The ACE Study
"We saw that things like intractable smoking, things like promiscuity, use of street drugs, heavy alcohol consumption, etc., these were fairly common in the backgrounds of many of the patients...These were merely techniques they were using, these were merely coping mechanisms that had gone into place." Vincent Felitti, MD
When Dr. Vincent Felitti, head of the Department of Preventive Medicine at Kaiser Permanente in San Diego, began to delve into the reasons for the high dropout rate of patients who'd been successfully losing weight in Kaiser’s obesity program, he found to his surprise that a high proportion of those dropping out had histories of childhood abuse or neglect. Dr. Robert Anda, who had been doing research with the Centers for Disease Control and Prevention on the psychosocial origins of health-risk behaviors in patients at VA hospitals, heard Felitti speak about his findings, and in 1992 the two began to collaborate on the largest-scale study to date of the incidence and effects of childhood trauma, known as the Adverse Childhood Experiences (ACE) Study.
According to data collected from the over 17,000 Kaiser patients in this ongoing retrospective and prospective study, adverse childhood experiences, though well concealed, are unexpectedly common, have a profound negative effect on adult health and well-being a half century later, and are a prime determinant of adult health status in the United States.
The ACE Study has major implications for the healthcare professions: that all patients should be routinely screened for adverse childhood experiences; that a childhood trauma history may be very relevant to both serious illness and vague somatic complaints; and that appropriate approaches to treatment must include dealing with childhood trauma. Additional data suggest that evaluating patients for ACEs is also cost-effective.
In this two-video series, Drs. Felitti and Anda, co-investigators of the ACE Study, describe the study and its ramifications. Psychiatrist Bessel van der Kolk, psychotherapist Mary Tendall, and eight adult survivors of childhood trauma add their perspectives. Released 2005.
The ACE Study I: Childhood Trauma and Adult Health
(#272, 45 min.)
This video, intended for general audiences and policymakers, discusses the ACE Study’s origins, findings, and the consequences of adaptive behaviors.
Origins and design of the ACE Study
Findings of the ACE Study
Cost to society
Raising children safely
"I think of my training as a medical student; I learned nothing of this. I think every medical student should be taught about adverse childhood experiences, abuse, violence, and neurodevelopment, and how the consequences will lay hidden right in front of their eyes unless it’s a standard part of medical care to inquire about it." Robert Anda, MD
The ACE Study II: Healthcare Implications
(#273, 45 min.)
Building on the findings described in Part I, this video describes the ACE Study’s implications for medical evaluation, treatment, and training. The presenters also discuss research showing that comprehensive patient evaluations can reduce healthcare costs.
Neurobiology of trauma
Trauma and addictions
Asking the right questions
Purchase price: One VHS/DVD $125, both $225
Rental price: One VHS/DVD $45, both $75
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Also available: Wounds That Wont Heal (#274, 30 min.)
For a description of this condensed version for clients, see Videos for Survivors
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About the Presenters
Robert F. Anda, MD, MS, has designed and conducted epidemiologic studies for more than 20 years. He has written more than 100 peer-reviewed and government publications, as well as several book chapters. He is currently a senior researcher at CDC, sponsored by the Oak Ridge Institute for Science and Education. As Co-Principal Investigator for the ACE Study he played the principal role in the design of the study, subsequent analysis of the ACE Study data, and preparation of its numerous scientific publications. He is frequently invited to speak about the ACE Study, and has presented its findings at Congressional briefings.
Vincent J. Felitti, MD, is Co-Principal Investigator of the Adverse Childhood Experiences Study, ongoing collaborative research between Kaiser Permanente and the Centers for Disease Control. A graduate of Johns Hopkins Medical School (1962), Dr. Felitti founded the Department of Preventive Medicine for Kaiser Permanente in San Diego, California in 1975, where he served as Chief of Preventive Medicine until March 2001. He is also Clinical Professor of Medicine at University of California, San Diego, a Fellow of The American College of Physicians, and founder of the California Institutes of Preventive Medicine.
Mary Tendall, MFT, is a licensed psychotherapist in private practice, specializing in combat trauma. She teaches classes and workshops on trauma and its treatment, and has consulted for trauma programs aired on Frontline and National Public Radio.
Bessel van der Kolk, MD, is Medical Director of The Trauma Center, which specializes in the study and treatment of survivors of severe psychological trauma, and Professor of Psychiatry at Boston University. He is co-author of Traumatic Stress: The Effect of Overwhelming Experiences on Mind, Body and Society.
Jim is the father of three sons and works as a consultant for marketing and sales of technical products.
Faith is a retired pharmaceutical representative and real estate broker.
Molly Fisk is a poet, essayist, and teacher in Nevada City, California, and the author of the poetry collection, Listening to Winter.
Sue Payne is a long-time care worker with disabled children in the public school system.
Oral Stallings is a Vietnam veteran, a commander in the American Legion, and is active in the veterans community.
Carol A. Redding, MA, is an Information Technology and Business Consultant, and the creator and Editor of both the ACE Reporter, a medical research publication on the ACE Study, and the ACE Study website: www.acestudy.org. She is a member of the Executive Committee of Authentic Voices, an organization affiliated with Prevent Child Abuse America.
Lelia Wood trained as a mathematics teacher, and is currently a secretary for a community college.
The Trainer’s Guide
The 56-page trainer’s guide includes objectives, reproducible outlines for note-taking, discussion and review questions, a resource list, the ACE questionnaires, and two journal articles, described below.
"The Relationship Between Adverse Childhood Experiences And Adult Health: Turning Gold Into Lead," is a short summary paper by Vincent Felitti, MD.
"Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults," by Vincent Felitti, MD, Robert Anda, MD, et al, is abstracted as follows:
The relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during childhood has not previously been described. A questionnaire about adverse childhood experiences was mailed to 13,494 adults who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.