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Craig Mastantuono Sept. 23, 2019

"When you were a child, did a parent often push, slap, grab, or throw something at you?"

Questions like this seek to find out how much trauma a person experienced as a child. At the bottom of this piece are the 10 Questions of the Adverse Childhood Experience (ACE) Questionnaire. According to the Center for Disease Control, the Kaiser-ACE study is one of the largest investigations ever conducted on childhood abuse and neglect and later-life health and well-being. The ACE Study found that childhood trauma affects the physiology of the brain, and revealed a graded relationship between high ACE results and negative health/well-being outcomes. In other words, as the number of ACEs increases so does the risk for detrimental health and life outcomes. No surprise.

At M&C Law, we've been administering the ACE Questionnaire to some of our clients in preparation for sentencing hearings. We let judges know the ACE outcome and the implications of the high number of positive answers our clients give (typically scoring higher than 6, often 8, 9, and 10), which reflects a lot of childhood trauma. This information is not presented as an excuse for violating the law, but rather to inform the difficult decision-making and presumptions that are involved in determining an appropriate criminal sentence. Research indicates that higher ACE scores pose higher risks of health, social and emotional problems, including depression, anxiety, and addiction. Our clients often present with mental health and addiction issues, suffering from depression/anxiety, and sometimes having smoked marijuana or used other drugs daily since their early teen years. For example, it is not unusual for clients to come to us in their 20's, having gotten high multiple times daily for more than 15 years straight, and frequently using other substances like opioid-based pills or codeine-syrup-based street concoctions like Lean and Purple Drank. It is common for people who are facing prison for selling drugs to also suffer from such drug abuse and addiction, untreated, and largely ignored by a reactionary criminal justice system. We refer these clients for treatment while the case is pending and we counsel the benefits of sobriety and mental health. When things go well, we see them become clean for the first time ever in their adult lives, in treatment for their mental health, and employed at legitimate jobs. The transformation can be remarkable and inspiring, and supports a later recommendation for a community-based sentence instead of prison. 

Experience tells us that people who resort to daily drug use during their teens are often trying to suppress feeling any emotions at all, typically tied to trauma in their past. Put more simply, chronic daily drug use in a young person is an atypical response to an atypical or traumatic childhood, marked by neglect, abuse, mental health and addiction issues by adult caregivers. Numbing that pain by avoiding feelings is a common and understandable reaction. ACE questions focus on identifying that trauma with specificity. At sentencing hearings, we present that information to strengthen the evidence-based action plan for an appropriate sentence recommendation. What is the goal of the sentence in each case? Is incarceration necessary and for how long? How can long-term rehabilitative needs be met? Is a community-based sentence or a prison-based sentence the best approach? These are the tough questions at a sentencing hearing, and we want our judges to have data and information with our recommendations rather than just rhetoric and arguments.

On the other side of the aisle, prosecutors typically focus on incarceration and punishment in a rationale-based argument: "he made the choice to do this, he needs to be punished, and then he'll learn." While emotionally appealing in its simplicity, this argument fails to address the root cause of the problems and the terribly limited positive choices many of our clients face after a life marked by trauma. The causes of crime and how to effectively intervene in criminal behavior are rarely as simple as a rational cause/effect exercise. The ACE process reveals in straight-forward graphic ways what we already know: that the people we represent often grow up being hit, hungry, without positive parentlng, and in a chaotic and strained childhood environment, one that presents too many options for making criminal choices daily in their teenage years. Their brain functioning and health is impacted by this upbringing, and can greatly increase at-risk behavior and poor decisions.

We can't incarcerate our way out of this; criminal sentences need to be much more evidence-based and sensitive to prior trauma in order to be effective. If we can reach the underlying causes of criminal behavior with combination of supervision, incarceration and habilitation programs that work, long-term intervention is achieved, and we're all safer. This isn't a knee-jerk response, it doesn't make headlines, it may not be emotionally satisfying, and some judges may see it as politically risky, but it works. 

The results of our presenting ACE outcomes are mixed so far. Some judges are a more patient and receptive audience for this information than others. Some judges put more into their decision-making than others. Our challenge is to provide the information in a way that makes judges see its relevance and want use it in their sentencing decsions and remarks.

We take great care to build trust with clients, working our way into the ACE questionnaire slowly over time, with the client's informed consent. Despite this, we've had many clients start the ACE interview in a normal state and end it sobbing, clearly the first time they've ever had someone even ask about these things, let alone help them get counseling. It's astonishing to see the reactions, often from people that are being prosecuted for serious criminal charges. As we reveal these results, experiences, and recommendations to judges, we're connecting more frequently with a thoughtful process at our sentencing hearings.  

Take a good look at the ACE questions below, and imagine answering 'yes' to 5, 6, 7, or more of them. Then think about growing up in a household and neighborhood environment where ACE scores this high are normal. The societal costs of traumatic experiences on children and young people are untold. 


Adverse Childhood Experience (ACE) Questionnaire - Finding your ACE Score

While you were growing up, during your first 18 years of life:

1. Did a parent or other adult in the household 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 … 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 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Try to or actually have oral, anal, or vaginal sex with you?

4. Did you 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 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 pushed, grabbed, slapped, or had something thrown at her? or Sometimes or 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?

More information on the CDC-Kaiser ACE Study at the Center for Disease Control website: