The most important thing I didn’t learn in medical school: Adverse childhood experiences



Dr. Nancy Hardt


The most important thing I didn’t learn in medical school is about adverse childhood experiences, also known as ACEs.

To be sure, if I had understood them then the way I do now, I would have been a better and more compassionate physician. Importantly, I would have avoided lots of mistakes.

What kind of mistakes, you ask?

I was pretty much a failure taking care of smokers, drinkers, drug addicts, and morbidly obese people. People who were chronically depressed or in chronic pain were not helped by me either.

I never understood that addictions to food, drugs, alcohol, and cigarettes, are imperfect solutions to the effects of toxic stress resulting from adverse childhood experiences. Toxic stress sets up pathways in the brains of traumatized children, pathways which persist into adulthood. We don’t outgrow these pathways, so as we get older, we try “home remedies” to treat them.

My mistake was to try over and over to get people to “give up” cigarettes, alcohol, pills, or overeating without addressing the reasons these things provide comfort. I was never taught that the stress receptors in our acelogo (1)brain that are soothed by these substances are set up in early childhood. Our early experiences create memories which become structural realities in our brains. To try to address chronic pain with pills simply compounds the problem by adding a new one: addiction.

I failed to find out what kind of pain people were facing.  I was not taught to ask the right questions. The ACEs questions.

Drs. Vince Felitti and Rob Anda found the connection between adverse childhood experiences and chronic illness in adults during research on insured middle class people. When I learned this, I became intrigued. Could this information help me understand health disparities better?

Indeed, it did, leading my career away from caring for one patient at a time and towards caring for people. Lots of people. A neighborhood of people, a community of people.

I learned that there is hope accompanying learning about ACEs in our community.

Resilience can overcome the effects of toxic stress. As adults, we can’t undo the early childhood trauma we experienced. But, our ability to develop resilience starts in early childhood and never goes away.

We can develop resilience in ourselves, and we can help others develop it in themselves.

In fact, if you suffered ACEs as a child and are living an adult life free of addiction and chronic illness, you have someone to thank for it. Someone helped foster your resilience.

Our understanding of ACEs and the developmental effects of them have revolutionized the way communities think about young children.  Investments in pre-school education, health care for children, and addressing behavior problems in school have been found to be not only wise but enriching. Yes, community money spent early saves enough to make a community prosper later.

A lot is happening in Gainesville and Alachua County, where I live, to avoid trauma in pre-kindergarten children and their families. Gainesville4All teams are addressing important social structures and supports for young children, Peace4Gainesville is enhancing systems understanding of adverse childhood experiences and resilience, Partnership for Strong Families is providing supports to vulnerable families, and our County Commission is poised to make significant strategic investments in preschool children.

For older children, Alachua County Schools are coordinating with law enforcement to reduce disproportionate contact of minority youth with juvenile justice, and the River Phoenix Center for Peacebuilding is fostering reconciliation and enhancing resilience in those experiencing trauma.

This month, our local papers, the Gainesville Sun and the Guardian launch a multipart series about ACEs science and how people and organizations are integrating trauma-informed and resilience-building practices based on ACEs science. Join us on this journey to learn about toxic stress and the power of resilience to overcome it.


Dr. Nancy Hardt is Professor Emerita, University of Florida College of Medicine. She was featured in an NPR story, A Sheriff and a Doctor Team Up to Map Childhood Trauma, in 2015.  

Written By Dr. Nancy Hardt

The most important thing I didn’t learn in medical school: Adverse childhood experiences was originally published @ ACEs Too High and has been syndicated with permission.


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