Violence is just one part of childhood trauma. So why are we focusing so much on childhood violence?

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Whac-A-Mole players (photo by Laura)

Many people and organizations focus on preventing violence with the belief that if our society can stop violence against children, then most childhood trauma will be eradicated.

However, research that has emerged over the last 20 years clearly shows that focusing primarily on violence prevention – physical and sexual abuse, in particular – doesn’t eliminate the trauma that children experience, and won’t even prevent further violence.

“Although violence can beget violence, it’s hardly the only cause of violence,” says Dr. Vincent Felitti, co-principal investigator of the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study), groundbreaking epidemiological research that showed a direct link between 10 types of childhood trauma and the adult onset of chronic disease, mental illness, violence and being a victim of violence, among many other consequences.

“Basically there’s lots of other ways,” he says. “Humiliating people. Isolating people. Verbally provoking them. All of those have potential for producing violence in response.”

In addition, violence can provoke nonviolent behavior that can be just as damaging as violence.

In other words, childhood trauma does not equal only violence.

The many types of childhood trauma

Violence is just one among many types of childhood trauma. The ACE Study found that violence is not more – or less — damaging than divorce, living with a parent who’s an alcoholic, being yelled at nearly every day of your childhood, or emotional neglect. Just as important, it rarely happens alone. If a child is experiencing violence, there’s usually some other type of trauma happening, too.

In fact, the entire approach to preventing violence against children – by focusing on only one type of trauma, by focusing on the child and ignoring the parents or caregivers, by ignoring the toxic stress imposed on the child and family by traumatizing systems – is so outdated that pioneers in this arena compare our current approach to a never-ending game of Whac-A-Mole.

They propose a completely different approach, one that focuses on creating and growing resilient children, families, organizations, systems and communities. It’s an approach that moves from blame, shame and punishment, to understanding, nurturing and healing.

The ACE Study is part of what’s being called a “unified science” of human development that recasts our understanding of how to solve our most intractable problems, such as poverty and homelessness, as well as childhood trauma. It comprises five areas of research:

  • the epidemiology of adverse childhood experiences (ACEs),
  • the neurobiology of toxic stress (the brain),
  • the biomedical consequences of toxic stress (the body),
  • the epigenetic consequences of toxic stress (passing from parent to child),
  • and resilience research.

Others call this “the theory of everything” in human development or NEAR science (neurobiology, epigenetics, ACEs, resilience). I just call it ACEs science.

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Time and again: This time, Orlando, and again more pertinent questions must be asked

Mourners in Orlando. Photo credit: Sam Hodgson for The New York Times

Mourners in Orlando. Photo: Sam Hodgson for The New York Times

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For those of us who know that childhood adversity can lead to chronic disease, mental illness, and violence, among other consequences, the questions about Omar Mateen, the man who killed 49 people and wounded 53 others in an Orlando night club early Sunday morning, aren’t answered yet. In fact, most of the questions that would address the roots of his violent actions — and our successful efforts to prevent other mass shootings — haven’t even been asked.

There are a couple of hints. According to this New York Times article, “Mr. Mateen had a chilling history that included talking about killing people, beating his former wife and voicing hatred of minorities, gays and Jews…”

He either had a brain tumor/stroke/dementia/physical injury that induced him to violence, which is unlikely because it’s so rare, or he had many adverse childhood experiences (ACEs) that he never resolved. If it’s the latter, which is much more likely, as I’ll explain later, then there are questions pertinent to understanding the trajectory of Mateen’s tragic life from the time he emerged from his mother’s womb as, hopefully, a wanted and loved infant, to certain suicide dying in a hail of bullets after killing so many. These questions are much more pertinent than asking if he was “self-radicalized”.

Mateen was born in the United States, and brought up in a family that had immigrated from Afghanistan, which isn’t an easy transition for most families, and can affect their lives for decades. Was life so unsafe in Afghanistan that his parents endured extreme hardship and had to leave? Were they involved in any of the country’s wars? His father appeared in videos where he railed against the Afghan government and Pakistanis; was that anger directed against his son verbally or physically?

