I’ve spoken about the  Adverse Childhood Experience Study multiple times  this year.  The very large study identifies 10 categories of adverse experiences, 3 types of abuse, 2 types of neglect and 5 types of family dysfunction.  Each category has a roughly equivalent negative effect on lifelong health and wellbeing.  The more categories experienced, the more likely one is to have chronic diseases, poor educational outcomes,  poor work performance,  poverty,  incarceration, and premature death.  The effect is so strong that an individual who has experienced 7 of these categories of ACE has a life expectancy reduced nearly 20 years.  ACEs are common in Vermont with the majority of Vermonters having at least one ACE and 14% having four or more ACEs.  Adverse Childhood Experiences cut across all socio economic groups.  In the lowest earning quartile of Vermonters, 18% of people have four or more ACEs.  In the highest earning quartile of Vermonters,  11% have four or more ACEs.  The problem is multigenerational and there are evidence based interventions which work best at young ages and in the context of the family.

2014 proposed legislation contained  several  initiatives regarding ACE.  First, it provides for an integrated pilot project based on the program from UVM’s Center for Children, Youth and  Families.  The pilot project was to be overseen in the AHS program for Integrated Family Services.  It was to be funded by redirected money within AHS and  grant funding.  The plan included training 30 Family Wellness Coaches and 20 of the therapy oriented Family Focused Coaches with continued support by the UVM Center.

In addition the Bill (initially H.762, later S,252) directed the Blueprint For Health to determine how screening and treatment for ACE can best be incorporated into Blueprint practices and Community Health Teams throughout Vermont and how to fund, measure and evaluate the program.  It asks Vermont Department of Health to report to the Green Mountain Care Board and the Legislature how best to implement the findings of the ACE Study into Vermont medical practices and VDH programs.

The legislation asked the Vermont Medical Society Educational Foundation to develop educational materials about the ACE Study and the lifelong health effects of ACE.  The material were to be distributed by the Board of Medical Practice and Board of Nursing.  We also asks the University of Vermont School of Nursing and College of Medicine to include or expand information in their curriculum regarding health effects of ACE.

Unfortunately, in conference committee, only the section related to the Blueprint for Health survived and was signed into law.

We can not hope to control rising medical costs, mental health costs, educational or incarceration costs without addressing the root cause.  The costs, both economic and humanitarian, are staggering. 

According to a CDC study released in 2011, just one year of confirmed cases of child maltreatment costs $124 billion over the lifetime of the traumatized children. The researchers based their calculations on only confirmed cases of physical, sexual and verbal abuse and neglect, which child maltreatment experts say is a small percentage of what actually occurs.

You’d think the overwhelming amount of money spent on the fallout of adverse childhood experiences would have inspired the medical community, the public health community and federal, state and local governments to integrate this knowledge and fund programs that have been proven to prevent ACEs. But adoption of concepts from the ACE Study and the brain research has been remarkably slow and uneven.


Over the last five years, 18 states, including Vermont, have done their own ACE surveys, with results similar to the CDC study.

Outcome             No ACEs      1-3 ACEs       4-8 ACEs

Heart disease     1 in 14          1 in 7                 1 in 6

Smoker                1 in 16          1 in 9               1 in 6

Alcoholic             1 in 69         1 in 9               1 in 6

Suicide attempt 1 in 96         1 in 10             1 in 5

IV-drug user        1 in 480       1 in 43             1 in 30


One in six people had an ACE score of 4 or more, and one in nine had an ACE score of 5 or more. This means that every physician probably sees several high ACE score patients every day, notes Felitti. “Typically, they are the most difficult, though the underpinnings will rarely be recognized.”

The kicker is this: The ACE Study participants were average Americans. Eighty percent were white (including Latino), 10 percent black and 10 percent Asian. They were middle-class, middle-aged, and 74 percent were college-educated. Since they were members of Kaiser Permanente, they all had jobs and great health care. Their average age was 57.

“It’s not just ‘them’. It’s us.”

