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"The Deepest Well" by Nadine Burke Harris

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"The Deepest Well" by Nadine Burke Harris

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Burke Harris narrates her journey in navigating the world of childhood stress and its lasting affects.

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"An extraordinary, eye-opening book."- People 2018 National Health Information Awards, Silver AwardThe New Jim Crow represent vitally important hope for preventing lifelong illness for those we love and for generations to come?.

"A rousing wake-up call . . . this highly engaging, provocative book prove[s] beyond a reasonable doubt that millions of lives depend on us finally coming to terms with the long-term consequences of childhood adversity and toxic stress."-Michelle Alexander, author of biological

Dr. Nadine Burke Harris was already known as a crusading physician delivering targeted care to vulnerable children. But it was Diego-a boy who had stopped growing after a sexual assault-who galvanized her journey to uncover the connections between toxic stress and lifelong illnesses.
The stunning news of Burke Harris's research is just how deeply our bodies can be imprinted by ACEs-adverse childhood experiences like abuse, neglect, parental addiction, mental illness, and divorce. Childhood adversity changes our systems, and lasts a lifetime. For anyone who has faced a difficult childhood, or who cares about the millions of children who do, the fascinating scientific insight and innovative, acclaimed health interventions in The Deepest Well How Children Succeed

"Nadine Burke Harris . . . offers a new set of tools, based in science, that can help each of us heal ourselves, our children, and our world."-Paul Tough, author of New York Times

"A powerful-even indispensable-frame to both understand and respond more effectively to our most serious social ills."-

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The Deepest Well: Healing the Long-Term Effects of Childhood Trauma and Adversity

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The Deepest Well: Healing the Long-Term Effects of Childhood Trauma and Adversity - Kindle edition by Burke Harris, Nadine. Download it once and read it on your Kindle device, PC, phones or tablets. Use features like bookmarks, note taking and highlighting while reading The Deepest Well: Healing the Long-Term Effects of Childhood Trauma and Adversity.

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Positive childhood experiences predict less psychopathology and stress in pregnant women with childhood adversity: A pilot study of the benevolent childhood experiences (BCEs) scale

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Positive childhood experiences predict less psychopathology and stress in pregnant women with childhood adversity: A pilot study of the benevolent childhood experiences (BCEs) scale

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JavaScript is disabled on your browser. Please enable JavaScript to use all the features on this page.

Abstract

This pilot study examined the psychometric properties of the Benevolent Childhood Experiences (BCEs) scale, a new instrument designed to assess positive early life experiences in adults with histories of childhood maltreatment and other adversities. A counterpart to the Adverse Childhood Experiences (ACEs) questionnaire, the BCEs was developed to be multiculturally-sensitive and applicable regardless of socioeconomic position, urban-rural background, or immigration status. Higher levels of BCEs were hypothesized to predict lower levels of psychopathology and stress beyond the effects of ACES in a sample of ethnically diverse, low-income pregnant women. BCEs were also expected to show adequate internal validity across racial/ethnic groups and test-retest stability from the prenatal to the postnatal period. Participants were 101 pregnant women ( M = 29.10 years, SD = 6.56, range = 18-44; 37% Latina, 22% African-American, 20% White, 21% biracial/multiracial/other; 37% foreign-born, 26% Spanish-speaking) who completed the BCEs and ACEs scales; assessments of prenatal depression and post-traumatic stress disorder (PTSD) symptoms, perceived stress, and exposure to stressful life events (SLEs) during pregnancy; and demographic information. Higher levels of BCEs predicted less PTSD symptoms and SLEs, above and beyond ACEs. The BCEs showed excellent test-retest reliability, and mean levels were comparable across racial/ethnic and Spanish-English groups of women. Person-oriented analyses also showed that higher levels of BCEs offset the effects of ACEs on prenatal stress and psychopathology. The BCEs scale indexes promising promotive factors associated with lower trauma-related symptomatology and stress exposure during pregnancy and illuminates how favorable childhood experiences may counteract long-term effects of childhood adversity.

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Positive childhood experiences predict less psychopathology and stress in pregnant women with childhood adversity: A pilot study of the benevolent childhood experiences (BCEs) scale

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JavaScript is disabled on your browser. Please enable JavaScript to use all the features on this page. This pilot study examined the psychometric properties of the Benevolent Childhood Experiences (BCEs) scale, a new instrument designed to assess positive early life experiences in adults with histories of childhood maltreatment and other adversities.

