Masterclass: Adverse Childhood Experiences explained by Integrative Physician
An In-depth Look at Adverse Childhood Experiences
As an integrative physician, meditation teacher, and trauma-trained recovery coach, I do this work because there are so many health conditions and mental health challenges that are caused by Adverse Childhood Experiences (ACEs). I feel that more people need to know about this because sometimes they are dealing with psychological or physical health issues and are going the traditional allopathic medicine route but not getting results. This information may be the key to their healing and recovery.
Who Can Benefit from This Masterclass?
Firstly, this masterclass is for people who need healing. If you’re living with an illness that is aggravated by stress or was caused by stress or developmental trauma, then this is for you. Secondly, if you are a parent, then this masterclass will help you understand how you can best support your children so that they do not end up with post-traumatic stress disorder or any of the other illnesses. Thirdly, this masterclass is useful for coaches, doctors, therapists, and healers so that you can have an understanding of exactly what happens in our bodies and brains when we experience toxic stress.
What You Can Gain from This Class
You will leave this masterclass with an understanding of why I say that healing is absolutely possible even if you have endured some of the worst forms of trauma or abuse. You’ll also understand how Positive Childhood Experiences can help you avoid these illnesses. Finally, you will leave more empowered and able to take effective action. Isn’t that what we all need? We all want to be equipped to avoid as much illness as we possibly can.
Let’s Jump Right In
Welcome to this masterclass on Adverse Childhood Experiences! If you haven’t heard of them, sometimes we refer to them as ACEs. We’re going to explore what the original ACEs are and what the new categories are. You’re going to learn about the long-term effects of childhood adversity. I’ll also answer the question, “Why is it that some people do better than others? Why do people raised in the same toxic families have different outcomes?” I’ll explain how toxic stress in childhood impacts the body’s organs, hormonal system, and brain. I’ll talk about what we can do today to help heal and prevent these effects. We’ll look at what we can do to build resilience.
This is the first in a series of four masterclasses. This first one will cover ACEs, the next one will be about Positive Childhood Experiences. Thirdly, we’ll talk about how to build the top 10 traits of resilience and our fourth masterclass will be on holistic healing and how trauma recovery works.
What Experiences are Considered to be ACEs?
Typically, when we think about ACEs, we’re looking at abuse, neglect, and family or household dysfunction. There are 10 categories in the original study that came out of CDC and Kaiser Permanente in the States. Looking first at maltreatment — this is emotional, physical, or sexual abuse. This includes emotional or physical neglect, which is actually a more common Adverse Childhood Experience. What we’re looking at with household adversity is did you grow up in a home where you saw your mother treated violently? Was there anyone in the home who abused substances, drugs, or alcohol? Was there someone in your home who had a mental illness, whether it was diagnosed or not? Here, we also look at growing up in a home where there was parental separation, either due to divorce or death. That’s an ACE. Having a family member household member who was incarcerated is another one. Did you grow up in the care of a foster family or another relative outside of your immediate family?
These ten things are on the original ACE quiz that you can find on my website. Those are the essentials that they look at in the ACE study. If you’d like to find out your ACE score you can take this free quiz. It will give you your adverse childhood experience score.
The other thing for us to think about is the more recent additions to this list. Studies are showing that other experiences such as discrimination count as ACEs. This includes racism, gender-based violence, ableism, homophobia, and transphobia. We’re also recognizing that social and environmental pressures can create a toxic stress environment for children that leads to long-term health problems. These pressures include extreme poverty and being a family member of someone who survived a war. It also includes if you’re witnessing and are immersed in a community where there’s violence; if you happen to be in a zone where there is a natural disaster; if you are a descendant of someone who is a Holocaust or other genocide survivor. If there has been intergenerational oppression as we’ve seen with slavery counts as an ACE too. All of these are considered Adverse Childhood Experiences and they can impact adult health.
What Conditions Are Linked to ACEs?
