hair-trigger response to events that other people shrug off.


Biomedical researchers say that childhood trauma is biologically embedded in our bodies: Children with adverse childhood experiences and adults who have experienced childhood trauma may respond more quickly and strongly to events or conversations that would not affect those with no ACEs, and have higher levels of indicators for inflammation than those who have not suffered childhood trauma. This wear and tear on the body is the main reason why the lifespan of people with an ACE score of six or higher is likely to be shortened by 20 years.



Scared Sick: The Role of Childhood Trauma in Adult Disease by Robin Karr-Morse with Meredith S. Wiley

Biologial Embedding of Early Social Adversity, Proceedings of the National Academy of Sciences, 2012

PubMed childhood adversity research publications


What’s epigenetics?

Most people believe that the DNA we’re born with does not change and that it determines all that we are during our lifetime. But the research from epigenetics—the study of how social and other environments turn our genes on and off—shows that toxic stress can actually alter our genes and cause long-term changes in all parts of our bodies and brains. What’s more, these changes can be transferred from generation to generation.

Epigenetics means “above the genome” and refers to changes in gene expression that are not the result of changes in the DNA sequence (or mutations). 


Resilience research: If you have a high ACE score, are you doomed?

The good news is that the brain is plastic, and the body wants to heal.


The brain is continually changing in response to the environment. If the toxic stress stops and is replaced by practices that build resilience, the brain can slowly undo many of the stress-induced changes.


There is well documented research on how individuals’ brains and bodies become healthier through mindfulness practices, exercise, good nutrition, adequate sleep, and healthy social interactions.


Research on families shows that interventions -- such as Nurse-Family PartnershipHealthy Steps, and Child First -- can improve the lives of parents and children. Evidence-based parenting practices (Incredible YearsTriple P Parenting, etc.), increase the health of parents and children.


Research on communities and systems is emerging, but early data, especially from schools and juvenile detention centers, is showing promise.  


Is anybody doing anything with this research?

Many people, organizations, agencies and systems are beginning to implement practices based on ACEs research.


Community Resilience Cookbook (nine case studies of cities and states that are integrating ACEs research)


What does trauma-informed mean?

According to the Substance Abuse and Mental Health Services Administration (SAHMSA), part of the U.S. Department of Health and Human Services, a trauma-informed approach refers to how an organization or community thinks about and responds to children and adults who have experienced or may be at risk for experiencing trauma. In this approach, the whole community understands the prevalence and impact of ACEs, the role trauma plays in people's lives, and the complex and varied paths for healing and recovery.


A trauma-informed approach asks: "What happened to you?" instead of "What's wrong with you?" It is designed to avoid re-traumatizing already traumatized people, with a focus on "safety first" (including emotional safety), and a commitment to do no harm. 



SAMHSA overview of what trauma-informed is and isn't

National Center for Trauma-Informed Care


Is there any ACEs legislation or federal policies?

California legislature resolution to reduce ACEs

Massachusetts bill on trauma-informed schools

Vermont attempt to pass ACEs bill

Overview of state, federal legislation

US Department of Health and Human Services guidelines to state health directors (and the letter to state health directors)


All resources:

CDC ACE Study site

Wikipedia -- Adverse Childhood Experiences Study

The 10 ACE Questions (and 14 resilience survey questions)

Harvard University Center on the Developing Child (neurobiology of toxic stress)

Alberta Family Wellness Initiative (Canada) – news site covering ACEs research and practices –social network (with 3,000+ members)

National Center for Trauma-Informed Care

Community Resilience Cookbook (nine case studies of cities and states that are integrating ACEs research)



ACE Study video (three minute trailer)

Video: Toxic Stress Derails Healthy Development (2 min)



Scared Sick: The Role of Childhood Trauma in Adult Disease by Robin Karr-Morse with Meredith S. Wiley

The Last Best Cure: My Quest to Awaken the Healing Parts of My Brain and Get Back My Body, My Joy, and My Life, by Donna Jackson Nakazawa


Louise Sloan

In Brooklyn, public school’s been up and running for almost two months now, and I can’t stop thinking about Jmyha Rickman. She’s the 8-year-old Illinois schoolgirl who threw an epic tantrum last year and was hauled out of Lovejoy Elementary in handcuffs. On Facebook, comments ranged from “that kid needs a whupping” to “what kind of crazy racist monsters call the cops on a third-grader?” I didn’t comment. I was too busy freaking out. My boy could be next.

