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Health & Exercise Forum

The impact of adverse childhood experiences

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Mar 20, 2017

Kathleen Nealon, MD2

Author: Kathleen Nealon, 2nd year medical student Geisinger Commonwealth School of Medicine

 This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of Geisinger Commonwealth School of Medicine.

Author: Kathleen Nealon,  MD2

Katie Nealon is a second year medical student at Geisinger Commonwealth School of Medicine. She is a Scranton native and hopes to become an Obstetrician/Gynecologist.


What if I told you that you could reduce your child’s future risk of heart disease, hepatitis, lung disease, cancer, and suicide in one fell swoop? What if I told you that even if you aren’t a parent, you could do the same for your niece, your grandchild, your student? I’d be willing to bet that I would get your attention. Well, here’s the thing: you can. It all has to do with a child’s extremely delicate cerebral and hormonal development.

In 1998, a study by Dr. Vince Felitti, MD from the Kaiser Permanente Clinic in San Diego was published, called the Adverse Childhood Experiences Study (the ACE study). The implications of the study have only improved over time. Researchers looked back at negative events that had happened during the childhood of about 17,000 adults. The categories they looked at were:

  • Abuse (physical, verbal, or sexual)
  • Neglect (physical or emotional)
  • Parental Dysfunction (substance dependence, mental illness, incarceration)
  • Family Dysfunction (domestic violence, parental separation or divorce)

Each type of adverse experience that a person had been subjected to before the age of 18 counted towards their ACE score, and it turned out that the prevalence of these events was very high. 66% of the respondents had experienced at least one of the adverse events and of those, 87% had experienced two or more types. Slightly over 12% of the respondents had experienced four or more ACEs.

Emotional and Physical Impact – changes in the brain

The research went even further, and correlated these ACE scores with some of the biggest killers in our society, and found that a person’s risk of ischemic heart disease, cancer, COPD, liver disease, skeletal fractures, autoimmune disease, obesity, smoking, abuse of alcohol & drugs, and suicidality were all raised significantly. Furthermore, the more ACEs someone had, the greater his or her risk was for these conditions. It has been demonstrated that these effects are not simply due to poor health choices; there are distinct changes in brain development in those who have experienced ACEs. Changes in the size of the prefrontal cortex (in part responsible for impulse control) and the nucleus accumbens (the brain’s reward center) are among the most significant found.

Impact Crosses Racial and Socioeconomic Lines

  • 75% white
  • 75% college educated (75% attended some college, 50% graduated)
  • Access to regular health care

There have been several hundred ACE-related studies since 1998, including over 200 by other investigators and individual studies by 32 states and the District of Columbia. The big question here is, if all this research is being done, why haven’t we heard anything about it? Why aren’t my children, grandchildren, students, patients being screened for ACE’s? Why have I not been screened?

Our research at TCMC began as a way of trying to answer those questions. We anonymously surveyed the clinical faculty of TCMC, asking questions like, “Have you heard of the ACE Study?”, “What is your level of familiarity with the study?”, and “Would you be willing to screen for ACEs?”. Our study found that that about 85% of respondents hadn’t heard of the groundbreaking study I’ve discussed here. The good news is that approximately 70% would be willing to screen for ACEs, and the same number were interested in learning more from us about the study. Pediatricians and Family Doctors were the most knowledgeable about the study, as any concerned parent would hope; however, fewer than 50% of them were aware of the study. Our work has shown that there is much to be done in the way of education, and that the physicians in our area are ready to learn.

Medical students only have four years to learn the crucial elements of being a physician … the truth is, we our limited by our time and education. The goal of our research is not to tell physicians that they don't know everything, but to remind us that there is more to learn, and to show us that there are new ways to understand some of the root causes contributing to ill health and risky behaviors. This information can help our patients and our society.

Potential Solutions … what can I do?

This problem is not only applicable to those who are uneducated or living in poverty. This is everyone’s problem, and no one is spared its effects. This means, however, that we can help our whole society by acting on the results of this study: coordinated care plans, ACE-screening techniques, and targeted therapy are the future of healthcare. This idea fits into the preventative health movement, which focuses on avoiding disease rather than waiting until we are already sick to do something about it.

You may be reading this and wondering, ‘I’m not a doctor, what can I do?’ The answer is that there is a lot you can do. Further research has shown that children who have experienced multiple ACEs, but who have a positive figure in their lives who acts in a supportive, mentoring capacity have reduced risk for the negative health outcomes described above. This means that whether you are a parent, teacher, grandparent, or community member, there is something you can do. Joining a mentoring program such as the Big Brothers Big Sisters group or church group, coaching a little league team, or simply being a supportive and positive presence in a child’s life can do more than you know. ACEs are a problem that affects us all, and it is up to all of us to be part of the solution.

GCSOM Faculty Advisor: Dennis Dawgert, MD

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” in the Scranton Times-Tribune.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.