Normalizing ACEs Awareness In Healthcare
Editor’s Note: The Adverse Childhood Experiences Study and its initiatives, formally named ACES, has evolved to include Positive and Adverse Childhood Experiences and is now referred to as PACEs. Kindred uses both terms on this website. You can find amazing resources on the PACEs Connection website, where Carey Sipp is the Southeastern US Regional Coordinator.
Take the ACEs Quiz to find your score here.
Read more stories on ACEs on Kindred.
Read the new study showing the Evolved Nest Buffers the Negative Effects of ACEs.
Discover more ACEs organizations and resources.
When you first hear about it, it sounds unlikely; the idea that something that happened to someone in utero, at the age of two months, or four years, or any time in childhood, is what is killing them as an adult, or making them want to die, or making them want to hurt themselves or others.
Yet the connection between childhood trauma and adult disease, mental illness, addiction, suicide, violence – most all of society’s ills – is as irrefutable as the myriad truths revealed about it in the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study). The groundbreaking research shows that the more childhood trauma you experience, the greater your likelihood of having serious illness, social and emotional problems — a life punctuated with trauma and drama.
Gregory Williams, author of Shattered by the Darkness: Putting the Pieces Back Together After Childhood Abuse, learned about the ACE Study around the same time he started telling people about his childhood trauma. That he learned about it as he began speaking his truth is no accident. That the science explained so much about his life and touches so many aspects of it – personally and professionally – has made him passionate about spreading the word about ACEs science. His passion is, for many reasons, an incredible gift to the world.
A little background on ACEs science
The original ACE Study queried more than 17,000 people in San Diego in the mid 1990s. The participants — mostly white, college-educated, all with jobs and great health care — completed a questionnaire of nearly 200 questions about their health and wellbeing. Researchers distilled the results of those questions to 10 types of childhood trauma that most people had experienced as children in their families, up to age 18. Five questions asked about physical, emotional or sexual abuse, and emotional or physical neglect. Five more asked about family dysfunction – violence against the mother, parental separation, mental illness, alcoholism or other addiction, and incarceration of a family member.
The study showed that 64% of the respondents had at least one ACE (adverse childhood experience), and that ACEs usually did not occur alone; if you have one ACE, there’s an 87% chance you have two or more. For the 12% of respondents with an ACE score of four, the consequences proved serious and expensive: The likelihood of chronic pulmonary lung disease increases 390 percent; hepatitis, 240 percent; depression 460 percent; alcoholism, 700 percent; attempted suicide, 1,220 percent. For people with an ACE score of 6 or higher, the risks are grave, literally. Their lifespan is shortened by 20 years.
The ACE Study produced 70 research papers and led to 37 US states doing their own ACE surveys, which produced similar results. Several nations and cities, as well as hundreds of organizations, have also done ACE surveys. The ACE Study has led to more than 1,000 research publications that show the link between ACEs and all types of disease, including auto-immune diseases, skin cancer, diseases of the eye, etc. — each supporting the original finding that childhood trauma causes adult disease and dysfunction.
There are many reasons why this is the case. A big part of it, though, can be explained by brain science and physiology. Toxic stress harms the structure and function of the brains of children. Basically, children with high ACE scores become “wired” for “flight, fight, freeze” behavior, and their lives – with higher incidence of illness, violence, drama, risky behavior, and trauma – are the living proof.
In addition to the fact that the wiring — the connections of brain cells (synapses) – becomes more developed in the parts of the brain that deal with survival than the parts of the brain that deal with long-term planning, the stress hormones of cortisol and adrenaline flooding a stressed body cause, over time, increased inflammation of all organ systems. At the cellular level, constant stress is like an ongoing chemical boil in the body. Kids who are constantly exposed to toxic stress are likely to grow into teens and adults whose brains and bodies are set to react to everyday challenges with fight, flight, or freeze fear. Think of an engine constantly revved at the highest revolution per minute. Such an engine is likely to break down more frequently and burn out more quickly.
The ACE Study was developed by two visionary physicians courageous enough to risk their reputations to make the connection between toxic stress and adult health issues. The life work of Drs. Vincent Felitti and Robert Anda, the study helps make sense of some of what has happened to Gregory in the decades since the day, as a 17-year-old with strength and a voice, he looked his father in the eye and told him to STOP the horrific sexual abuse he had experienced daily for 13 years.