You’ve probably heard before that several conditions are linked to toxic stress and ACEs. What we know is that if you’ve had 4 or more of those ACEs, you’re 3 times as likely to have lung disease or be a smoker and 14 times more likely to attempt suicide. If you have had 4 or more ACEs, you’re 4 ½ times more likely to develop depression. I was in that group — my ACE score is 4 and I definitely lived with depression. Having 4 or more ACEs increases your risk of being an IV drug user, you’re more likely to be sexually promiscuous, and more likely to get liver disease.
We’re going to get into the mechanism of why this all happens but basically what we know is it’s when you have these Adverse Childhood Experiences at the base. Remember, it could also be intergenerational stuff — family trauma that’s been passed down. We know that those Adverse Childhood Experiences disrupt our brain development which leads to social, emotional, and cognitive impairment. That leads to health risk behaviors or self-harm behaviors. Later, that shows up as disease, disability, social problems, and even early death.
I’m talking about this because I didn’t even find out about this study until I was well into my medical career, even though the original ACE study happened while I was still in medical school back in 1998. We need more people to know about it because a lot of that stuff we kind of just brush under the rug as if it’s totally normal. So many people deal with it yet don’t connect it with their health challenges.
Here’s a list of conditions that are linked to Adverse Childhood Experiences:
alcoholism and substance abuse, allergies, Alzheimer’s, anorexia, anxiety, arthritis, asthma, autoimmune disease, acting-out behaviors, binge-eating, cancer, chronic fatigue syndrome, compulsive shopping, gambling, overeating, criminality, depression, diabetes, fibromyalgia, heart disease, high blood pressure, poor immune function, infertility, lung disease, liver disease, early mortality, osteoporosis, premature aging, relationship difficulties, smoking, sexually risky behavior, suicide, and violence.
That’s a lot! You must be aware of this because if you’ve been suffering from any of these conditions and you know that you had something in your past that’s made you a little more fragile, then this could be the key to your healing.
Why do Some People Cope Better Than Others?
There’s a concept of these social determinants of health and if you’re a public health person, you already know this. What we’re talking about here is, did a child have safe housing, transportation, and a safe neighborhood to grow up in? Were they exposed to violence, discrimination, and racism? What about in their environment — were there opportunities for jobs, income, education, access to nutritious foods, and physical activity? Did they have clean air and water? Language and literacy skills are also social determinants of health.
These are the things that policymakers, pediatricians, and other health care providers are working toward. We’re going to have an entire masterclass about Positive Childhood Experiences but just to give you a clue, there are seven things we look at when we look at your risk for developing some of those illnesses we just talked about. If you could talk to your family about your feelings, that is considered a Positive Childhood Experience that can counteract or serve as a buffer for toxic stress. For instance, if you were a child and your parent was an alcoholic, or someone was abusive, or a parent died. Did you have the ability to talk to someone? Unfortunately, so many people grew up in families, myself included, where there was no space to talk or share their feelings. “You don’t talk about our business to other people.” That was detrimental to us as children when we had to regulate our nervous systems.
Did you feel that your family stood by you during difficult times? That would be a positive experience. Did you enjoy participating in community traditions and rituals? These could be things like holidays or other festivities. That is a positive buffer. Did you feel a sense of belonging in high school? This is a tricky one because adolescence is a time when we were trying to differentiate ourselves and many of us struggle. Feeling supported by friends is a Positive Childhood Experience. This is why if you know that your child is being bullied and doesn’t fit in at school, then you’ve got to find some of these other positive experiences. They need to have at least two non-parent adults who take a genuine interest in them. This could be an aunt, teacher, coach, or some other mentor but that’s a really important positive experience. Feeling safe and protected by an adult is a critical Positive Childhood Experience and we’ll get into why these things impact the brain way that they do.
