al. 2004). The purpose of the study was to examine the impact of exposure to toxic levels of stress across the lifespan. So far, this is the largest study of its kind to examine the long-term health and social effects of adverse childhood experiences and included almost 18,000 participants. The researchers asked these willing participants-all who were members of the Kaiser HMO in San Diego-if they would take a survey. The majority of those who participated were Caucasian, fifty years of age or older, and were well-educated, representing a solidly white, middle-class population. An adversity score or "ACEs" score was calculated by simply adding up the number of categories of exposure to a variety of childhood adversities that the person had experienced before the age of eighteen. These categories included: severe physical or emotional abuse; contact sexual abuse; severe emotional or physical neglect; living as a child with a household member who was: mentally ill, imprisoned, a substance abuser; or living with your mother who was being victimized by domestic violence; or parental separation/divorce. So, for example a client comes for treatment or for some kind of help, and you find out that she was sexually abused by an uncle as a child, her parents were divorced, her mother was hospitalized for depression, and her father drank heavily and used drugs. Her ACE score would be at least "4"-one each for sexual abuse, parental divorce, mental illness in her mother and substance abuse in her father. Or, a client tells you that his father spent time in prison when he was growing up, his mother was a drug addict and neglected him, and his stepfather beat him. His ACE score would be five-score 1 for living with someone as a child who was in prison, another for his mother's drug addiction, one each for emotional and physical neglect, and one for physical abuse. Of this largely white, middle-class, older population, almost two-thirds of the participants had an ACEs score of one or more, while one in five was exposed to three or more categories of adverse childhood experience (Centers for Disease Control and Prevention 2006). Two-thirds of the women in the study reported at least one childhood experience involving abuse, violence or family strife. Once they had gathered this data, the researchers compared the ACEs score to each person's medical, mental health, and social health data. What they found was startling and very disturbing. The higher the ACE score, the more likely a person was to suffer
