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Frank W. Putnam, MD
Professor of Pediatrics & Child Psychiatry
Mayerson Center, Cincinnati Childrens Hospital
Perniciousness of ACEs
Major contributors to the leading causes of death and disability
Life-shortening (~20 years for people with 6+ ACEs)
Persistence of ACES
Life-time effects
Likelihood of intergenerational transmission
OhioCanDo4Kids.Org
N=5692
19 DSM-IV Diagnoses
3
Males
Males
2.5
2
Females
1.5
Females
1
.5
CRS
mean
se
0.76
0.04
1095
1.24
0.09
606
1.71
0.13
2.68
0.27
185
4+
3.37
0.25
171
0.72
0.03
1352
0.50
0.06
850
1.74
0.12
2.25
0.16
302
4+
3.28
0.22
353
0
0
1
2
3
Cumulative Risk Score (CRS)
4+
Putnam,Harris,Putnam
unpublisheddata,2011
325
453
CRS = 1
Moderate
Large
Neurological
CRS = 2
Musculoskeletal
Respiratory
Cardiovascular
Gastrointestinal
CRS = 3
CRS 4
4 DSM Categories
Metabolic
3 DSM Categories
2 DSM Categories
Autoimmune
1 DSM Category
No DSM Diagnosis
General Health
0
N=5692
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
OhioCanDo4Kids.Org
AdverseChildhoodExperiences
Abuse andNeglect (e.g.,psychological,physical,sexual)
HouseholdDysfunction (e.g.,domesticviolence,substanceabuse,mentalillness)
ImpactonChildDevelopment
NeurobiologicEffects (e.g.,brainabnormalities,stresshormonedysregulation,physical
developmt)
PsychosocialEffects (e.g.,poorattachment,poorsocialization,poorselfefficacy,revictimization)
HealthRiskBehaviors (e.g.,smoking,obesity,substanceabuse,promiscuity)
DiseaseandDisability
LongTermConsequences
SocialProblems
MajorDepression,Suicide,PTSD
DrugandAlcoholAbuse
HeartDisease
Cancer
ChronicLungDisease
SexuallyTransmittedDiseases
Intergenerationaltransmissionofabuse
OhioCanDo4Kids.Org
Homelessness
Prostitution
CriminalBehavior
Unemployment
Parentingproblems
Highutilizationofhealthandsocialservices
Data:www.AceStudy.org,www.nasmhpd.org
Number of Positive
Childhood Experiences and
Percent of Women with
Elevated CES-D Scores
Beyond ACEs
Link ACEs to existing and future programs
seeking to prevent mental illness, medical
diseases, health risk behaviors, and social
dysfunction
Prevent ACEs
Zero ACEs
Prevent further ACEs in maltreatment victims