Stress, Resilience, and Post-traumatic Growth are Linked
Let’s look now at how stress, resilience, and post-traumatic growth are intertwined. Ultimately, we all want to end up with post-traumatic growth. However, what we’re always faced with is this sort of a seesaw between stressful, toxic events, and positive experiences. Ultimately, there are three ways that we respond or react to stress. One is that we can survive but not really thrive. We get sick and this is when that stress overwhelms the system, or there aren’t enough buffers in the system and we end up with PTSD or a chronic illness. You could also survive your toxic childhood and just kind of arrive at a baseline. That’s resilience, and we’ll talk about that in-depth in our third masterclass. The third way that we react to toxic stress and adversity in childhood is by adaptation. We can end up thriving and evolving with post-traumatic growth.
Types of Stress
In this four-part series, I’m going to get you into that range of post-traumatic growth where you can bounce forward and not just bounce back. Ultimately there are three types of stress that we talk about when we’re looking at the human animal. First, here’s a little definition — stress is a mental, physical, and biochemical response to a perceived threat or demand. We can respond positively such as when we have a good attachment relationship and we experience some mild stress. We might have a mild elevation of our stress hormones. That’s going to increase our heart and respiration rates. An example of positive stress could be when you’re going to take an exam or play a soccer game. That’s fine because it’s brief and gives you a little bit of an immune boost. You could even end up with extra resilience because we need to stress our systems a little bit. An example could be when a baby has to go to the doctor. As long as there’s a good attachment figure, this could be a positive stressor because it’s temporary and they’re going to come back down from it. That’s positive stress.
Another type of stress is what we consider just tolerable. There’s a serious threat or demand, it’s temporary and it’s buffered by a supportive relationship. In this case, it’s tolerable. We are going to see the stress response system kick in with increased heart rate and all of those things. However, because you’ve got the presence of a positive compassion figure, you can adapt. Even though the stress response system was up and tweaked, it’s still a temporary response even though it may last a little bit longer. Examples in this category could be the death of a family member or a natural disaster. A current example is this coronavirus pandemic and all of the isolation that we’re living with. It could be an injury. An injury is a stress to the system such as having your leg in a cast or your arm in a sling. It could be discrimination or divorce. These are things that are still temporary but are quite serious. As long as you have a compassionate adult pulling alongside you, you can buffer that.
The third type of stress is the one you’ll hear me talking about a lot — toxic stress. This is when you’ve got strong, frequent, uncontrollable, prolonged adversity. This is where we are talking about physical or emotional abuse, sexual abuse, or neglect. When we have this prolonged activation of the stress response system, we start to see it impact brain development. That’s when we know that there are risks to our immune and cardiovascular systems. An example of this kind of toxic stress could be living with a family member who’s abusing substances or has a mental illness. This stress is going to last for a much longer time in childhood. Exposure to violence or poverty is another example. We know that all of these lead to those illnesses on our list.
How Does Toxic Stress Affect Us Physically?
Toxic stress can impact our genes and our DNA. This is called epigenetic change. There’s also something called intergenerational transmission. Toxic stress affects the brain and entire neurological system, hormonal system, immune system, cardiovascular system, and even our telomeres which are little end caps on our DNA. Let’s take these one by one.
1) Brain and neurological impact. The first thing that we have to look at is the time we were in the womb. New research is looking at the entire perinatal period. We’re even looking at the months before our mothers conceived. If there was stress and adversity and if she herself grew up in a toxic environment, this would have affected her eggs so the baby is already impacted by that stress. We look at whether the expectant mom is enduring any sort of traumatic experience. If so, we know that her stress hormones are elevated and they’re crossing through that placenta, straight to the baby, which means it’s going to impact the child’s hormonal system. It will affect the HPA axis (hypothalamus, pituitary, and adrenals). It’s going to impact the limbic system which is our sort of emotional detection part of the brain which helps to regulate our alertness and emotions. The autonomic nervous system will be affected as well. So, if a mom had a hard time with her pregnancy, she’s going to have a hard time regulating her stress hormones and emotions and that can impact the baby. If a mother experienced any adversity, it’s certainly going to affect her bonding relationship with the baby. All of that can impact a little one.