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https://www.alliance1.org/web/resources/pubs/balancing-adverse-childhood-experiences-aces-hope.aspx

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https://www.acesconnection.com/blog/growing-resilient-communities-2-0

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Adverse Childhood Experiences of Low-Income Urban Youth

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Adverse Childhood Experiences of Low-Income Urban Youth

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BACKGROUND AND OBJECTIVE: Current assessments of adverse childhood experiences (ACEs) may not adequately encompass the breadth of adversity to which low-income urban children are exposed. The purpose of this study was to identify and characterize the range of adverse childhood experiences faced by young adults who grew up in a low-income urban area.

METHODS: Focus groups were conducted with young adults who grew up in low-income Philadelphia neighborhoods. Using the nominal group technique, participants generated a list of adverse childhood experiences and then identified the 5 most stressful experiences on the group list. The most stressful experiences identified by participants were grouped into a ranked list of domains and subdomains.

RESULTS: Participants identified a range of experiences, grouped into 10 domains: family relationships, community stressors, personal victimization, economic hardship, peer relationships, discrimination, school, health, child welfare/juvenile justice, and media/technology. Included in these domains were many but not all of the experiences from the initial ACEs studies; parental divorce/separation and mental illness were absent. Additional experiences not included in the initial ACEs but endorsed by our participants included single-parent homes; exposure to violence, adult themes, and criminal behavior; personal victimization; bullying; economic hardship; and discrimination.

CONCLUSIONS: Gathering youth perspectives on childhood adversity broadens our understanding of the experience of stress and trauma in childhood. Future work is needed to determine the significance of this broader set of adverse experiences in predisposing children to poor health outcomes as adults.

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Adverse Childhood Experiences of Low-Income Urban Youth

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BACKGROUND AND OBJECTIVE: Current assessments of adverse childhood experiences (ACEs) may not adequately encompass the breadth of adversity to which low-income urban children are exposed. The purpose of this study was to identify and characterize the range of adverse childhood experiences faced by young adults who grew up in a low-income urban area.

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Positive Childhood Experiences Tied to Better Adult Mental Health

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Positive Childhood Experiences Tied to Better Adult Mental Health

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https://www.reuters.com/article/us-health-childhood/positive-childhood-experiences-tied-to-better-adult-mental-health-idUSKCN1VU2CP

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https://www.thenationalcouncil.org/areas-of-expertise/trauma-informed-behavioral-healthcare/

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The "life-changing" story Oprah reports this week

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https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/about.html

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A video from a national meeting held in order to organize a national research and action agenda.

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A video from a national meeting held in order to organize a national research and action agenda.

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Childhood Trauma: America’s Hidden Health Crisis

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Screening for adverse childhood experiences 

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Screening for adverse childhood experiences 

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cautions and suggestions

https://www.sciencedirect.com/science/article/pii/S0145213417302715

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This article gives a brief definition of what ACEs are and what they can cause throughout life.

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Adverse Childhood Experiences (ACEs) come in many forms, from physical and mental abuse to neglect and household dysfunction. In 1998, CDC-Kaiser Permanente published a groundbreaking study that investigated the impact of ACEs on physical and mental health problems in over 17,000 adults. During the study, the adults were given a survey asking about 10 different types of ACEs and if they had experienced them prior to the age of 18. The study showed a direct correlation between ACEs and future health complications. ¹

Since this study, we've not only learned more about the psychological effects of ACEs on young minds, but also the long-term health complications that can come from recurring exposure to ACEs. Now that we understand how toxic stress affects the minds and bodies of children, we can interrupt these changes by providing safe, stable, nurturing environments, while helping children build social-emotional skills and resilience.

10 ACEs, as identified by the CDC-Kaiser study:

Abuse

Neglect

Household Dysfunction

Incarcerated Relative

Substance Abuse

Graphic used with permission from The Robert Wood Johnson Foundation. See it here.

There are other types of adverse childhood experiences not included in the list of 10 ACEs above, including community and environmental ACEs such as racism, bullying and community violence. Researchers have begun to include these experiences as ACEs, too, because they create the same biologic changes as the original 10 ACEs.
Additional resources with examples of these expanded ACEs are:

Quick highlight: How are ACEs measured?

You can download and fill out the questionnaire below to get your own ACEs score. For more information on what your ACEs score can tell you, click here.

ACEs can get under our skin, impacting health through toxic stress.

