Adverse Childhood Experiences: Impact, Prevention, and Treatment

Home > Adverse Childhood Experiences: Impact, Prevention, and Treatment

Children’s Mental Health

Adverse Childhood Experiences: Impact, Prevention, and Treatment

THC Editorial Team October 30, 2021
Photo by Melissa Askew on Unsplash (article on adverse childhood experiences)
Photo by Melissa Askew on Unsplash

Contents

People of all socioeconomic backgrounds can experience varying levels of trauma as children. In a single year, one billion children (ages 2–17) are estimated to have been exposed to some form of trauma.1 Traumatic experiences, including abuse, neglect, parental separation, and familial violence, can have a detrimental impact on children’s emotional health. Research has also demonstrated that these events, called adverse childhood experiences (ACEs), are also linked to poorer outcomes in adulthood and the development of a variety of physical and psychological conditions.2 By understanding the potential impact of ACEs, therapists, physicians, and others in the caring professions might be able to adjust their treatment protocols to address underlying causes of distress properly.

What Are Adverse Childhood Experiences?

The term “adverse childhood experiences” was coined by researchers from the Centers for Disease Control and Prevention and Kaiser Permanente.2 Between 1995 and 1997, utilizing the ACE Study Questionnaire, the researchers surveyed more than 13,000 members of a health management organization about their current health and behavioral choices as well as their childhood experiences. They grouped ACEs into seven categories, and based on the participants’ reports, analyzed the effects of those experiences on the participants’ health status, engagement in risk-taking behaviors, and disease. They found that experiencing ACEs as children correlated with increasing negative health and disease outcomes as adults. Adults who had experienced a greater number of ACEs as children had a significantly increased risk of health-related conditions when they were older.2

ACEs include different types of trauma that children might face within their homes before reaching the age of 18. Since the original study, many other studies have found that experiencing several ACEs can have a detrimental impact on the health and well-being of individuals when they become adults.3 One study of more than 48,000 adults found a strong relationship between ACEs and early morbidity factors; specifically, the study revealed an increased relationship between risky health choices and people who had experienced four or more ACEs in childhood.4

ACEs are estimated to affect 20% to 50% of all adults.5

What Are Some Types of Adverse Childhood Experiences?

In the original ACE Study Questionnaire, questions were categorized into the following types of adverse experiences:

  • psychological abuse
  • physical abuse
  • sexual abuse
  • violence against mother
  • living with household members who were:
    • substance abusers
    • mentally ill or suicidal
    • imprisoned

Affirmative responses to one or more questions in a category qualified as exposure to that particular ACE category.2

According to a recent analysis, the more ACEs a person experiences as a child, the likelier that he or she will engage in risky behavior and experience poor health outcomes and disease in adulthood.1

How Do Adverse Childhood Experiences Potentially Impact a Person’s Health?

ACEs are thought to affect a person’s health status by contributing to the development of health conditions and diseases primarily through two factors:6

  • the long-term effects of various coping mechanisms a person utilizes as a result of ACE exposure, including smoking, overeating, substance abuse, and risky sexual behaviors
  • prolonged exposure to toxic stress, causing the release of “chronic hypercortisolemia and proinflammatory cytokines”

What Are the Potential Impacts of Experiencing Adverse Childhood Experiences on a Person’s Life?

Numerous studies have found that people who have experienced multiple ACEs as children are likelier to experience a variety of diseases and poor health outcomes as adults.1

Some of the potential negative impacts of ACEs include increased risks for the following conditions:

  • premature mortality7
  • depression8
  • anxiety
  • alcohol abuse9
  • substance abuse
  • obesity10
  • chronic obstructive pulmonary disease (COPD)11
  • behavioral problems10
  • learning difficulties10
  • lower levels of adult education and employment12
  • adult homelessness13
  • adult criminality14
  • frequent headaches in adults15
  • risky sexual behavior16
  • adolescent violence17
  • sleep disturbances18
  • increased hallucinations independent of substance use19
  • attention-deficit/hyperactivity disorder in adolescence20

A recent study found an increasing, graded relationship between experiencing four or more ACEs and developing cardiovascular disease, depression, arthritis, COPD, and asthma. The researchers, who reviewed data from people across 14 U.S. states, found less correlation between experiencing four or more ACEs and diabetes or cancer.21