Patients who had four or more categories of adverse childhood experiences “their odds of having learning or behavior problems in school were 32 times as high as kids who had no adverse childhood experiences

The ACE Study became even more significant with the publication of parallel research that provided the link between why something that happened to you when you were a kid could land you in the hospital at age 50. The stress of severe and chronic childhood trauma – such as being regularly hit, constantly belittled and berated, watching your father often hit your mother – releases hormones that physically damage a child’s developing brain.



Adverse Childhood Experiences and Health and Well-Being Over the Lifespan

This chart shows the sequence of events that unaddressed childhood abuse and other early traumatic experiences set in motion. Without intervention, adverse childhood events (ACES) can result in long-term disease, disability, chronic social problems and early death. 90% of public mental health clients have been exposed to multiple physical or sexual abuse traumas. Importantly, intergenerational transmission that perpetuates ACES may continue without implementation of interventions to interrupt the cycle.

Adverse Childhood Experiences

(Birth to 18)

Impact of Trauma and Adoption of Health Risk Behaviors to Ease Pain of Trauma

Long-Term Consequences of Unaddressed Trauma

 Abuse of Child

  • Emotional abuse 11% *
  • Physical abuse 28% *
  • Contact sexual abuse 22%
  • Alcohol or drug user by household member 27%
  • Chronically depressed, emotionally disturbed or suicidal household member 17%
  • Mother treated violently 13%
  • Imprisoned household Member 6%
  • Not raised by both biological parents 23% (Loss of parent by separation or divorce, natural death, suicide, abandonment)
  • Physical neglect 19%
  • Emotional neglect 15%

Trauma in Child’s Household Environment

Neglect of Child

*Above types of ACEs are the “heavy end” of abuse. Eg., Emotional: recurrent threats, humiliation, chronic criticism; Physical: beating vs spanking; Neglect: Lack of basic needs for attachment, survival/growth

One ACE category

= score of 1.

List is limited to ACE study types. Other trauma may include: combat, poverty, street violence, historical, racism, stigma, natural events, persecution etc.

Neurobiologic Effects of Trauma

  • Disrupted neuro-development
  • Difficulty controlling
  • Anger – Rage
  • Hallucinations
  • Depression (and numerous other mental health problems – see below)
  • Panic reactions
  • Anxiety
  • Multiple (6+) somatic problems
  • Sleep problems
  • Impaired memory
  • Flashbacks
  • Dissociation
  • Smoking
  • Severe obesity
  • Physical inactivity
  • Suicide attempts
  • Alcoholism
  • Drug abuse
  • 50+ sex partners
  • Repetition of original trauma
  • Self-injury
  • Eating disorders
  • Perpetrate interpersonal violence (aggression, bullying, etc.).
  • Ischemic heart disease
  • Cancer
  • Chronic lung disease
  • Chronic emphysema
  • Asthma
  • Liver disease
  • Skeletal fractures
  • Poor self rated health
  • Sexually transmitted disease
  • Homelessness
  • Prostitution
  • Delinquency, violence and  criminal behavior
  • Inability to sustain employment
  • Re-victimization: by rape; DV, bullying, etc
  • Compromised ability to parent
  • Negative alterations in self-perception and relationships with others
  • Alterations in Systems of Meaning
  • Intergenerational transmission of abuse
  • Long-term use of multi human service systems

Health Risk Behaviors

Disease and Disability

Social Problems

At Annual Cost of:


Multiple studies reveal the origin of many mental health disorders may be found in childhood trauma, including Borderline Personality Disorder BPD, Anti-Social Personality Disorder, PTSD, Schizophrenia, Bipolar Disorder, Dissociative Identity Disorder DID, Anxiety Disorders, Eating Disorders including severe obesity, Attention Deficit Hyperactivity Disorder ADHD, Oppositional Defiant Disorder ODD and others.

Sources: Adverse Childhood Experiences Study (CDC and Kaiser Permanente, see http:// The Damaging Consequences of Violence and Trauma (see and Trauma and Recovery (J Herman). Cost data: 2007 Economic Impact Study (PCAA). Chart created by Ann Jennings, PhD. Revision: April 6, 2010