3. • “…variations in the amount of licking and
grooming received during infancy had a direct
effect on how stress hormones…were
expressed in adulthood. The more licking as
babies, the lower the stress hormones as
grown-ups.”
Hurley, D. (2015) Grandma’s experiences leave a mark on your genes. Discover. Retrieved from
http://discovermagazine.com/2013/may/13-grandmas-experiences-leave-epigenetic-mark-on-your-
genes
4. • Why is this the case?
• How is it relevant to us?
5. The original ACE study
• “…the most important public health study you
never heard of.” http://www.huffingtonpost.com/jane-ellen-stevens/the-adverse-
childhood-exp_1_b_1943647.html
• In the mid-1990’s, 17,337 participants (Kaiser-
Permanente HMO recipients) were given
questionnaires about childhood experiences
and current health problems.
• Based on observations that many obese
patients were reporting abuse histories.
7. ACES questionnaire
• The original ten ACE items that had the most
significant impact on adult health
• More have been added from other studies
– History of being bullied
– Growing up in low socioeconomic status
– Growing up with neighborhood violence
• Each ACE adds to risk of health or behavior
problem in a “step-wise” manner
8. A PERSON WITH 4 OR MORE ACES IS:
• 12.2 times as likely to attempt suicide
• 10.3 times as likely to use injection drugs
• 7.4 times as likely to be an alcoholic
• 2.2 times as likely to have ischemic heart disease
• 2.4 times as likely to have a stroke
• 1.9 times as likely to have cancer
• 1.6 times as likely to have diabetes
9. • Basic findings from original study have been
independently replicated by many different
studies http://acestoohigh.com/research/
10. Effect of prenatal stress
Animal experiments have shown that prenatal stress can
cause all the following effects on the offspring:
• More anxiety
• Reduced attention
• Learning deficits
• Less difference in function between the left and right
sides of the brain
• Effects different on male and female offspring
• Altered sexual behaviour – males show homosexual
behaviour and females are less nurturing mothers.
– http://www.beginbeforebirth.org/
11. So should the patient blame his
parents?
Understand epigenetics (past trauma lives in our genes)
• “According to the new insights of behavioral
epigenetics, traumatic experiences in our past, or in
our recent ancestors’ past, leave molecular scars
adhering to our DNA. Jews whose great-grandparents
were chased from their Russian shtetls; Chinese whose
grandparents lived through the ravages of the Cultural
Revolution; young immigrants from Africa whose
parents survived massacres; adults of every ethnicity
who grew up with alcoholic or abusive parents — all
carry with them more than just memories. ”
• Hurley, D. (2015) Grandma’s experiences leave a mark on your genes. Discover. Retrieved
from http://discovermagazine.com/2013/may/13-grandmas-experiences-leave-epigenetic-
mark-on-your-genes
13. Implications for us
“People who served in the military tend to have
experienced more traumatic childhood events, such as
being abused or living with an alcohol-dependent parent,
than people who are not veterans... Men who
volunteered for the military were more than twice as
likely as men without military experience to report at
least one adverse event in childhood, which supports a
theory that people may use the military to escape from
dysfunctional home lives, the researchers write in JAMA
Psychiatry.”
– http://www.reuters.com/article/us-military-childhood-
study-idUSKBN0FT2NN20140724
14. Implications for us
Understand that the care we provide, will not
only help the patient, but may also help the
patient’s child, effecting our society’s future.
15. Implications for us
• ACE score as part of intake screening?
• Those with higher ACEs will likely require
longer, more comprehensive treatment
• Address ACEs and connect to current
difficulties functioning/interpersonal stress.
16. Implications for providers
• If Antwone Fisher didn’t improve, should he
have been medically or administratively
separated? Does he have PTSD or Adjustment
Disorder?
• When trauma/neglect occurs before service,
does that get reported during medical
screening such as at MEPS. Did he/she report
depression/anxiety on 2807-1, if not should it
be an erroneous/fraudulent enlistment?