Another study found that ACEs were linked to experiencing early-onset chronic disease in young adulthood. The researchers looked at data from the Behavioral Risk Factor Surveillance System of 89,968 people from nine states from 2011 to 2012. They found that young adults with four or more reported ACEs were two to four times likelier to have early-onset cardiovascular disease, COPD, depression, cancer, prediabetes, or diabetes than their peers with no reported ACEs. They also found that the youngest respondents were the likeliest to report experiencing four or more ACEs.11

ACEs have also been linked with diminished mental well-being and increased mental illness among people in prison. In a study of incarcerated people in the U.K., researchers found that 84.2% had experienced at least one ACE, and 45.5% had experienced four or more ACEs. Prisoners who had experienced four or more ACEs were four times likelier to report mental health diagnoses and suicide attempts and 10 times likelier to report incidents of self-harm than those who reported experiencing no ACEs.22

What Are Potentially Effective Treatments for Adverse Childhood Experiences?

Treating individuals who have experienced ACEs may include some of the following methods:

One study, using data from the 2011–12 National Survey of Children’s Health, assessed associations between ACEs and children’s development and lifelong health. They concluded that building resilience, which they defined as “staying calm and in control when faced with a challenge,” was associated with greater school engagement in children aged 6 to 17 years. They also noted that children who received care in a “family-centered medical home” demonstrated more resilience.24

A comprehensive analysis of systematic reviews published in 2020 found that the most effective psychotherapeutic approach for treating people who have experienced ACEs is cognitive-behavioral therapy rather than broad support interventions, parental training, or other psychotherapeutic approaches. They found that psychodynamic therapy, family therapy, and motivational interviewing were not effective. However, cognitive-behavioral therapy demonstrated an improvement in mental health outcomes for people who had experienced childhood trauma.31 The researchers also found that there are substantial gaps in the research on effective interventions for exposure to ACEs.

Health care providers are encouraged to use a trauma-informed care approach to treating people with ACEs, to recognize that adults with certain types of diseases may have experienced ACEs as children, and to conduct trauma-informed interviews to identify these types of experiences in childhood. Mind-body techniques, including mindfulness, relaxation techniques, biofeedback, and guided imagery, can then be used to help people address toxic stress from ACEs that may be impacting their health and behavioral choices as adults.32

Summary/Key Takeaways

According to Vincent Felitti, one of the original ACE study’s authors, “…what happens in childhood—like a child’s footprints in wet cement—commonly lasts throughout life. . . . Time does not heal; time conceals.”6

Many people have experienced ACEs as children. Exposure to ACEs increases the likelihood of risk-taking behavior, mental health conditions, substance abuse, and the development of chronic disease. Addressing childhood trauma through therapeutic methods might help people make healthier choices and heal from their traumatic experiences.

