Psych Eval Podcast: Episode 1 Adverse Childhood Experiences




Psych Eval Podcast: Episode 1 Adverse Childhood Experiences

  • The ACE Study compares adverse childhood experiences against adult health status, on average a half-century later. The experiences studied were eight categories of adverse childhood experience:

  • 3 categories of abuse

  • physical abuse

  • emotional abuse

  • contact sexual abuse


  • growing up in a household with:

  • an alcoholic or drug-user

  • a member being imprisoned

  • a mentally ill, chronically depressed, or institutionalized member

  • the mother being treated violently

  • loss of a biological parent


  • 2 categories of neglect

  • emotional

  • physical



  • scoring is given as one point for each category you experience as a child with a total score of 0-10

  • Often these come in groups, ex. Dad was a alcoholic, then got angry physical abuse, then pass out and there is no dinner, so neglect: ACE=3

ACES in the population revealed:

  • > 1 ACE 66.66% (2 in 3)

  • 1 ACE 25% (1 in 4)

  • If 1 ACE, 87% chance of 1 other & 50% chance of 3 others


  • 2 ACE 15% (1 in 6-7)

  • 3 ACE 10% (1 in 10)

  • 4 ACE 6% (1 in 16-17)

  • 4 ACE 17% (1 in 5.88 people)

  • 5 ACE 11% (1 in 9)

CDC data (only what’s reported):

  • 1 in 8 witness mothers hit..

  • 1 in 5 molested <18.

  • 1 in 4 physically abused.

  • 1 in 4 alcoholism.

Ace study found:

  • Exponential growth as ACE Score increases

  • ACE score >=4 the chance of being obese are 250% greater or 2.5 times

  • ACE score >4 350% higher rates of depression

  • ACE score of 5 or more (4 pretty close) 300% increase in antidepressant medication prescription

  • ACE score >4 1350% 9 (or 13.5x) more likely to commit suicide

  • • ACE of 6 or higher you are 3000-5000%, 30-50x greater

  • Suicide the 10th leading cause of death in adults (but unintentional death is number 3, when they dont know it is labeled as this)

  • between ages of 10-24 suicide is the leading cause of death


  • ACE score >5 there is a 200% or 2x likely you will be on antianxiety medications in adulthood.

  • • Ace score of 4-5 200% chance, 2x risk of smoking

  • • ACE score 6 or more: 250%, or 2.5x the risk of being a smoke as an adult

  • they also found the earlier you smoke the more likely you are to have experienced trauma as a child


  • • ACE score >4 is 650% higher or 6.5x more likely to have alcoholism

  • Ace score of 4 or more are 3000% more likely to inject drugs

  • Ace score of 6 4600% more likely to inject drugs

  • Ace score 4 or more there is a 650% increase of the likelihood of being sexually assaulted later in life

  • • Higher the ACE score >5 the more likely you will have 3 or more marriages.

  • • ACE score related to the risk of perpetrating violence, having hallucinations, being prescribed an antipsychotic, impaired work performance, COPD, heart disease, liver disease, somatic disorders

  • Higher the ACE score the younger you die: ACE of 6 you can die 20 years earlier

Under reported for males specifically sexual abuse

  • Woman walk down the street are scared to be killed

  • Men walk down the street fearing they’ll be laughed at

How ACES influence health and well-being throughout life

  • have the experience which leads to a disrupted neurodevelopment

  • which leads to social, emotional, and cognitive impairment

  • causing an adoption of health-risk behaviors that lead to disease, disability, and social problems

  • all which cause early death


Raising Awareness of ACE's can help:

  • Change how people think about the causes of ACEs and who could help prevent them.

  • Shift the focus from individual responsibility to community solutions.

  • Reduce stigma around seeking help with parenting challenges or substance misuse, depression, or suicidal thoughts.

  • Promote safe, stable, nurturing relationships and environments where children live, learn, and play.

Let’s help all children reach their full potential and create neighborhoods, communities, and a world where every child thrives.

Once you have ACES=trauma treatment is trauma treatment

  • mindfulness, yoga, mind-body work

  • inner child work

  • trauma therapy

  • EMDR for PTSD: EMDR is different than most talk therapies. It does not require a person to explain their trauma in detail. Instead, a person will do eye movements or tapping while focusing on an image related to the trauma. EMDR therapy helps a person become “unstuck” so their brain can go through its’ natural healing process. It is designed to help a person quickly resolve traumatic memories. Unlike other therapies, there is no focus on changing emotions, thoughts, or behaviors related to the trauma.

  • CBT: CBT focuses on recognizing problematic thinking patterns and working to change them, which then helps change behavior patterns.

  • Prolonged exposure therapy: This is a specific type of CBT that primarily applies behavioral therapy techniques. In PE, individuals are gradually exposed to their trauma-related memories, emotions, thoughts, and physical sensations. Since avoidance is a common symptom of trauma, PE helps people stop avoiding their trauma reminders. The types of exposures may include:

  1. Imaginal exposures: Recounting the details of the traumatic event.

  2. In vivo exposures: Repeatedly confronting trauma-related situations or people in their everyday life that they have been avoiding.

  3. Interoceptive exposures: Creating and then experiencing feared physical sensations that are associated with the trauma but are actually harmless.


  • Cognitive Processing Therapy focuses on reevaluating how a person thinks following a traumatic event

  • Trauma focuses CBT: Designed for children and teens, TF-CBT works to improve a range of trauma-related outcomes in minors. It addresses other trauma-related challenges like anxiety, depression, and behavior problems. Also, the caregiver or trusted adult can relieve their distress about the child’s traumatic event and learn effective parenting skills.

  • Medications: Medication can be used in combination with any of the methods above. Can be used to reduce some of the symptoms of trauma, but will not heal trauma.


Mind body connections

“the body weeps the tears the eyes wish to shed”

Practice with Trauma informed care

SAMSHA’s Six Key Principles of Trauma Informed Approach

  1. Safety

  2. Trustworthiness and Transparency

  3. Peer Support

  4. Collaboration and Mutuality

  5. Empowerment, Voice, and Choice

  6. Cultural, Historical, and Gender Issues

The power of 2 min: Asking, Listening, and implicit Accepting…

  • You do not even have to ask you just state “I see on your questionnaire you marked ………….., how old were you when you first began smoking/drinking/drugging?...... why do you think it happened then? How do you think that effected you later in life”

  • Feel cared for, seen, heard or validated


  • The professional relationship w/your patients/clients (trust) is what activates their innate healing response

  • Us asking them questions to help them discover what they know on some deep level already and to bring it up to where it’s useful

  • Asking people about their lives doesn’t harm. I see on the questionnaire…How old were you when you first began ____? Why do you think it was then? How has that affected you later in your life?

  • We learn all these deeply shameful things about them, yet we’re still accepting of them. Supportive adult : Mister Rogers. Similar to priest : confessional.

  • The reason many of us entered into our profession, was to help people;

“If you want to interrupt ACEs, you have to help the adults heal”






References:


Center for Disease Control. (2021). Adverse Childhood Events. https://www.cdc.gov/violenceprevention/aces/index.html


Felitti, V. J. (2006). The origins of addiction. Evidence from adverse childhood experiences.


Felitti, V. J. (2009). Adverse childhood experiences and adult health. Academic pediatrics, 9(3), 131-132.Chicago


Felitti, V., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al., (2001) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. In K. Franey, R. Geffner, & R. Falconer, (Eds.) The cost of child maltreatment: Who pays? We all do. (pp. 53-69). San Diego, CA: Family Violence and Sexual Assault Institute.