Childhood trauma makes some people sick; it makes others want to die. Gregory helps get this point across by sharing the truths of his resulting heart condition, surgery, and challenges with suicidality, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), insomnia, and perfectionism.
Borrowed time, buffering factors, resilience, hope.
Gregory, with an ACE score of 8, also knows he would be living on borrowed time, and would most likely be dead, were it not for his also being an example of another aspect of the science: how buffering factors – in his case, caring relatives – helped offset some of the negative physiological consequences of the abuse, helping him become somewhat resilient, which he will share more about in subsequent work.
How Gregory survived the pain, shame, guilt, fear, and the physical manifestations of those emotions – the toxic stew of stress hormones that eat away at every cell in the body – can be explained, in part, perhaps, by research on resilience, another part of ACEs science.
Resilience research shows what helps people build the ability to respond to adversity and survive. We know from these studies what a profoundly positive impact that one consistently caring adult can have on a child who is being abused.
That Gregory survived is a miracle. That he had caring adults in his life, I believe, made all the difference. Even though, perhaps, they didn’t know what was going on, an aunt and uncle whom Gregory saw several times a week from the ages of four through about age eight, provided a home base of safety and stability, love and some joy in the midst of the terror you’ll read about soon.
I tell you this because despite Gregory’s story being so horrific, it is because of who he is as a person who somehow maintained optimism, that this is also a story of hope and triumph over adversity. His recognition of the people who loved him as a child is to me one of the most important parts of his story. It is also a call to action to all of us to look for opportunities to be that caring adult for a child, and to be the caring adult to question why a child is upset, is acting out, or is not thriving.
Explanations, divine timing, how speaking his truth is saving Gregory’s life, and will help save the lives of others.
For Greg, discovering ACEs science – information shared with him by a close friend and physician at Baylor College of Medicine – was a life-changing moment. ACEs science might explain why a valve in his heart had given way and needed to be repaired when he was 48. It certainly explained why he suffered from OCD. The science helped make sense of why he could not sleep – his hypervigilance – even though it’s been 38 years since the last time his father abused him. Even after his father’s death in 2002.
Yes, darkness had always brought fear, but Gregory’s new understanding of the physical effects of that fear – the impact of cortisol, adrenaline, and other stress hormones — helped him make sense of his health and mental health issues, and also inspired him to speak the truth about what happened to him to anyone who would listen, and especially to physicians. That Gregory works with and hires physicians is one more amazing aspect of his remarkable and profoundly important story.
For Gregory, speaking his truth is saving his life. When abuse survivors cannot tell the truth, cannot share their stories, or when their stories are not believed, the results can be toxic. The stress of trauma builds up in the body. There is much science to support the statement best summed up as the title of a best-selling book on toxic stress and trauma: The Body Keeps The Score.* Gregory’s failing heart valve is an anecdotal case in point.
Out of respect to his mother, Gregory did not share his story publicly, until her passing in 2017. It was when he was able to share his story without fear of harming his mother that this next phase of Gregory’s life’s work was revealed, and began in earnest.
Though I’ve not met Gregory in person, and have only known him for a few months, I know we share a bond that covers lifetimes and a faith that is as deep and wide, as we are both abuse survivors and know, without a lot of elaboration, much about what comes with that experience.
We both know that it is remarkable that we’ve survived into our fifties and sixties. It is fair to say that we both believe our meeting, and my connecting Gregory to his publisher, is no accident.
And then there is the way Gregory and I met, which is as the result of my being offered the dream position of opening up the southeastern United States to help build communities for an organization that advances ACEs science. I’d hoped for that opportunity for five years before the funding came for me to be hired by ACEs Connection, an international social network dedicated to advancing ACEs science, preventing and healing childhood trauma, and building resilience. It was through his research and finding ACEs Connection that Gregory found my address and included me in a mass emailing about his book. I was one of a handful of people who answered the email.
I answered his request for ideas about how to help him get the word out about his book because I wanted to help, and I because wanted to know more about someone who would share the most intimate, sad, dark corners of his life with others, yet who looked so happy about doing it.
