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Losing with ACEs 

by MICK LLOYD-OWENS & r & & r & & lt;span class= & quot;dropcap & quot; & D & lt;/span & r. Robert F. Anda is one of the principal investigators in the ongoing "ACE Study" conducted by the Centers for Disease Control and Prevention and Kaiser Permanente. One of the largest scientific studies of its kind, the ACE Study looks at the connection between adverse childhood environments and the problems that children raised in them face as adults. Dr. Anda will speak in Spokane on April 24 in conjunction with the "Our Kids: Our Business" public awareness campaign. Here are some excerpts from his conversation with the Inlander last week.

What can you tell us about your work?

What we set out to do was to look at the childhood origins of risk factors for diseases and various health and social problems. We asked 17,000 people about their childhood experiences and called the negative ones "adverse childhood experiences" or ACEs, which is where the term ACE Study comes from.

We asked them about many things in their lives, but the ones we were particularly interested in were instances of childhood abuse: childhood neglect or growing up in what we call a severely dysfunctional household -- having things like alcohol or drug abusing people living in the home, mentally ill people living in the home, or having someone attempt suicide; witnessing domestic violence, parental separation or divorce; or having someone in the household sent to prison while they were growing up.

What's the conclusion?

The first thing that we found that really surprised me -- given that these were people living in San Diego and in the Kaiser health plan -- was that those experiences were really common. Surprisingly common. This is a middle- to upper-middle-class group of people, and ACEs are really common.

The second thing we found was that adverse childhood experiences are highly interrelated. When a person has one of them growing up, they tend to have two, three or sometimes all of them in their lives.

In order to look at our original idea of how ACEs may be a pathway to health and social problems, we created what we call an ACE score. That's simply adding up the number of categories mentioned -- abuse, neglect and household dysfunction. With that we created an ACE score that ranged from zero to 10.

The next thing that we found -- that as a researcher really surprised me -- is that as the ACE score goes up, the risk of a wide array of health and social problems goes up. In research we call that a dose/response relationship. If you think of the ACE score as a childhood trauma dose, [then] as that dose goes up the risk of a variety of things goes up. The list of things we've documented in the scientific literature now is what I like to call a who's who list of the top health and social problems in our country -- things like alcohol and drug abuse, mental illness, teen pregnancy, suicide attempts, and many of the leading causes of death: heart disease, lung disease, liver disease.

We're now pretty sure, based upon data from the neurosciences, that traumatic stress during childhood has a negative effect on the developing brain. The more [researchers] look at brain structure and function between abused people and non-abused people, the more differences they see. These effects last well into adult life, because the people in our study ranged from 19 to 94 years old.

That being said, I think that adverse childhood experiences are probably the most important health and social problem in our country today because they affect so many things and the level of exposure is so high.

That's important because people who have a lot of ACEs tend to take on those characteristics later on... it gets passed on. It's cyclical. It's really person-to-person transmission of stress -- almost like an infectious disease.

Now that the biology is becoming more clear, it can help our culture to be willing to take these things on as a major health issue and not just the Child Protective Service's problem -- it's a broad cultural problem.

Do the findings of this study suggest a course of action?

The first and broadest is to stop the transmission of traumatic stress and to interrupt the cycle. One way is identifying and treating those whose lives have been affected by ACEs so that they can get better assistance in dealing with those problems so they are less likely to pass them on to their kids. It really requires a long-term commitment to gradually reducing the level of ACEs in our culture.

Is there any conflict between this goal and protecting people's privacy?

Privacy needs to be protected, and it can be. We do this kind of thing routinely in medicine and health. In order to understand these issues in people's lives we need to be able to find out who has experienced them and screen for them. I think that can be worked out and done safely and still protect people's privacy.

Dr. Robert F. Anda is scheduled to speak on Thursday, April 24, at 11:30 am at the Spokane Convention Center, Ballroom A. Cost: $30. To register, visit or 838-6581.
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