Was he bullied by classmates or teachers when he was a child for being an immigrant or for his religion?

Did he witness abuse against his mother or some other family member? Was a family member depressed or have some other mental illness? Was a family member imprisoned or killed (either in Afghanistan or the U.S.)? Did he experience sexual abuse, or was he emotionally or physically neglected? If he was sexually abused as a boy, was he so ashamed of that experience that he thought he might be a homosexual, and was he so deeply afraid of being such that it turned into abject hatred for homosexuals as well as for himself? Were his reported many visits to Pulse, the nightclub where he killed or wounded nearly a third of the patrons, because he was a homosexual, and, if so, did his resulting inner conflict with his family and religion lead to his unmanageable rage?

Why these questions? They come out of the science around adverse childhood experiences. Specifically, the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study), which focused on 10 types of childhood trauma — physical, sexual and verbal abuse; physical and emotional neglect. And five types of family dysfunction — a family member who’s an alcoholic or addicted to some other substance, a family member who’s depressed or has some other mental illness, a family member who’s incarcerated, witnessing a mother being abused, and losing a family member to divorce or separation. Subsequent ACE surveys have included bullying, racism, witnessing a sibling being abused, living in a war zone, and even systems abuse, such as being involved with the foster care system, or living in an unsafe community.

The ACE Study — as well as several dozen ACE surveys in U.S. states, cities and organizations — show that ACEs are extraordinarily common — two-thirds of us have experienced at least one of these types of trauma; 12% of us have experienced four.  The more types of adversity a child experiences, the more severe the consequences. For example, compared to someone who has an ACE score of zero (none of the 10 types of childhood adversity in the ACE Study), a person with an ACE score of 4 (e.g., physical and verbal abuse, bullying and witnessing a mother being abused) is 12 times more likely to attempt suicide, seven times more likely to become an alcoholic, and twice as likely to have heart disease or cancer. Compared to a man who has an ACE score of zero, a man who experienced physical abuse, sexual abuse and witnessed his mother being abused is nearly four  times more likely to physically abuse his wife.

The ACE Study is the epidemiology part of ACEs science, sometimes called the “unified science of human development”. The other parts are the neurobiology of toxic stress — how toxic stress from ACEs damages a child’s brain. When a child suffers extreme and chronic stress, the outward behavior looks like fighting, fleeing or freezing (fright), while the brain’s function and structure is harmed by too many stress hormones. Toxic stress also produces long-term wear and tear on our bodies (biomedical consequences), and it’s passed from one generation to the next (epigenetic consequences). Resilience research shows our brains are plastic and our bodies want to heal.

The ACEs questions are the same questions that should have been asked of the lives of Boston bombers Tamerlan and Szhokar Tsarnaev, whom Mateen called out during his last day of rage. As I wrote in that article, Looking at the Boston Marathon bombers through a trauma-informed lens is not the same as investigating how they committed their crime, or identifying an immediate motive. Instead of attributing the starting point to being “radicalized” or “self-radicalized”, a trauma-informed lens reveals what a family experienced, and what a community did or did not do for a family and its members on their journey to the point where they decided to use violence.”

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“Silent Evidence” worth hearing about

Tennessee Jane Watson’s audio story, Silent Evidence, is about the sexual abuse she experienced when she was a girl, at the hands of an instructor. She’s posted two of three episodes. The first is below. Here’s the description, from her website, SilentEvidenceProject.com:

Sometimes silence protects us. Sometimes silence does us harm. The story of one young woman as she faces her abuser, the criminal justice system and most of all, herself. 

Watson says the real story behind all the headlines about sexual abuse is that most people who have survived sexual abuse never talk about it. On her site, she says that one out of 10 people experience sexual abuse, but the CDC’s Adverse Childhood Experiences Study (ACE Study), says it’s one out of five.

In Silent Evidence Watson breaks through the barrier of silence with a story focused on the “ramifications of sexual abuse, as they are lived by her and the people closest to her, over the course of a 28-year journey to go public.”