Not all stress is bad. Some stress is healthy and positive because it prepares us to respond to temporary challenges in our lives, such as running a race, public speaking, or starting a new job. Our stress response activates and then quickly returns to baseline. More intense or longer lasting stressors can be tolerable if we have support systems in our lives to help us cope. If we don't have supports, severe or frequent exposure to certain types of stress can have a 'toxic' effect on the body and brain.
It is this toxic stress that, when not properly addressed and reduced, can lead to long-term behavior issues, health complications, and diseases that are caused by ACEs.

The effect of toxic stress on the brain.

Sustained activation of the body's stress response, toxic stress, impacts many of the brain's vital systems, including but not limited to:

THE STRESS PATHWAY - Dysregulated HPA Axis, decreased hippocampal volume: leads to anxiety, depression and impaired learning and memory.

EMOTIONAL PROCESSING AND REGULATION - Decreased gray matter in the prefrontal cortex (PFC) and increased amygdala volume leads to hypervigilance and reduced attentional control.

EVALUATION OF REWARD - Decreased reward response in ventral striatum leads to anhedonia, the difficulty in experiencing joy.

BRAIN CONNECTIVITY - Disrupted amygdala to ventromedial PFC pathway, decreased activity in the default mode network, and increased activity in salience networks leads to difficulty understanding the relevance of situations and how to respond. ³

The lifelong (and generational) risks of toxic stress.

Toxic stress also affects children as they grow older, and leads to many common health and behavioral issues later in life. ⁴ The CDC-Kasier ACE study found that adults with an ACE score of 4 or more were at significantly greater risk for many behavioral, physical, and mental health issues later in life.

Behavioral

Drug Abuse

Missing Work

Physical & Mental Health

Broken Bones

Graphic used with permission from The Robert Wood Johnson Foundation. See it here.

The effects of toxic stress on epigenetics

Genes are the blueprint that provide instructions for making proteins in our bodies. All processes that make us human require these proteins and help to define who we are. Epigenetics describes the way that our genes are turned on and off - whether a specific gene is used or not. We now know that what we experience in life changes our epigenetic profile, or in other words, life experience changes our genes - really getting under our skin. Not only does this affect the individual, the way our bodies respond to stress can be passed from one generation to the next through our genes.⁵

Ways to prevent toxic stress:

Provide a nurturing, safe and stable environment.

Help children learn to cope with adversity.

Reduce a child's ACE exposure.

ACEs work through experience, not just exposure. Exposure alone doesn't necessarily mean a child is affected. If the ACE is prevented from causing toxic stress, the harm should not occur. With a caring and nurturing environment, we can build children with the resilience to protect them from ACEs.

Resilience: our brains are maleable

Resilience is the ability to thrive, adapt and cope despite tough and stressful times, and is an ideal counterbalance to ACEs. ⁶

Resilience tips the scale toward healthy

According to the Center on the Developing Child at Harvard University, one way to understand the development of resilience is to visualize a balance scale. Protective experiences and coping skills on one side counterbalance significant adversity on the other. Resilience is evident when a child's health and development tips toward positive outcomes - even when a heavy load of factors is stacked on the negative outcome side.

Seven core ideas to help develop and foster resilience in children:

1. Competence - Building their understanding of their skills.

2. Confidence - Helping kids grow a true belief in their own abilities.

3. Connection - Connecting children with other people, schools and communities to further build their support system.

4. Character - Helping them comprehend a clear sense of right and wrong, and teaching them moral values.

5. Contribution - Offering children a chance to contribute to the well-being of others. They learn that giving service feels good and then feel more confident to ask others for help as well.

6. Coping - Discovering a variety of healthy coping strategies to prevent children from dangerous "quick fixes" to stress.

7. Control - Teaching children to make decisions on their own so they can experience a sense of control.

To explore these 7Cs in more detail, click here.

Additional ways to promote resilience:

Acknowledge the child's experience of ACEs and how it may be influencing their behavior - reframing "What's wrong with you?" to "What happened to you?"

Help children identify their emotions, talk about them, and express them appropriately.

Empower children to problem solve and work through their issue/problem.

Promote healthy coping habits of meditation and mindfulness, exercise, and sleep routines.

Build my understanding and empathy

When working with others who may have experienced ACEs, consider the following:

What ACEs have you possibly experienced?

How have ACEs impacted your life (physically, emotionally, professionally)?

What internal and external support helped you deal with your ACEs?

How have your ACEs impacted your ability (both positively and/or negatively) to help others as they cope with their own ACEs?

Working together to build better outcomes.

We all have a role to play in providing better futures for children. No matter where you live or who you are, you can play a role in building better outcomes. To learn more, explore our audience-specific guides below about how ACEs and fostering resilience can help change the future for children.

