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


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the parents or caregivers, by ignoring the toxic stress imposed on the child and family by traumatizing systems – is so outdated that pioneers in this arena compare our current approach to a never-ending game of Whac-A-Mole.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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The single best medical appointment of my life was when a nurse practitioner asked about my adverse childhood experiences (ACEs)

2015ace rocker 2

Heidi Aylward spent much of 2015 going to doctor’s appointments for back and joint pain, dizziness, swelling of the legs and feet, high blood pressure, elevated platelets, heart palpitations and extreme fatigue.

2016 isn’t looking much better. She’s worn a heart monitor, had a bone marrow biopsy and continues to have blood work. She holds down a job as a full-time project manager, tends to her daughters, home and pets.

But she feels like her body is falling apart.

“I’m not going to make it to 60,” she said, “Why do I even contribute to my retirement savings account?”


Heidi Aylward: Present

Heidi is 39.

She’s also one of my best friends.

I can’t help but wonder how much her body is burdened by her chaotic childhood.

For personal and professional reasons, I’ve been learning about the new science of human development, which includes the epidemiology of childhood adversity and how toxic stress from childhood trauma can damage the structure and function of a child’s developing brain. Toxic stress also embeds in a person’s biology to emerge decades later as physical disease.

The CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study) shows that childhood trauma is linked to the adult onset of chronic disease, mental illness, violence and being a victim of violence. The research, led by Dr. Vincent Felitti (Kaiser) and Dr. Robert Anda (CDC) measured 10 types of childhood adversity that occurred before the age of 18.

They are physical (1), verbal (2) and sexual abuse (3); physical (4) and emotional (5) neglect; a family member who has been incarcerated (6), is abusing alcohol or drugs (7), or has a mental illness (8), witnessing a mother being abused (9); and losing a parent to divorce or separation (10). The lowest possible score is 0 and the highest 10. Of course there are many other types of childhood adversity – bullying, witnessing violence outside the home, being homeless, witnessing a sibling being abuse, experiencing a severe illness or accident – but this study focused just on these 10.

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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


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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At Science of Trauma briefing on Capitol Hill, U.S. Sen. Heitkamp urges panelists to “keep preaching”


When U.S. Sen. Heidi Heitkamp (D-ND) arrived mid-way through a congressional briefing on the Science of Trauma last week, she delivered her remarks with passion, humor, and most of all, a sense of urgency to the room full of Capitol Hill staff and a smattering of advocates. Her message was macro as well as micro—change national policy to incorporate what the ACEs science tells us about trauma, and see and respond to the needs of those you encounter in everyday life. (Her remarks start at 27:48 and continue through 41:45.)

ACEs science refers to adverse childhood experiences. This includes the epidemiology of ACEs (the CDC-Kaiser Permanente Adverse Childhood Experiences Study and several dozen ACE surveys in U.S. states and organizations), the neurobiology of toxic stress, the effects of toxic stress on our bodies, how toxic stress is passed from one generation to the next (epigenetic consequences), and resilience research, which shows our brains are plastic and our bodies want to heal.

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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,

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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Paying attention as the most exhausting part of parenting with ACEs

Kai in china

I used to sneak away for a hot bath as often as possible when my daughter was in the need-me-every-minute years. I’d soak long past when the water went cold and I felt guilty at times but sometimes I needed to be alone.

To read poetry.

To have some physical space.

To exhale.

I didn’t always know where or how to pamper or provide self-care to myself. There were few adults I trusted to help me. I believed in attachment-style parenting and wanted to be there all of the time for my daughter. And that even made me feel guilty when I craved alone time. Like any alone time I took meant not being present for my daughter.

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A working ranch integrates ACEs and animals into treatment for teens

HorseCU Although it’s too soon to tell if integrating trauma-informed and resilience-building practices based on adverse childhood experiences (ACEs) sciences is making a difference for the teens living at Home on the Range, a residential treatment center in Sentinel Butte, ND, it’s made a huge difference for the people who work there. They now understand that kids aren’t born bad.

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