The “ACE” Study & Unaddressed Childhood Trauma

1. There is no trust more sacred than the one the world holds with children. There is no duty more important than ensuring that their rights are respected, that their welfare is protected, that their lives are free from fear and want and that they grow up in peace. Kofi A. Annan

2. The “ACE” Study&Unaddressed Childhood Trauma Presented by Ann Jennings Ph.D. www.TheAnnaInstitute.Org

3. Anna’s Story

4. This is Anna at age one and a half This is Anna years later – in a mental institution What happened?

5. Anna Caroline Jennings 1960 - 1992

6. Collaboration between Kaiser Permanente’s Department of Preventive Medicine in San Diego and the Center for Disease Control and Prevention (CDC) The Adverse Childhood Experiences Study (ACE)

7. ACE Study slides are from: • Robert F. Anda MD at the Center for Disease Control and Prevention (CDC) • September 2003 Presentation by Vincent Felitti MD “Snowbird Conference” of the Child Trauma Treatment Network of the Intermountain West • “The Relationship of Adverse Childhood Experiences to Adult Medical Disease, Psychiatric Disorders, and Sexual Behavior: Implications for Healthcare” Book Chapter for “The Hidden Epidemic: The Impact of Early Life Trauma on Health and Disease” Lanius & Vermetten, Ed)

8. What is the Adverse Childhood Experiences (ACE) Study? • Decade long. 17,000 people involved. • Looked at effects of adverse childhood experiences over the lifespan. • Largest study ever done on this subject.

9. ACE Study Findings • Childhood experiences are powerful determinants of who we become as adults

11. Adverse Childhood Experiences are Common Of the 17,000 HMO Members: • 1 in 4 exposed to 2 categories of ACEs • 1 in 16 was exposed to 4 categories. • 22% were sexually abused as children. • 66% of the women experienced abuse, violence or family strife in childhood.

12. The higher the ACE Score, the greater the likelihood of : • Severe and persistent emotional problems • Health risk behaviors • Serious social problems • Adult disease and disability • High health and mental health care costs • Poor life expectancy For example: The following information and slides are from September 2003 Presentation at “Snowbird Conference” of the Child Trauma Treatment Network of the Intermountain West, by Vincent J. Felitti, MD. And from Lanius/Vermetten Book Chapter 6/2007

13. Emotional Problems

14. Childhood Experiences Underlie Chronic Depression

15. Childhood Experiences Underlie Suicide 4+ 3 2 1 0

16. ACE Score and Hallucinations Abused Alcohol or Drugs Ever Hallucinated* (%) ACE Score *Adjusted for age, sex, race, and education.

17. Childhood Sexual Abuse and the Number of Unexplained Symptoms Percent Abused (%) Number of Symptoms History of Childhood Sexual Abuse

18. ACE Score and Impaired Memory of Childhood Percent With Memory Impairment (%) ACE Score 1 2 3 4 5 ACE Score

19. Health Risk Behaviors

20. Adverse Childhood Experiences and Current Smoking %

21. Childhood Experiences and Adult Alcoholism 4+ 3 2 1 0

22. ACE Score and Intravenous Drug Use N = 8,022 p<0.001

23. Basic cause of addiction is experience-dependent, not substance-dependent • Significant implications for medical practice and treatment programs

24. Serious Social Problems

25. Childhood Experiences Underlie Rape 4+ 3 2 1 0

28. Adverse Childhood Experiences andLikelihood of > 50 Sexual Partners

29. ACE Score and Unintended Pregnancy or Elective Abortion

30. Sexual Abuse of Male Children and Their Likelihood of Impregnating a Teenage Girl 1.8x 1.4x 1.3x Percent who impregnated a teenage girl 1.0 ref Not 16-18yrs 11-15 yrs <=10 yrs abused Age when first abused

31. Frequency of Being Pushed, Grabbed, Slapped, Shoved or Had Something Thrown at Oneself or One’s Mother as a Girl and the Likelihood of Ever Having a Teen Pregnancy Pink =self Yellow =mother Percent who had a teen pregnancy Never Once, Sometimes Often Very Twice often

32. ACE Score and Indicators of Impaired Worker Performance Prevalence of Impaired Performance (%)

33. Adult Disease and Disability

34. Adverse Childhood Experiences andHistory of STD

38. High Health and Mental Health Care Costs

42. Poor Life Expectancy

43. Effect of ACEs on Mortality Age Group

45. ACE Study • www.cdc.gov/nccdphp/ace • www.acestudy.org

46. Other Studies on Childhood Sexual and/or Physical Abuse

47. Sarah Joe, Anna John Mary • Early Child Sexual Abuse (CSA) may especially impair resiliency

48. Substance Abuse and Unaddressed Childhood Sexual/Physical Abuse • 2/3rds of men and women in SA treatment - physical and/or sexual abuse • 75% of the women - sexually abused. SAMHSA/CSAT, 2000; SAMHSA, 1994 • Teenagerswith alcohol and drug problems - 6 to 12 times more likely physically abused , • 18 to 21 times more likely sexually abused . Clark et al, 1997 • Of AI/AN women in SA treatment – 86% report physical abuse histories, 69% sexual abuse histories. • Of those with sexual abuse histories, 96.7% physically abused . 96% of both (sa, pa) emotionally abused. Saylors, 2003; 2004

49. Serious Mental Illness and Unaddressed Sexual/Physical Abuse • 51 – 98% of public mental health clientswith severe mental health diagnosesGoodman et al, 1999, Mueser et al, 1998; Cusack et al, 2003 • 93% of psychiatrically hospitalized adolescents Ipschitz et al, 1999

50. Criminal Justice Problems andUnaddressed Sexual/Physical Abuse • More than 75% of girls in juvenile justice system Calhoun et al, 1993 • 80% of women in prison and jails Smith, 1998 • 100% of men on death row Freedman, Hemenway, 2000 • Boys who commit violencevan derKolk, 1998