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What are ACEs? | Joining Forces For Children

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Adverse Childhood Experiences (ACEs) come in many forms, from physical and mental abuse to neglect and household dysfunction. In 1998, CDC-Kaiser Permanente published a groundbreaking study that investigated the impact of ACEs on physical and mental health problems in over 17,000 adults.

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Nadine Burke Harris: "How Childhood Trauma Affects Health Across A Lifetime"

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Nadine Burke Harris: "How Childhood Trauma Affects Health Across A Lifetime"

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This TED Talk is preformed by Nadine Burke Harris, "the founder and CEO of the Center for Youth Wellness, an initiative at the California Pacific Medical Center Bayview Child Health Center that seeks to create a clinical model that recognizes and effectively treats toxic stress in children." (https://www.ted.com/speakers/nadine_burke_harris_1)

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How childhood trauma affects health across a lifetime

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Childhood trauma isn’t something you just get over as you grow up. Pediatrician Nadine Burke Harris explains that the repeated stress of abuse, neglect and parents struggling with mental health or substance abuse issues has real, tangible effects on the development of the brain. This unfolds across a lifetime, to the point where those who’ve experienced high levels of trauma are at triple the risk for heart disease and lung cancer. An impassioned plea for pediatric medicine to confront the prevention and treatment of trauma, head-on.

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Positive Childhood Experiences and Adult Mental and Relational Health

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Positive Childhood Experiences and Adult Mental and Relational Health

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Recent study on PCEs and their effect on Adult Mental/Relational Health. The link is here as well! https://jamanetwork.com/journals/jamapediatrics/fullarticle/2749336

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Take a minute to review these overview of resilience

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Center on the Developing Child at Harvard University

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Reducing the effects of significant adversity on young children's healthy development is critical to the progress and prosperity of any society. Yet not all children experience lasting harm as a result of adverse early experiences. Some may demonstrate " resilience," or an adaptive response to serious hardship. A better understanding of why some children do well despite early adversity is important because it can help us design policies and programs that help more children reach their full potential. These three videos provide an overview of why resilience matters, how it develops, and how to strengthen it in children.

1. InBrief: What is Resilience?

The science of resilience can help us understand why some children do well despite serious adversity. Resilience is a combination of protective factors that enable people to adapt in the face of serious hardship, and is essential to ensuring that children who experience adversity can still become healthy, productive citizens. Watch this video to learn about the fundamentals of resilience, which is built through interactions between children and their environments.

2. InBrief: The Science of Resilience

One way to understand the development of resilience is to picture a balance scale or seesaw. Protective experiences and adaptive skills on one side counterbalance significant adversity on the other. Watch this video to visualize the science of resilience, and see how genes and experience interact to produce positive outcomes for children.

3. InBrief: How Resilience Is Built

Children are not born with resilience, which is produced through the interaction of biological systems and protective factors in the social environment. The active ingredients in building resilience are supportive relationships with parents, coaches, teachers, caregivers, and other adults in the community. Watch this video to learn how responsive exchanges with adults help children build the skills they need to manage stress and cope with adversity.

Subscribe to our newletter

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InBrief: Resilience Series - Center on the Developing Child at Harvard University

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These three videos provide an overview of why resilience to serious hardship matters, how it develops, and how to strengthen it in children.

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What are ACEs?

For more, see: https://developingchild.harvard.edu/resources/aces-and-toxic-stress-frequently-asked-questions/

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What a score means and what a score does not mean

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An ACE score is a tally of different types of abuse, neglect, and other hallmarks of a rough childhood. According to the Adverse Childhood Experiences study, the rougher your childhood, the higher your score is likely to be and the higher your risk for later health problems. You can take the test below:

So, you've got your score. Now what?

First, remember that the ACE score isn't a crystal ball; it's just meant as guidance. It tells you about one type of risk factor among many. It doesn't directly take into account your diet or genes, or whether you smoke or drink excessively - to name just a few of the other major influences on health.

To learn more, check the CDC's ACE Study website. You'll find, among other things, a list of studies that explore the ways adverse childhood experiences have been linked to a variety of adult conditions, ranging from increased headaches to depression to heart disease.

Remember this, too: ACE scores don't tally the positive experiences in early life that can help build resilience and protect a child from the effects of trauma. Having a grandparent who loves you, a teacher who understands and believes in you, or a trusted friend you can confide in may mitigate the long-term effects of early trauma, psychologists say.

"There are people with high ACE scores who do remarkably well," says Jack Shonkoff, a pediatrician and director of the Center on the Developing Child at Harvard University.