Think about this from birth to age 3. We know that at this age the child is experiencing rapid brain development. There’s a rapid growth of millions of connections in the brain. Literally every second our brains are developing and then they start to prune away certain connections. There are all sorts of neuron-to-neuron connections and network connections happening across brain regions. This is why it’s very important in that birth to 3-year period that the child has an attuned caregiver. Babies need something called serve and return. That’s when you’re cooing to the baby and the baby will look and orient towards you and will eventually start to babble and will reach for you. That serving in return is an interaction that is crucial for brain development. So, we need a caregiver to be attuned to this baby, especially in those first couple of years. We also need the caregiver to be responsive. That means that when the baby cries, they get picked up or fed, have their diaper changed, or be burped or whatever needs to be done. Maybe they need a warmer blanket or fewer blankets. We need that caregiver to be responsive because the parts of the brain that are impacted by this direct our emotional and stress regulation. We learn this from a caregiver. Those parts of the brain develop based on caregiving.
Why am I stressing this so much? Because if you happened to have been a colicky baby, for example, maybe you were crying all the time. Perhaps because of this, you were left in the crib to “cry it out”. You know back in the day they used to just say, “Oh, you’re going to spoil the baby if you hold her too much. Just let her cry it out.” I get it, believe me, I get it. My daughter was nursing every 2 hours for the first 9 months, and she wasn’t sleeping through the night. It was hell. If you leave babies to cry it out though and they’re not getting that responsiveness, it can impact the brain. It’s really, really important that we have this because we ultimately need to be able to calm ourselves down and learn to regulate.
Of course, we know that physical, emotional, and sexual abuse are awful. But did you know that 70 to 80% of the maltreatment of children in ACEs, is simply unresponsive care and neglect? That’s why I’m talking about it because if you happen to be a mom like I was, a single mom, things become very difficult. Imagine trying to do everything yourself. You’re exhausted, you’re not sleeping, and you have a colicky, crying baby. It’s a perfect setup for either abuse or neglect. Fortunately, I had someone step in who saw me struggling and provided support. It was like a godsend! But if babies don’t get responsive care, it can lead to cognitive decline, delays, stunted physical growth. They have a hard time regulating themselves and this can lead to attention deficits. It can cause behavioral disorders in childhood, anxiety, and depression as well as an increased risk of having interpersonal problems. Poor impulse control and all of the personality disorders are associated with people who’ve had unresponsive caregivers or been neglected. Neglect also leads to poor executive function and impulse control, low high school graduation rates.
These are the things that the studies have shown are very important times for brain development and it doesn’t stop there. When we get to adolescence, we have another explosive time of brain development and brain chemistry happening. If our children were not well attended to as babies then as adolescents, when they’re flooded with emotions and hormones and feeling kind of chaotic, they will struggle to learn how to self-regulate. That’s often when we see teenagers doing crazy things like drugs, alcohol, sex, extremely dangerous sports, and the like. In adolescence, if you haven’t managed to develop those brain centers, you can have a stress response system that is hyper-tweaked so that you feel anxious at the littlest thing. It takes longer than normal to calm down after something stressful happens.
2) Genetic impact. Stress affects our genes and what we’re talking about here is DNA methylation. Toxic stress can cause some genes to be activated and others to be deactivated. Perhaps the gene that regulates blood glucose gets impacted. There happens to be this neurotropic receptor that will alter the neurons’ structure in response to toxic stress.
We can also talk about telomeres here. For those of you who don’t know what telomeres are, they’re little things on the ends of our chromosomes. Some of us think of them as like the little aglets that fit on the end of shoelaces to stop them fraying. Normally our DNA is all wound up but when the cell needs to divide, it unwinds and makes a copy of itself. Those little end caps protect the DNA so that all of the sequences are there. Toxic stress ends up wearing away those little tips, those telomeres, making it more likely that when that cell tries to replicate those DNA strands, it can make a mistake. The cells that it makes could either be cancerous or just defective so that the body kills them off. We know that adults with a high ACE score have shortened telomeres, and that’s why they have premature aging.