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Troubled moms and dads learn how to parent with ACEs

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A father in county jail is ordered to take a parenting class, but isn’t too enthusiastic about it. As part of the class, he learns about the ACE Study, and does his own ACE score.

“Oh my god!” he announces to the class. “I have 7 ACEs.” His mother’s an alcoholic. His dad’s been in and out of jail. He himself started dealing drugs at age 11, and doing drugs at 14.

“I’ve got two kids at home experiencing the same things I did,” he says. The light bulb goes on.

A few days after a woman who’s ordered by the court to take parenting classes learns about her ACE score, she quits smoking.

“I’ve been smoking for years,” she tells the class. “My ACE score was one of the reasons.” She quit, she says, because she decided smoking wasn’t helping her children.

Another parent of three kids was saddened when he did his ACE score.

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Five-minute video primer about Adverse Childhood Experiences Study

Many people have been asking for a short video that explains the CDC-Kaiser Permanente Adverse Childhood Experiences Study, the groundbreaking epidemiological research that revealed the link between childhood trauma and the adult onset of chronic disease, mental illness, violence and being a victim of violence.

KPJR Films, which came out with Paper Tigers last year and Resilience this year, put together this wonderful five-minute overview of the ACE Study. It was edited by Jen Bradwell.

KPJR Films’ executive producer is Karen Pritzker. Its director-producer is James Redford.

“Resilience” premieres at Sundance Film Festival to sold-out houses

(l to r) Dr. Nadine Burke Harris, who appears in Resilience; Robert Redford, father of Resilience director James Redford; Clifford Beers Guidance Clinic site coordinator Laura Lawrence, who appears in Resilience; Resilience producer and director James Redford; Resilience co-producer Dana Schwartz

(l to r) Dr. Nadine Burke Harris, who appears in Resilience; Robert Redford, father of Resilience director James Redford; Clifford Beers Guidance Clinic site coordinator Laura Lawrence, who appears in Resilience; Resilience producer and director James Redford; Resilience co-producer Dana Schwartz

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Resilience, a documentary that looks at the birth of the CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study and how it spawned a movement across the world, premiered at the Sundance Film Festival on Friday. The first two screenings — both on Friday — were sold out.

Not bad for a film whose director, James Redford, wasn’t even planning on submitting it to the festival.

The buzz started before the festival even began. Wired.com listed Resilience as No. 2 in the 25 documentaries not to miss. WhatNotToDoc.com also singled it out. Nonfictionfilm.com did a story about the documentary.

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“Resilience” an official selection of Sundance Film Festival

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He wasn’t even planning on submitting Resilience to the prestigious Sundance Film Festival, says James Redford, whose production of Paper Tigers has been screening to sold-out audiences around the U.S. this year.

But late this summer, he shuffled some papers aside on his desk, and there was the application. It was due the next day. What the heck, he thought. I’ll submit it, as I have every other film I’ve made, but I won’t tell anyone. Why get people’s hopes up…again?

Two weeks ago, he was astonished to hear that Resilience was chosen to be an official selection. This gives the documentary great visibility and considerable boost for further distribution. It also brings information about the CDC-Kaiser Permanente ACE Study, its import and how it’s being used to another large and influential group of people.

Resilience: The Biology of Stress and the Science of Hope looks at the birth of the CDC-Kaiser Permanente ACE Study and how it’s spawned a movement across the U.S. It focuses on the work of pediatricians, therapists, educators and communities. It features interviews with several leaders in the ACEs movement nationally and in communities, including Laura Lawrence and Laura Porter, and Drs. Robert Anda, Vincent Felitti, Nadine Burke Harris, Victor Carrion, Jack Shonkoff and David Johnson.

Dr. Nadine Burke Harris and a patient.

Dr. Nadine Burke Harris and a patient.

The ACE Study measured 10 types of childhood adversity, those that occurred before the age of 18. They are physical, verbal and sexual abuse; physical and emotional neglect; a family member with mental illness, or

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