Resilience, he says, builds throughout life, and close relationships are key. Recent research also suggests that for adults, "trauma informed" therapy - which can center on art, yoga or mindfulness training - can help.

How best to find and help kids who are experiencing abuse and neglect right now?

Child psychologist Hilit Kletter, of Stanford University's School of Medicine, says that to spot these children, she looks for visible signs of stress to understand what might have happened to them and how best to intervene. Some kids have nightmares or recurring thoughts of a stressful event, she says, or may re-enact the trauma through play. Or the child may seem distracted or withdrawn.

"This will come out at school," Kletter says. "Teachers will tell parents [their child] seems to be in a daze in the classroom, not paying attention."

Kletter says reactions to trauma are sometimes misdiagnosed as symptoms of attention deficit hyperactivity disorder, because kids dealing with adverse experiences may be impulsive - acting out with anger or other strong emotions.

"It's something that's very common in trauma: difficulty in regulating emotions and behavior," she explains. "That's why a lot of these kids get in trouble with the classroom."

Shonkoff's research center at Harvard tests interventions that can build resilience in kids who are growing up with adverse experiences - not just problems in the family, such as those the ACE study investigated, but also trauma stemming from poverty, for example, or from the chronic stress of racial or gender discrimination.

To bolster parents, the Harvard team is testing interventions right now that use video coaching to show moms and dads how to engage their babbling infants, using sounds and facial expressions in a style Shonkoff calls serve and return.

Shonkoff says these early interactions - a kind of conversation - have been shown to help children with later learning and literacy. Even more important, they boost kids' resilience, by helping them build secure attachments with caring adults. Research suggests that just one caring, safe relationship early in life gives any child a much better shot at growing up healthy.

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Take The ACE Quiz - And Learn What It Does And Doesn't Mean

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First developed in the 1990s, the 10 questions of the Adverse Childhood Experiences test are designed to take a rough measure of a difficult childhood. Finding out your score is easy. Now what?

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Read NPR's overview, or, if you're interested in the full journal article, see: file:///Users/shana/Downloads/jamapediatrics_bethell_2019_oi_190057.pdf

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Plenty of research shows that adverse childhood experiences can lead to depression and other health problems later in life. But researcher Christina Bethell wondered whether positive experiences in childhood could counter that. Her research comes from a personal place.

In the 1970s, in a low-income housing complex in Los Angeles, Bethell had a tough childhood. Sometimes she didn't have money for lunch. Sometimes, when a free bus came through to take kids to church, she would get on it, just to go somewhere else. "In low-income areas and in California in general, there was a lot of drugs and drinking - it was the norm," she says.

But there were positive things in her childhood too. Her grandmother would come by every few months and tell her that anything she needed was inside her. She was engaged in school; she played sports, and she stayed late to help the teacher clean up.

And there was a woman in her housing complex with an open door to all the kids who lived there. They called her "Mrs. Raccoon," and she held a birthday party with tea and candy every Saturday for whoever had a birthday that week. "We would just sit there together and celebrate," Bethell recalls. "She was the sweetest woman - just present, didn't talk a lot, but she was there. I started just traipsing over as a child - she had these little red berry hard candies, and to this day, that's my favorite candy."

Today, Bethell is a professor at the Johns Hopkins Bloomberg School of Public Health. Her study, out Monday in JAMA Pediatrics,found that this kind of positive relationship in childhood may have lasting effects on people's mental health into adulthood.
What question were you trying to answer with this research?
Numerous studies have shown that the more negative childhood experiences adults report when they reflect back on their life, the more likely they are to have an array of physical, mental and social problems as an adult. We often call these adverse childhood experiences, or ACEs. They include things like physical and emotional abuse, neglect, sexual abuse, having lived in a home with an adult with an alcohol or drug problem or where there was violence.

We were especially curious to learn whether adults with multiple negative childhood experiences were less likely to have the problems associated with having [them] if they also reported having had more positive experiences.
How did you go about measuring positive experiences and their impact?
We analyzed data from the Wisconsin Behavioral Risk Factor Survey [of 6,188 people] - a representative sample of all adults age 18 and older in the entire state.