Speaking with Gregory, I immediately understood: After having the story bottled up for decades, his being able to speak and write about his abuse is cathartic, healing, and again, is literally saving his life.
It is nothing short of incredible to me though, that in less than seven months since I answered Gregory’s introductory email, Gregory’s self-published book sold more than 100,000 copies, his book is now being published and distributed by a major publishing house (Health Communications, which published a book of mine 11 years ago), he is working on his own radio show (Breaking the Silence), and he is creating, via the book, radio show, his website, and his work with me to take ACEs science into medical schools, an important space for others to be heard, believed, and affirmed.
Further, Gregory is playing an important role in his own community by managing the Baylor College of Medicine ACEs Connection community site. That site is one of more than 170 geographic community sites supporting ACEs initiatives in those communities. Among the sectors represented are pediatrics, education, justice, social work and more. Their members meet and look for ways to bring ACEs science and trauma-informed practices into their communities. Doing so helps communities in many ways, as evidence shows improved school attendance and grades, decreased crime, improved health outcomes and more in areas communities that have been keeping track of the effects of this work. ACEs Connection would welcome your community group into our growing community of communities which includes neighborhoods, cities, regions, states, and nations dedicated to preventing and healing trauma.
Gregory’s work, and the work of ACEs Connection, is creating the space for millions of people – and thousands of physicians – to be educated, engaged, and offered the chance to become activists to help prevent childhood trauma and its devastating lifelong impacts.
That Gregory has the trust, respect, and attention of physicians can change medicine, and more.
Gregory’s experiences are likely to have special impact on the lives of the one in four girls and one in five boys who are victims of sexual abuse. For millions upon millions of adult men and women survivors, Gregory’s story and awareness of ACEs science will help explain the “why” of so many of their lifelong physical and mental health challenges, and why their lives – our lives – have seemed, or been, harder than most. For many of us who experienced a high load of toxic stress, our brains were literally wired to create and be attracted to more toxic stress. This revelation will, I hope, inspire a tremendous amount of self-empathy, and empathy from and for others. Yes, the old saw is true: Hurt people do hurt people. Understanding the why behind the hurts, the addiction, the impulsivity, the violence, can help stop the pain, shame, guilt, and hurt.
My hope is that Gregory’s story will help prevent sexual abuse and other childhood traumas, and I know that is his greatest hope, too.
That Gregory speaks to physicians, has their respect, trust, and attention, and has the complete backing of his employer, the Baylor College of Medicine, is especially heartening to me, and to others who advocate for medical professionals to recognize childhood trauma as the root cause of most all adult disease, most all social ills.
I know we both want to
- see the science of childhood trauma and resilience research taught in medical schools, so physicians can better understand why a patient is suffering from a stress-related illness, and, in addition to prescribing traditional medical interventions, can also offer recommendations and supports that may help reverse the damage done by years of toxic stress. Imagine a prescription to “spend a day in nature” or “go help coach a little league baseball team” or “join a choral group”? Physicians who are prescribing just such “therapies” are seeing success in programs to prevent opioid addiction relapse, depression, and more.
- see physicians ask what’s going on “at home,” and ask, even if informally, questions about their patients’ trauma history, even if it is on an ACE survey that only shows the total score and is not included in a medical record,
- see obstetricians, gynecologists, pediatricians, and family practice physicians ask pregnant women about their own childhood trauma, as studies show that pregnant women who are aware of their own childhood traumas, and of the impact of childhood trauma, are less likely to experience post-natal depression or to abuse their children.
- see kindergartens, elementary, middle and high schools become places where children aren’t shamed and blamed for acting out and asked, “What’s wrong with you?” but are instead asked, “What’s happened to you? How can I help?” and where their parents are not shamed or blamed, either. When parents understand more about the lifelong health consequences of trauma, the likelihood of children being traumatized decreases; children who feel safer at home do better in school.
- help people learn that the body is resilient, our brains and bodies want to heal. Given understanding, acceptance, community, and information about resilience research, people with high ACEs scores can develop greater resilience as individuals, and in their families, workplaces, and communities.
