Andres Sciolla, a psychiatrist and professor of psychiatry at UC Davis Medical School, hopes that an expanded version of ACEs becomes completely integrated into the medical profession in the future. By “expanded,” he explains: “Medicine would have to integrate sustainable and practical ways to address social determinants of health,” such as affordable housing, basic income, and access to affordable health care.
Sciolla earned his undergraduate and medical degrees at the University of Chile in Santiago, and also completed his residency in his native Chile. He became aware of the flagship 1998 CDC-Kaiser Permanente Adverse Childhood Experiences Studyin 2005, when he was a faculty member at UC San Diego. (He completed a second residency training in psychiatry there).
At the time, he was assigned to work at a clinic in San Ysidro, near the border with Mexico. “Most of my patients were underserved Mexican Americans and Mexican immigrants,” he says.
When meeting his patients during the initial evaluation, he says he would ask, “Tell me about your childhood.”
In response, most of them told him about their childhood adversity. Listening to their stories, “I became keen on the relationship between poverty and other adversities and the role they had on chronic forms of mental illness that were hard to treat and diagnose.
“Some colleagues of mine knew about my interest in childhood trauma,” he continues. They told him he should meet Dr. Vincent Felitti, the co-principal investigator, with Dr. Robert Anda, in the original ACE Study.
“We met over dinner in 2005,” says Sciolla.
ACEs is a term that comes from a landmark study that showed how widespread childhood adversity is. The CDC-Kaiser Permanente Adverse Childhood Experience Study of more than 17,000 adults linked 10 types of childhood adversity — such as living with a parent who is mentally ill, has abused alcohol or is emotionally abusive — to the adult onset of chronic disease, mental illness, violence and being a victim of violence. Many other types of ACEs— including racism, bullying, a father being abused, and community violence — have been added to subsequent ACE surveys.
Sciolla’s first impression on hearing Felitti describe his seminal study? “My patients have different ACEs than yours. My patients have additional ACEs. But I kept this to myself.” He notes that immigration status and being undocumented are still not considered part of ACEs.
His second impression: “I was astounded by the physical health effects.”
The ACE Study found that the higher someone’s ACE score — the more types of childhood adversity a person experienced — the higher their risk of social, economic, health and civic consequences. The study found that most people (64%) have at least one ACE; 12% of the population has an ACE score of 4 or higher. Having an ACE score of 4 nearly doubles the risk of heart disease and cancer. It increases the likelihood of becoming an alcoholic by 700 percent and the risk of attempted suicide by 1,200 percent. (For more information about how this works and about the full complement of ACEs science, go to PACEs Science 101. To learn more about your ACEs and PCEs (positive childhood experiences), go to What ACEs & PCEs Do You Have?)
Sciolla’s impressions of the correlation between mental health and ACEs were confirmed later when he moved to Sacramento to work at University of California Davis. He was assigned to a county clinic in Natomas, serving the publicly insured, and for six years he treated first- and second-generation immigrants from all over the world: Southeast Asia, the former Soviet Union republics, the Middle East, and Central America, as well as many African Americans. Many of these people had experienced extended ACEs, such as poverty and growing up in families receiving public assistance.
For the past three years, the psychiatrist has seen patients at the UC Davis Behavioral Health Center, and the mostly middle-class population, which is covered by private insurance, is less diverse. He does not screen patients for ACEs with the help of a checklist but notes that “some forms of ACEs – such as having a parent going to prison – are less common in the population I have now” than in the patients he saw at the county clinic east of Sacramento.
Instead of screening for ACEs, he facilitates trauma-informed conversations about ACEs. This exploration can also help uncover more subtle forms of developmental trauma that result in insecure attachment style.
A firm believer in trauma-informed approaches to help patients regulate their stress response system, Sciolla described the history of trauma research. “ACEs didn’t come out of the blue,” he says. “It (the ACE Study) is one study in a cloud of dozens and dozens of studies.”
He notes that there have been studies of early life stress in animal models, and there is a large literature that precedes the flagship ACE Study.
He also credits the women’s movement in the 1970s – with its exposure of intimate partner violence and child sexual abuse – with creating an awareness of childhood trauma, which in turn led to research on its health and mental effects in adulthood.
The difference with the ACE Study, however, was that “it sent a very powerful message.”
“That for 17,000 people their ACE score was able to predict their adult physical health outcomes was very novel,” he says. “There had been nothing before of that scale.”
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