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~	Explore the relationship between ACEs and trauma
~	Identify the impact of ACEs and traumatic injury on mental, physical and interpersonal health in adults
~	Explore risk factors for ACEs and subsequent prevention and intervention measures.

Overview of LTE of ACEs
~	Adverse childhood experiences (ACEs) are stressful or traumatic events that children experience before age 18 years. Studies have linked exposure to ACEs and negative health, and developmental and behavioral outcomes.
~	Traumatic Event: Direct or indirect exposure to an event that involved the possibility of death or serious injury 
~	Traumatic Injury: Psychological consequences sometimes experienced after a trauma.
~	61% of adults surveyed across 25 states reported that they had experienced at least one type of ACE, and nearly 1 in 6 reported they had experienced four or more types of ACEs.
~	Over 50% of adolescents have been exposed to ACEs which can have detrimental effects on learning and behavior and is associated with increased suicidal ideation in adolescents
~	68.1% of people who reported homelessness in childhood also reported experiencing four or more ACEs. Only 16.3% of people were never homeless in childhood reported experiencing four or more ACEs
~	ACEs have a different impact on the brain based upon the age of exposure, individual factors and  microsystem protective factors
~	Strongest impacts are found for younger children (ages 2-5) and those living in households with incomes below 200% of the federal poverty level
~	ACEs contribute to disturbances in cognitive and affective processing including 
~	Heightened attention toward threatening stimuli
~	Increased experience of loneliness
~	Increased HPA-Axis dysregulation / reduced impulse control
~	Functional alterations in key stress–and emotion associated brain regions particularly the anterior cingulate cortex [ACC], amygdala and hippocampus (shrinkage)
~	Initial increase in amygdala volume after ACEs, followed by a decrease in volume due to persistent distress in later life
~	These brain regions are particularly susceptible to damage from trauma/HPA-Axis hyperactivation due to the high density of glucorticoid receptors
~	Exposure to specific types of ACEs selectively affect the sensory systems which were involved in perceiving the trauma
~	Mental disorders in individuals with ACE exposure tend to have more severe symptomatology, increased risk of comorbidity and are less likely to respond to standard treatments (why?)
~	In adults, ACE exposure is associated with 
~	A wide range of physical disorders including obesity, dysregulation of the immune system, autoimmune disorders and abnormal pain perception with and without underlying causes
~	Stress itself can sensitize nociceptive neurons in the spinal cord which result in comparable changes in pain-perception and related behavior.
~	Increased levels of pro-inflammatory cytokines
~	Disruptions in intestinal microbiota and the mucosal immune system
~	200-400% increased risk of  heart disease, cancer, chronic lung disease, skeletal fractures, depression, diabetes and prediabetes,  liver disease

~	More than 60% of people have experienced ACEs
~	It is believed the rate of exposure to ACEs has increased significantly during COVID
~	Not everyone who experiences ACEs will develop traumatic injury
~	Injuries related to ACE trauma include:
~	Borderline and antisocial personality disorder
~	Mood disorders
~	Addictions
~	Autoimmune issues including IBS, Chron’s, Diabetes
~	Heart disease, cancer, chronic lung disease, liver disease
~	Increased difficulty in interpersonal relationships due to above issues
~	Increased risk to become a perpetrator of ACEs