- see communities foster groups of laypeople and professionals from all sectors, including education, medicine, justice, the arts, mental health, and housing, to identify and prevent trauma including structural racism and income, health, and education inequality, as racism and poverty are as every bit as stressful and toxic to a child as any other type of abuse.
Though we didn’t know each other through our years of parenting – Gregory has two adult sons and three grandchildren, and I have a son and a daughter – we both vowed to stop the cycles of abuse with our own children. We are both grateful to have relatively healthy, happy adult children, and worked hard and mindfully to prevent cycles of addiction and abuse.
That Gregory works for a leading medical institution that supports his promulgating ACEs science is no accident. That I work for an organization that is all about preventing and healing childhood trauma; building resilience, creating a trauma-informed world, is no accident. Again, our faith is affirmed as we marvel at the timing!
I hope that helping to bring this book into the light, and Gregory’s using his radio show, prodigious talents as a writer, speaker, and interviewer, as well as his leadership position at Baylor College of Medicine, will raise awareness among doctors, nurses, therapists, social workers, teachers, law enforcement officers and policymakers of the need to learn and teach all professions about the devastating consequences of childhood trauma. I hope policymakers will hear the alarm to understand that policies that punish people for the addictions and behaviors that are the direct result of childhood trauma do not help, but instead further traumatize already traumatized people.
I hope Gregory’s audience is wide, loyal, accepting, and encouraging.
I truly believe Gregory will change the world by taking this book into medical schools and teaching physicians and nurses about the root cause of most adult illness: childhood trauma. He understands and makes clear that while the sexual abuse was the most dramatic part of his trauma, that the secrecy, isolation, neglect, verbal, and other physical abuse was deadly as well. This is, indeed, important information to share as policymakers learn about creating schools, hospitals, businesses, cities, states, nations that are about preventing and healing childhood trauma, and building resilience. As we face, in our communities, adverse community experiences including structural racism, bullying, income inequality, and, in our world, increasing numbers of adverse climate experiences – the loss of homes, livelihood, a way of life – as the result of wildfires, storms, floods and other natural disasters, I hope we will become gentler with each other and more mindful of protecting our environment, our natural resources.
I look forward to Gregory’s subsequent books about how he is continuing to heal, as I believe he will shed light on childhood trauma and its impact across the lifespan. He will educate a new generation of physicians and allied health professionals about ACEs science and resilience research and findings, and share ways patients can use their own agency to find life solutions that do not include addiction and risky behaviors to handle their fears.
ACEs scores and “obits” and hopes
In the effort to demystify, remove stigma, and help prevent AIDs some 30 years ago, families started sharing that their loved ones had died of acquired immune deficiency (AIDS). Some shame was lifted. Acceptance was more widespread. Empathy helped spur funding research into cures, and campaigns to raise awareness. Education, and prevention, helped slow the spread of the disease.
As suicide has become epidemic, many families of loved ones are choosing to share, in obituaries, the cause of death as suicide, in hopes of raising awareness, reducing the stigma, encouraging others to get help.
Someday perhaps ACEs scores will be listed in obituaries, in hopes of people understanding the direct correlation between childhood trauma and adult disease and premature death. As a woman in my early sixties, I’ve lost many friends who had high ACE scores, and am watching others suffer from chronic diseases that are, no doubt, related to their ACEs. I know I want my ACE score listed in my obituary, not as a point of shame or pride, but in hopes of its being a “teachable moment.” I also want to include information about resilience research, as in, “despite having an ACE score of 8, Sipp credited her long life to the exercise, diet, community work, and other healthy endeavors that were part of resilience research, an evidence-based way of helping to reduce the impact of ACEs, which she practiced and promoted as a part of her work.”
That Gregory and I have both been able to share our truths, learn about ACEs science and resilience research, and find joy and purpose in helping to prevent childhood trauma will, I hope, prevent our obituaries from being published any time soon! I hope that is true, too, for the millions who will experience “aha moments” as they learn the truths about the importance of our preventing trauma in the lives of others, be it by preventing blame, shame, bullying, racism, and violence, or by our promoting health, acceptance, empathy and love, especially toward children and their families. As families and communities heal, I believe we will heal the earth. Learning and teaching ourselves how to be kinder and gentler to ourselves, each other, our earth? There is nothing more sacred; no work more vitally important.