Clinicians use a common tool to assess the extent of toxic stress a child has experienced during his or her childhood. It’s called the Adverse Childhood Experience test, or ACE for short. It’s a simple tool made up of just 10 yes or no questions. The lower the score, the better. In a meta study conducted by the U.S. Centers for Disease Control and Prevention and Kaiser Permanente, researchers tracked the health outcomes of adults based on the extent of the adverse experiences they dealt with as children. The results were alarming.
In a column discussing the research, David Brooks succinctly summarized the adult outcomes associated with higher ACE scores.
The link between childhood trauma and adult outcomes was striking. People with an ACE score of 4 were seven times more likely to be alcoholics as adults than people with an ACE score of 0. They were six times more likely to have had sex before age 15, twice as likely to be diagnosed with cancer, four times as likely to suffer emphysema. People with an ACE score above 6 were 30 times more likely to have attempted suicide.
Later research suggested that only 3 percent of students with an ACE score of 0 had learning or behavioral problems in school. Among students with an ACE score of 4 or higher, 51 percent had those problems
Answer the yes-or-no questions below to determine your or another person’s ACE score. Each yes equals one point.
1. Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? OR Act in a way that made you afraid that you might be physically hurt?
2. Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? OR Ever hit you so hard that you had marks or were injured?
3. Did an adult or person at least five years older than you ever… Touch or fondle you or have you touch their body in a sexual way? OR Attempt or actually have oral, anal, or vaginal intercourse with you?
4. Did you often or very often feel that… No one in your family loved you or thought you were important or special? OR Your family didn’t look out for each other, feel close to each other, or support each other?
5. Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? OR Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
6. Were your parents ever separated or divorced?
7. Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? OR Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? OR Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
9. Was a household member depressed or mentally ill, or did a household member attempt suicide?
10. Did a household member go to prison?
Add up your “Yes” responses. This is your ACE score. In the spirit of full disclosure. I carry a score of seven.
When you were a child, how many times were you asked, “What do you want to be when you grow up?” If you’re like any typical American, the answer is probably too high to count. It’s innocuous enough, right? In my case, the answer for most of my life was “left fielder for the Boston Red Sox.” An inability to get around a good fastball necessitated a recalibration sometime between high school and college.
Now how many times were you asked, “Whom do you want to be when you grow up?” Or, “What kind of person would you like to be?” Frankly, I can’t remember ever being asked that question until I attended a conference last year. When I heard this jarring juxtaposition, I wondered, why didn’t anyone ask me this sooner? And why wasn’t I asking this question to my own children or nephews and nieces?
In the first instance, “What do you want to be?” is a reflection of our cultural bias towards achievement and success. For right after any child answers that question with doctor, astronaut, or left fielder for the Boston Red Sox, the adult asking the question typically responds with some version of, “That’s great. Well, you keep working at it and if you work hard enough, I bet you’ll be able to do it.”
In the second instance, “Whom do you want to be?” actually reflects what we value. As Adam Grant from the University of Pennsylvania and author of Give and Take: Why Helping Others Drives Our Success writes, success is actually not the number one priority for most parents. “We’re much more concerned about our children becoming kind, compassionate, and helpful.” And his statement is supported by research, not just in the U.S., but across the globe.
So why then do we default to “What do you want to be?” instead of “Whom do you want to be?”? And more important, what would happen if we started asking the latter more than the former?