Recent news about the ACE (Adverse Childhood Experiences) study, which collected data on more than 17,000 HMO members over 15 years ago, brings to light the impact of childhood trauma and family dysfunction on later emergence of serious problems - medical, psychological and social.

The findings are correlational rather than causal, and mediated by many factors. Nevertheless, from a simple 10-item questionnaire, researchers found that the higher the score, the greater the risk for developing one or more of the following:

  • Alcoholism and alcohol abuse
  • Chronic obstructive pulmonary disease (COPD)
  • Depression
  • Fetal death
  • Health-related quality of life
  • Illicit drug use
  • Ischemic heart disease (IHD)
  • Liver disease
  • Risk for intimate partner violence
  • Multiple sexual partners
  • Sexually transmitted diseases (STDs)
  • Smoking
  • Suicide attempts
  • Unintended pregnancies
  • Early initiation of smoking
  • Early initiation of sexual activity
  • Adolescent pregnancy

Here are the 10 yes/no ACE questions:

Prior to your 18th birthday:

  1. Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?
  2. Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?
  3. Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?
  4. Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?
  5. Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
  6. Was a biological parent ever lost to you through divorce, abandonment, or other reason?
  7. Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
  8. Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?
  9. Was a household member depressed or mentally ill, or did a household member attempt suicide?                        
  10. Did a household member go to prison?




Despite dozens of peer-reviewed research studies on the correlation between adverse childhood experiences and health outcomes, many physicians are not even aware of the ACE questionnaire.

Dr. Vincent Felliti, one of the researchers in the ACE study, stated in an  interview with NPR that the medical community has not shown much interest in administering the questionnaire, because physicians are uncomfortable asking about these types of problems, and also are not quite sure how to handle patients' reactions when recalling childhood trauma. However, he maintains that integrating people's ACEs into routine medical care could help patients reduce shame about their past, as well as improve understanding and treatment of addictive behaviors and chronic medical problems related to lifestyle.


How mental health clinicians can help

In the wake of recent publicity on the the correlation between adverse childhood experiences and adult chronic illness and psychological problems, it's an ideal time for mental health clinicians to offer education, consultation and training to the medical profession and to the public.

For medical professionals:

  • Do an in-house workshop at physicians' offices, on how to broach sensitive topics with patients, as well as how to manage their own discomfort with patients' reactions. Distribute a handout with a brief checklist or decision tree, which can help physicians decide when to make a referral to a mental health clinician. Include a sample script for those who might need guidance on what to say.
  • Get booked on a discussion panel at a medical convention. You'll probably need to be invited by a member of the professional association. (That's where your ongoing networking will come in handy.)  Find relevant data for your presentation at the CDC website, and also via searches at Google Scholar or digital repositories such as Hathitrust. Follow news and other updates at ACEsTooHigh, a website founded by a health, science and technology journalist.

For the general public:

  • Give presentations to community groups on one or more of the psychological problems listed above. Mention the link with adverse childhood experiences.  Address parent groups with tips on how to help build confidence and resilience in their children.  For lay audiences you can refer to facts and figures. However, examples and stories will more likely resonate with them and motivate them to take action.
  • Get involved (on either a paid or volunteer basis) with social service agencies and other organizations that work with troubled families. Most agencies are well aware of the connection between difficult childhoods and adult poverty and social problems. However, they may not be aware of medical problems that could be averted through early intervention.