My 8-year-old is That Kid. The one who drives the teachers crazy. At best, he’s the class clown. At worst, he gets suspended for a fistfight with the other kid in his grade who can’t stay out of trouble, either. Last year there were 17 official incident reports.

What’s going on? Despite some $20,000 in professional assessments, the reasons my son acts out are still not entirely clear. He’s definitely extremely anxious about school and has been since a drill-sergeant-style preschool teacher traumatized him at age 3, which kicked off the behavior problems.

Ultimately, the why’s are irrelevant. It’s the “what now?” that concerns me. We’re still in that start-of-school honeymoon period, though Halloween is usually when he starts to take off the “good student” mask. Will this be the year he’s cuffed and carted out? And what about all the other kids like him?

Handcuff worries may be overblown, in my case. My son is 70 pounds, the same size as Jmyha was, and, like her, he’s occasionally out of control. But he’s white, and I’m an Ivy League educated editor with the cell numbers of friends at large media companies and law firms on my iPhone. Race and class privilege may keep him out of jail.


[For more of this story, written by Louise Sloan, go to http://parenting.blogs.nytimes....S.&pgtype=Blogs]


Kevork Djansezian/Getty Images


For a long time, the conventional political wisdom was that no one ever lost an election for being too tough on crime. That wisdom has been turned on its head in recent years, as both politicians and the public are realizing how much damage the lock-’em-up mind-set has caused.

In recent polls asking about the most important problems facing the country, crime ranks way at the bottom. That’s because crime is at its lowest levels in decades, even while overstuffed prisons cripple state budgets.

A familiar retort is that crime is down precisely because the prisons are full, but that’s simply not true. Multiple studies show that crime has gone down faster in states that have reduced their prison populations.

An encouraging example comes from California, the site of some the worst excesses of the mass incarceration era, but also some of the more innovative responses to it.


[For more of this story go to]




We know that about 10 million more people have insurance coverage this year as a result of the Affordable Care Act. But until now it has been difficult to say much about who was getting that coverage — where they live, their age, their income and other such details.

Now a large set of data — from Enroll America, the group trying to sign up people for the program, and from the data firm Civis Analytics — is allowing a much clearer picture. The data shows that the law has done something rather unusual in the American economy this century: It has pushed back against inequality, essentially redistributing income — in the form of health insurance or insurance subsidies — to many of the groups that have fared poorly over the last few decades.

The biggest winners from the law include people between the ages of 18 and 34; blacks; Hispanics; and people who live in rural areas. The areas with the largest increases in the health insurance rate, for example, include rural Arkansas and Nevada; southern Texas; large swaths of New Mexico, Kentucky and West Virginia; and much of inland California and Oregon.


[For more of this story, written by Kevin Quealy and Margot Sanger-Katz, go to;abt=0002&abg=1]

Photos (1)



As colleges continue to scramble under federal pressure to overhaul how they handle cases of sexual assault, the list of schools under investigation for botching cases continues to grow.

That's left some wondering if campuses will ever get it right, or if they might be better off leaving the job to others.

A growing number of campuses already have made the choice to do just that: Rather than try to train their provosts and professors to act like prosecutors, they're outsourcing the job to real ones instead.

Djuna Perkins is a former prosecutor who is now an investigator-for-hire focusing on sexual assault. Her office, just outside Boston, is lined with college pennants from a growing list of Massachusetts schools that are her clients: Amherst, Brandeis, Bentley, Harvard, Tufts, Williams, Emerson and more.

"The phone starts ringing, you know, the first day after Labor Day, and I sort of joke that I'm like legal 911," Perkins says. The schools are "stressed like you cannot believe," she says. They would rather have someone else handle the investigations, she adds, "because they, at a certain point, might feel a little bit out of their element."


[For more of this story, written by Tovia Smith, go to]

Photos (1)
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