The survey asked whether the respondents recall that they were able to talk with their family about their feelings, felt that their families stood by them during difficult times, had at least two nonparent adults who took genuine interest in them, whether they felt safe and protected by an adult in their home, felt supported by friends and felt a sense of belonging in high school, and participated in their community. These are relational childhood experiences - not other things like achievement in school and other things that are also positive.
Isn't it tricky to rely on people's memories to figure out whether they had these positive experiences or not?
Well, these are experiences as lived and recalled by the person, which is what the brain and the body and emotions are responding to and reinforcing. So even if someone else might look in and say, 'You didn't have adversity' or 'You had lots of nurturing as a child,' it's really what we took in and built our beliefs and identity around, and that has a big impact on us.

Our study questions were based on well-established science that explains how our relational experiences in childhood - both positive and negative - really get under our skin.
And what kind of effect did these positive experiences have on people's mental health later on?
First of all, we did find that positive reports on any one of the seven types of positive experiences we assessed were indeed associated with lower rates of mental health problems and higher rates of having relationships as an adult where you get the social and emotional support you need. Yet, as we hypothesized, the biggest effect was when we counted up how many of these experiences were reported - just like it's done on all those other studies on adverse childhood experiences. We see that accumulation of positive experiences, just like the accumulation of adverse experiences, really packs a punch.

Getting into the numbers, we found that having higher counts of those positive experiences was associated with 72% lower odds of having depression or poor mental health overall as an adult. We also found that those with higher levels of positive experiences were over 3 1/2 times more likely to have all the social and emotional support they needed as an adult.
What are the lessons people can take from these findings?
Every moment matters. Every interaction with a child has a reaction in that child. Even as we keep working to address the many social and cultural factors we need to address to prevent negative experiences, we should be focused on proactive promotion of the positive. In particular, there's a need to promote that "through any door" kind way of being - like happened in my childhood [with Mrs. Raccoon]. So that wherever a child goes - to school, early care, walking around their community, to a doctor - they're met with warm adults who purposely try to see and respond to them and meet their needs for care and guidance.

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Positive Childhood Experiences May Buffer Against Health Effects Of Adverse Ones

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Plenty of research shows that adverse childhood experiences can lead to depression and other health problems later in life. But researcher Christina Bethell wondered whether positive experiences in childhood could counter that. Her research comes from a personal place. In the 1970s, in a low-income housing complex in Los Angeles, Bethell had a tough childhood.

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The two biggest myths about ACEs science are:

MYTH #1 - That it's just about the 10 ACEs in the ACE Study- the CDC-Kaiser Permanente Adverse Childhood Experiences Study. It's about sooooo much more than that.
MYTH #2 - And that it's just about ACEs...adverse childhood experiences.
These two myths are intertwined. The ACE Study issued the first of its 70+ publications in 1998, and for many people it was the lightning bolt, the grand "aha" moment, the unexpected doorway into a blazing new understanding of the link between childhood adversity and the adult onset of chronic disease, mental illness, violence and being a victim of violence, among many other surprising consequences. Most people don't realize that the original ACE questionnaires had more than 100 questions, and explored many aspects of a person's family history. To make things easier to grasp, one of the people working with Drs. Robert Anda and Vincent Felitti, the co-principal investigators, came up with the suggestion for a shortened version, and the 10 ACEs and the ACE score were born. By the way, Anda and Felitti recognized that there were many other ACEs than those they chose to look at - including racism, bullying, a father being abused, and community violence - but they settled on those ten because they were identified as common in a pilot study of about 300 people; several of the adverse experiences - such as sexual abuse and physical abuse - had been individually well studied.

Since the original ACE Study was done, there have been many other surveys and studies, and many of those have expanded the types of ACEs. Based on the other parts of ACEs science, we now know that any experience that results in toxic stress can be regarded as an ACE. So, we put together this infographic to show the three realms of ACEs:

This infographic expands the types of experiences in the original ACE Study and combines them with the "Pair of ACEs" described by Wendy Ellis, director of Building Community Resilience Collaborative and Networks, and adverse experiences from climate crises, which are sure to increase over the next several decades. The truth of the matter is that the experiences listed in the three areas in the infographic can all cause harm to children's brains and bodies. How they recover - or cope - depends on the supports provided them after the experience.

There's no doubt that the ACE Study is an easy door to go through to begin to explore the mind-bending, world-changing knowledge of ACEs science, but there was so much more going on before, during and after the ACE Study was first published. The story of that evolution is for another time. For this post, it's important to grok that around 2012, give or take a couple of years, among leaders of the ACEs movement, ACEs science jelled into what it is today - an interlocking matrix of five areas of complementary research:

The ACE Study and subsequent ACE surveys that show how many people experience ACEs, at what levels, and the consequences (epidemiology).

How toxic stress from ACEs damages children's developing brains (neurobiology or brain science).