What Can We Do to Help Ourselves Now?
All right, that’s enough about the nerdy stuff. What is it we can do today? The first thing is to break the silence. So many of us have grown up in families where we don’t talk. We were told to not even feel our feelings, not trust our feelings, and definitely not to trust other people.
I’ve been trying to undo this thinking. I didn’t intend for my career to go on about talking about my family, but here we are. We have to break the silence so that people can get the healing that they need. Ultimately, that means you might need to speak to a therapist or a trauma-trained coach, a trusted friend, or a pastor but breaking the silence is the first thing that gets us out of denial and isolation and into healing.
What else can we do today? Well, connecting with a support group is helpful. Some of you have heard that I recently just finished a 6-week program called Stories with Soul where many of us were for the first time breaking the silence and getting healing in a supportive group. It’s also very helpful to join a 12-step fellowship so that you don’t have to recover alone.
If you do have a high ACE score, then you begin by re-parenting yourself. Yes, you can do it. In this regard, we talk about neuroplasticity which is one of the hot topics of the decade. It’s not only just learning new habits and new skills but it’s also about how we can repair some of the damage from our faulty and dysfunctional homes. Re-parenting yourself is a way that you can recover. Ultimately, it’s about connecting and identifying with your own loving parent and the inner parent. Most of us are familiar with the inner critic but what if you could install and nurture your own inner loving parent? This is really what helps create a foundation for emotional growth.
This creates post-traumatic growth. Getting from basic resilience to growth and reparenting, ultimately means that you end up with a complete identity because many of us who lived with trauma or family dysfunction, didn’t develop our original, true identity. We ended up putting on masks and becoming people-pleasers or codependents. You know, we became the good girl or the hero or the scapegoat. We took on these adaptive behaviors, survival mechanisms, masks, roles, how many other ways can I say it? But all that is the false self. By reparenting, we reconnect with our authentic selves and bring them to the forefront. Part of reparenting also involves grieving our past.
For people who’ve heard, “It’s over, just get over it,” there’s evidence that shows that these experiences from our childhood are lodged in our cells, tissues, muscles, bones, and brains. Through reparenting, we need to go through the grief process.
If you are someone who has chronic PTSD, if you have a flooded energy system, you might need to do this with a therapist or a coach so that you can move through this denial to awakening to grieving and finally a healing process. We’re going to talk about that in the fourth master class on holistic healing with all of the various modalities that I recommend that you get in touch with.
Healing your trauma is important because you don’t want to continue to pass it down. You can also build resilience. Even though you may have been wounded, you still have the capacity for resilience. We’re going to talk more about that in our third masterclass.
Second Masterclass — Positive Childhood Experiences
What can parents do today? In my recent masterclass on Positive Childhood Experiences. I explained how and why they work to counteract stress. We need more Positive Childhood Experiences! If you’re a parent, you need to heal your trauma so that you’re not passing it down the line and so that you can regulate your nervous system and teach your children to do the same.
Third Masterclass — How to Build the Top 10 Traits of Resilience
We were born with the basic capacity for resilience, so if we focus on building these 10 traits we can develop a stress resistant personality. Actions we take today to build resilience will help us in the moment to reduce stress, increase self-awareness and emotional intelligence while we prepare for an inspiring future filled with posttraumatic growth.
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Fourth Masterclass — Holistic Healing
If you’re a coach, healer, therapist, or doctor, then ultimately what we need to do today is to aim for holistic healing. This means that we don’t just look at someone as some number on a scale or a diagnosis. They are a whole person and so holistically, we look at mind, body, soul, relationships, and environment. It’s not just about nutrition, exercise or self-care. It’s about all of that. If you are not trauma-trained or trauma-informed, then please refer your clients to trauma-trained therapists, and coaches, so that they can go through this healing process.
