A few months ago our Northeast Michigan Trauma-Informed Community Action Group sent out the ACE questions through a survey monkey link to our regional community through a free local advertiser.  We didn't receive many responses until the survey was sent to members of our Human Services Coordinating Committee and Promoted by some members of the committee locally on Facebook.  

Below are the results of 86 individuals who completed the ACEs survey for our region.  Seven categories of ACEs are significantly higher than the ACE study results.  A very high percentage (34.6)  reported 4 or more ACE exposures and 17.3 percent reported 6 or more categories of ACE exposure.   The most common form of abuse in our respondents was emotional at over 41 percent (which was also the most common ACE in the Michigan ACE study).  

It is important to understand regional ACE exposure.  It is also important to understand that Emotional Abuse is a toxic form of abuse.  However, emotional abuse is incredibly hard to recognize and is the least likely to be investigated by CPS.  Youth exposed to emotional abuse have more inattention, hyperactivity, noncompliance, conduct problems and delinquency.  They also have increased risk for internalizing disorders such as anxiety, low self-esteem, and suicidality.  Emotional abuse results in attachment problems, generalized anxiety and substance use disorders.  Psychological maltreatment not only independently is a toxic form of abuse but it augments the psychological disruption of other forms of abuse. From the paper in Pediatrics in 2012 by Roberta Hibbard et. al  "Psychological Abuse is the strongest most consistent predictor of internalizing problems such  as generalized anxiety, attachment disruption, and substance use disorder."