How toxic stress from ACEs affects our short- and long-term health.

How we pass ACEs from generation to generation through our genes (epigenetics).

And how resilience research shows that our brains are plastic and our bodies can heal through implementing protective factors and resilience-building practices based on ACEs science.

The other 10 myths:

MYTH #3 - The ACE Study findings are just about figuring out your ACE score. It's more complicated. And eye-opening.

1. ACEs are surprisingly common - 64% of the 17,000 in the ACE Study had one of the 10 ACEs; 12 percent had four or more.

2. There's an unmistakable link between ACEs and adult onset of chronic disease, mental illness, violence, being a victim of violence, and so much more, including more broken bones (from thrill sports).

3. The more types of childhood adversity, the direr the consequences. An ACE score of 4 increases the risk of alcoholism by 700%, attempted suicide by 1,200%; it doubles heart disease and lung cancer rates.

4. ACEs contribute to most of our health problems, including chronic disease, financial and social health issues.

5. One type of ACE is no more damaging than another. An ACE score of 4 that includes divorce, physical abuse, a family member depressed or in prison has the same statistical outcome as four other types of ACEs. This is why focusing on preventing just one type of trauma (stopping sexual abuse) and/or coping mechanism (stopping smoking) won't ever eliminate that trauma or coping mechanism.

MYTH #4 - If you have ACEs, you're doomed. If you have no ACEs, you're fine. The brain is plastic. The body wants to heal. No matter who has ACEs - kids or adults - it's not too late to heal. Understanding ACEs science is the first step, because that leads to understanding that you weren't born bad, you had no control over your childhood, the way you coped was appropriate because you weren't given healthy alternatives, and you can heal. Recent research shows that if you have protective factors in your childhood along with ACEs, you do much better than people who have ACEs and no protective factors. And here's something interesting: if you have no or low ACEs, that doesn't mean life is a bed of roses. Without protective factors, you do worse than someone with ACEs and protective factors. Those protective factors are crucial to health and well-being.

MYTH #5 - Screening should be done everywhere. Not necessarily. When you want to know the burden of ACEs and the promise of protective factors in a community, a school, an organization - and it's extremely useful to know what the ACEs burden is, as well as the level of protective factors - an anonymous ACE and resilience survey is enough. But in healthcare an individual's score is useful for treating and following patients. In both circumstances an ACE questionnaire should never be done without explaining ACEs science. Some people don't think ACEs screening should become common, and often say, "What if insurance companies start screening for ACEs to determine insurance rates?" Well, we're hoping to build enough of a movement so that insurance companies would have to look at the ACEs in their own organization first, before using it in a nefarious manner.

MYTH #6 - Physical and sexual abuse are the worst ACEs. The brain can't distinguish between different types of ACEs - once the experience goes into the brain, it's toxic stress. The ACE Study showed that it doesn't matter what the types of ACEs are. An ACE score of 4 that includes divorce, physical abuse, an incarcerated family member and a depressed family member has the same statistical outcome as an ACE score of 4 that includes living with an alcoholic, verbal abuse, emotional neglect and physical neglect. "We studied a whole range of outcomes - emotional, social, financial, biomedical, etc. If someone had an ACE score of 2 or 4 or 7, it didn't matter how you made the ACE score up. It didn't matter. That was unexpected and a surprise," says Felitti.

MYTH #7 -You don't need to learn about ACEs science if you're becoming trauma-informed. We know organizations that skipped over the ACE Study, included a little bit of brain science, and went right to implementing a trauma-informed approach. But that approach is not going to get an organization to be as successful as it could be if it integrated ACEs science.

MYTH #8 -You can't ask someone about ACEs because you'll traumatize them. When the ACE Study was going through the design and approval process, the institutional review board that decided if the study could be done turned it down at first because they thought that people would have what is known in layperson's terms a "nervous breakdown" if they were asked the questions. To receive approval for the study, a person on the research staff was required to wear a pager 24-7 for the dozens, perhaps hundreds of people the review board thought would be needing emergency care. Not one person called this hotline. However, although anyone can do the 10-question ACE survey online - it's in lots of places (e.g., NPR, here) - it's NOT a good idea to introduce ACEs science in a staff meeting by requiring everyone to take the survey first. The trauma-informed approach is to educate people about ACEs science, make time for questions and discussion, then do the survey anonymously. And always have someone there available to talk with people who have their lives suddenly altered by the knowledge and want to talk about how it's affecting them. It happens. Some therapists have been reluctant to ask their patients about ACEs. But what better place to address ACEs than with a therapist?

