Thousands upon thousands of research studies are done each year in the mental health and medical fields. The research is used to better understand diseases and disorders. It’s used to test which treatments are more effective. The research is used to help educate the public about how to prevent diseases and disorders from developing, and, how to get treatment if you need it. As mental health and medical professionals, we’re expected to continue educating ourselves about the latest research in our field, especially about our expertise within our field.
In all of the research done during my career, the one I find most profound has been the ‘ACE’s study. It’s often called “the largest public health study you’ve never heard of,” but, that’s beginning to change.
‘ACE’s stands for Adverse Childhood Experiences. The study began in the 1980s, when Dr. Alan Frizetti, a weight loss doctor in Southern California, noticed the clients losing the most weight in his clinic, were the same ones most likely to drop out of the weight loss program. Determined to understand why patients would drop out when they were losing weight, he began to interview “drop outs.” What he found was shocking: The way people were treated as children was the biggest predictor of their mental and medical health — even when people were in their 50s, 60s, 70s and 80s. And, the behaviors many of us see as dysfunctional, like smoking, overeating, and substance use, are viewed as helpful to people who experienced childhood traumas. For example, smoking can help with anxiety, and obesity can feel protective by keeping others at arms’ length.
Dr. Frizetti joined forces with Kaiser Permanente and later the U.S. Center for Disease Control. He developed a questionnaire with only 10 questions. All of the questions ask about maltreatment the adult experienced when they were a child. The questions ask about experiences such as physical and sexual abuse, domestic violence between parents, or if a parent was an alcoholic. Each subjects’ physical and mental health was then assessed.
It was a huge research study: 17,000 adults, mostly white, middle-and upper-middle class, college-educated people with good jobs and with good health care participated (all were employed at Kaiser Permanente). The results were so profound they shocked even the researchers themselves. Only 40 percent of these ‘high functioning’ adults had experienced no “adverse childhood experiences.” Twenty-six percent had a score of one, and 13 percent had a score of 4 or higher. Even more shocking was ‘ACE’s experiences were so profound upon a child’s developing brain, the higher score an individual had, the more likely they were as an adult to have chronic diseases such as heart disease and emphysema, the more likely they were to smoke, drink or use illegal drugs, the more likely they were to use prescription medications, and the more likely they were to be absent from work. Those with a score of 6 or above, lived, on average, 20 less years than those with a score of 0 or 1.
Don’t be surprised, if in the near future, your doctor administers the ACEs questionnaire to you as part of your annual medical examination. This is why. Research is finding when people know what their ACEs score is, and learn how it affects mental, social and physical health, they’re often surprised. This information is usually a relief, and also a big motivator, to get needed mental health and medical care.
Communities across the country are developing support groups for ‘ACEs too high’ individuals. These groups focus on education and helping folks develop support and coping skills.
Equally important, is the mandate for our country: We must develop social prevention so adverse experiences don’t happen to children in the first place. ‘ACE’s experiences are rampant in our country. The health and social problems that result from childhood maltreatment are astronomical and the financial cost to our country is profound. Programs like nurses visiting first time parents at home, parent training projects, high quality child care, social support for parents, and early identification and family preservation services for at-risk and traumatized families, will pay for themselves a million times over.
You can complete the questionnaire and get your ACEs score at acestoohigh.com, acestudy.org or at cdc.gov. These websites explain the ‘Adverse Childhood Experiences’ research and findings more in depth, and also offer support and recommendations. The most important message from all of this research is: It’s never too late to heal.
Lisa Keating, Ph.D., is a Carson City clinical psychologist.