I can’t tell you how many people I have heard about who’ve been in therapy, who’ve been to see multiple doctors and therapists but they get to a difficult part in the recovery and the therapist doesn’t know how to deal with it. So, the person just shuts down and ends up carrying it on and on. That’s a tragedy because there are fabulous therapists around the world. So, join us for the holistic healing fourth masterclass.
There are lots of helpful resources available to you. You can check them out at AndreaPennington.com.
- I have recently published a book, Holistic Healing. There’s also Life After Trauma. These two are compilation books of several authors who shared their stories about overcoming some Adverse Childhood Experiences and traumas.
- The Top 10 Traits of Highly Resilient People is also a group book. I’ve included myself and my story and there are several other authors who shared how their adversity has been turned into resilience and post-traumatic growth.
- Then, of course, there’s my book, The Real Self Love Handbook that includes the five-step process that I use for recovering from trauma, liberating your authentic self and creating an epic life that’s full of resilience in alignment with your values.
- Every month, I lead a live monthly coaching call with a guided meditation to help you connect with the various parts of yourself and heal. It’s on the second Tuesday of the month. It’s free and when you sign up, you also get access to past sessions. You can download my guided meditations so that you can listen to them anytime you want.
- There are also several writing prompts and journal exercises, including this one — The Three Keys to Becoming the Hero of Your Life. This is an important one because as we’re healing the body, we also have to reprogram the mind to get rid of any limiting beliefs and to install our original source code, which is you living a heroic life.
- My LifeWriting exercise is in The Real Self Love Handbook and guided meditations. It’s put together as a mini-course it’s like a taster of Stories with Soul, which is my six-week course. Get that — it’s completely free! Just visit AndreaPennington.com and then join us every month so that you can get some support and healing for free in community with a bunch of beautiful people from around the world.
- In the next masterclass on Positive Childhood Experiences, I’m going to tell you about HOPE for the future (and H-O-P-E spells out something in particular). I’m going to walk you through how you can build those top ten traits, even in the midst of a pandemic, even in the midst of chaos. The way I see it is all of us are being called to build a parachute of resilience while we’re free falling from an airplane, you know, hurtling towards the Earth. The good news is you can do it and it’s especially important if you happen to have a high ACE score meaning you’ve had experiences of trauma or adversity.
- Then our fourth masterclass in this series is all about Holistic Healing, and I’m going to share what I’ve learned in 23 years as an integrative physician and acupuncturist doing trauma recovery and addiction work. I’m going to share the framework that has worked for me and my patients and you’ll hear about the different modalities that work.
- Please, make sure that you go take the ACE quiz at In8vitality.com and you’ll be signed up then as well to get some further resources.
- On the exciting future side of things, we have a new resilience quiz coming at the beginning of June. The resilience quiz will help you find your overall resilience score so you can find out how resilient you are according to the top 10 traits of highly resilient people. It will also tell you what you can do to build up each of these ten things. So, if you enjoy having an in-depth report on yourself, that is coming.
I hope you’ve learned something new from this masterclass. Please let me know if you have any questions before the next one. For this masterclass, I wanted more people to be aware of Adverse Childhood Experiences so that we can all get the healing that we need. Healing is possible! We can recover, we can build these neural networks associated with compassion, we can use whatever happened in our lives back then or in the last year and two months of the pandemic. We can use this as a springboard towards post-traumatic growth or evolution.
We are all on this journey together — none of us is alone. So, thank you. Thank you for being here. Please know this, my friend, you’re not a lost cause. If you’ve been dealing with illnesses and other people have said, “Maybe it’s in your head,” it’s not just in your head. It’s in your body, it’s in your genes and that’s not meant to be a death sentence because there’s a lot that we can do. This first step of awakening and becoming aware is an important one on the journey.
So, just know that you have my support, you have the support of our community, and you can heal. I look forward to being a part of that healing journey. Thank you for reading this. Until next time remember that you are a gift to the world so share your presence with passion.
Much love everyone. 💜