MYTH #9 - For physicians to start asking about ACEs, they need to have a therapist on staff. When Felitti realized the power of the ACE survey, he integrated it into the Health Appraisal Center at Kaiser Permanente in San Diego. Over the next few years, more than 440,000 patients who came through the center took the survey. He didn't have a therapist on staff. For a while, a therapist had a temporary office in his clinic, and the nurse-practitioners called on him when necessary. It turns out that just the act of listening and acknowledging can make a difference - in the only study that's been done on this, of 125,000 people who went through his center, there was a 35% drop in doctor visits and an 11% in visits to emergency rooms.

Felitti wrote:
It turned out that asking, listening, and accepting are a powerful form of doing that appears to provide great relief to patients. A common interchange was for the examiner to remark, "I see on the questionnaire that ...... (your father killed himself / you were raped / you were frequently beaten as a kid). Can you tell me how that has affected you later in your life?" It took patients only a minute or two to describe how their childhood trauma affected them later in life. Their responses were to the point and usually helpful to understand what might be done.
MYTH #10 - There's no difference in being trauma-informed or ACEs-science informed. Being ACEs-science informed is the bedrock, the foundation of becoming trauma-informed. You need both. ACEs science is the WHAT and WHY. Trauma-informed is the HOW. If we do only the how, becoming trauma-informed risks becoming a fad, especially if implementing trauma-informed practices without ACEs science shows only slight improvement.

MYTH #11 - Since ACEs only happen during childhood, we only have to focus all our resources on kids and we'll solve our problems. Research shows that parents pass their ACEs on to kids, so you have to involve parents. If parents address their ACEs, learn about ACEs science, and get help, they get healthier, and, as a result, their kids get healthier. What causes ACEs? Toxic stress. And since toxic stress appears in the community and the environment, parents won't get as healthy as their kids need them to be until the organizations and systems they work for and interact with, the communities they live in, and the nations they're part of stop traumatizing already traumatized people, and start healing. The early ACEs science pioneers have shown that we can solve our most intractable problems, but we won't solve our most intractable problems unless all organizations, systems in all sectors, all communities and nations integrate trauma-informed practices based on ACEs science.

MYTH #12 - We need to address ACEs only in poor people of color who live in urban areas, because they're the demographic with the highest burden of ACEs. This just further exacerbates the them-us culture we're all living in now, and is remarkably short-sighted. ACEs are everywhere, in all demographics. And people with ACEs in power - which in the United States are mostly white men who come from middle-class and upper middle-class backgrounds - can and do act out their ACEs by abusing people individually and by the policies that they create, either in the organizations they lead or the positions they hold in public service. You can find many examples of leaders in the business, faith-based, healthcare, entertainment, political and other arenas who have done so, and are doing so, due to their own ACEs. So it's just as important to educate kids and their parents in Palo Alto High School in Palo Alto, CA., about ACEs science as it is kids and their parents in McClymonds High School in Oakland, CA.

ACEs are everywhere, but, generally speaking the people with the least burden of ACEs are those who have the most power, because they have the most resources. Those with the greatest burden of ACEs are those with the least power and the fewest resources, no matter what country you're talking about. Traditionally, the people in power create a social structure that keeps those without the power as powerless as possible by instituting racism, sexism, classism, etc.

The promise of ACEs science is that we humans finally understand that these "isms" harm everyone - the powerful and the powerless - and that it's better for everyone to institutionalize sharing. Yeah, I know - much easier said than done. But now we have - and are accumulating more - scientific evidence, and, just like the increasing evidence for climate disruption, that genie won't be put back in the bottle.

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Gail Kennedy of our ACEs Connection team came up with the idea for the 3 realms of ACEs while talking with Elaine Miller-Karas of the Trauma Resource Institute and Bob Doppelt of the Resource Innovation Group. She brought in the rest of our ACEs Connection team to come up with the approach and content, and handed it over to graphic designer Mindy Atwood to make it look gorgeous. Thank you all for creating this very useful infographic! A two-sided PDF is attached: infographic on one side, facts about ACEs on the other. For more information about ACEs science, go to ACEs Science 101.

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The two biggest myths about ACEs science are: MYTH #1 - That it's just about the 10 ACEs in the ACE Study - the CDC-Kaiser Permanente Adverse Childhood Experiences Study. It's about sooooo much more than that. MYTH #2 - And that it's just about ACEs...adverse childhood experiences.

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Benevolent (Positive) Childhood Experiences 

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Benevolent (Positive) Childhood Experiences 