References

  1. Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., Jones, L., & Dunne, M. P. (2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet. Public health, 2(8), e356–e366.
    https://doi.org/10.1016/S2468-2667(17)30118-4
  2. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.
    https://doi.org/10.1016/S0749-3797(98)00017-8
  3. Boullier, M., & Blair, M. (2018). Adverse childhood experiences. Paediatrics and Child Health, 28(3), 132–137.
    https://doi.org/10.1016/j.paed.2017.12.008.
  4. Campbell, J. A., Walker, R. J., & Egede, L. E. (2016). Associations between adverse childhood experiences, high-risk behaviors, and morbidity in adulthood. American Journal of Preventive Medicine, 50(3), 344–352.
    https://doi.org/10.1016/j.amepre.2015.07.022
  5. Tink, W., Tink, J. C., Turin, T. C., & Kelly, M. (2017). Adverse childhood experiences: Survey of resident practice, knowledge, and attitude. Family medicine, 49(1), 7–13.
  6. Felitti, V. J. (2009). Adverse childhood experiences and adult health. Academic Pediatrics, 9(3), 131–132.
    https://doi.org/10.1016/j.acap.2009.03.001
  7. Brown, D. W., Anda, R. F., Tiemeier, H., Felitti, V. J., Edwards, V. J., Croft, J. B., & Giles, W. H. (2009). Adverse childhood experiences and the risk of premature mortality. American Journal of Preventive Medicine, 37(5), 389–396.
    https://doi.org/10.1016/j.amepre.2009.06.021
  8. Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R., Edwards, V. J., & Anda, R. F. (2004). Adverse childhood experiences and the risk of depressive disorders in adulthood. Journal of Affective Disorders, 82(2), 217–225.
    https://doi.org/10.1016/j.jad.2003.12.013
  9. Dube, S. R., Anda, R. F., Felitti, V. J., Edwards, V. J., & Croft, J. B. (2002). Adverse childhood experiences and personal alcohol abuse as an adult. Addictive Behaviors, 27(5), 713–725.
    https://doi.org/10.1016/s0306-4603(01)00204-0
  10. Burke, N. J., Hellman, J. L., Scott, B. G., Weems, C. F., & Carrion, V. G. (2011). The impact of adverse childhood experiences on an urban pediatric population. Child Abuse & Neglect, 35(6), 408–413.
    https://doi.org/10.1016/j.chiabu.2011.02.006
  11. Sonu, S., Post, S., & Feinglass, J. (2019). Adverse childhood experiences and the onset of chronic disease in young adulthood. Preventive Medicine, 123, 163–170.
    https://doi.org/10.1016/j.ypmed.2019.03.032
  12. Metzler, M., Merrick, M. T., Klevens, J., Ports, K. A., & Ford, D. C. (2017). Adverse childhood experiences and life opportunities: Shifting the narrative. Children and Youth Services Review, 72, 141–149.
    https://doi.org/10.1016/j.childyouth.2016.10.021
  13. Herman, D. B., Susser, E. S., Struening, E. L., & Link, B. L. (1997). Adverse childhood experiences: Are they risk factors for adult homelessness? American Journal of Public Health, 87(2), 249–255.
    https://doi.org/10.2105/AJPH.87.2.249
  14. Reavis, J. A., Looman, J., Franco, K. A., & Rojas, B. (2013). Adverse childhood experiences and adult criminality: How long must we live before we possess our own lives? The Permanente Journal, 17(2), 44–48.
    https://doi.org/10.7812/TPP/12-072
  15. Anda, R., Tietjen, G., Schulman, E., Felitti, V., & Croft, J. (2010). Adverse childhood experiences and frequent headaches in adults. Headache, 50(9), 1473–1481.
    https://doi.org/10.1111/j.1526-4610.2010.01756.x
  16. Hillis, S. D., Anda, R. F., Felitti, V. J., & Marchbanks, P. A. (2001). Adverse childhood experiences and sexual risk behaviors in women: a retrospective cohort study. Family Planning Perspectives, 33(5), 206–211.
  17. Duke, N. N., Pettingell, S. L., McMorris, B. J., & Borowsky, I. W. (2010). Adolescent violence perpetration: Associations with multiple types of adverse childhood experiences. Pediatrics, 125(4), e778–e786.
    https://doi.org/10.1542/peds.2009-0597
  18. Chapman, D. P., Wheaton, A. G., Anda, R. F., Croft, J. B., Edwards, V. J., Liu, Y., Sturgis, S. L., & Perry, G. S. (2011). Adverse childhood experiences and sleep disturbances in adults. Sleep Medicine, 12(8), 773–779.
    https://doi.org/10.1016/j.sleep.2011.03.013
  19. Whitfield, C. L., Dube, S. R., Felitti, V. J., & Anda, R. F. (2005). Adverse Childhood Experiences and Hallucinations. Child Abuse & Neglect, 29(7), 797–810.
    https://doi.org/10.1016/j.chiabu.2005.01.004
  20. Hunt, T., Slack, K. S., & Berger, L. M. (2017). Adverse childhood experiences and behavioral problems in middle childhood. Child Abuse & Neglect, 67, 391–402.
    https://doi.org/10.1016/j.chiabu.2016.11.005
  21. Waehrer, G. M., Miller, T. R., Silverio-Marques, S. C., Oh, D. L., & Harris, N. D. (2020). Disease burden of adverse childhood experiences across 14 states. PLoS ONE, 15(1).
    https://doi.org/10.1371/journal.pone.0226134
  22. Ford, K., Bellis, M. A., Hughes, K., Barton, E. R., & Newbury, A. (2020). Adverse childhood experiences: A retrospective study to understand their associations with lifetime mental health diagnosis, self-harm or suicide attempt, and current low mental wellbeing in a male Welsh prison population. Health & Justice, 8(1), 13.
    https://doi.org/10.1186/s40352-020-00115-5
  23. Sciaraffa, M. A., Zeanah, P. D., & Zeanah, C. H. (2018). Understanding and promoting resilience in the context of adverse childhood experiences. Early Childhood Education Journal, 46(3), 343–353.
    https://doi.org/10.1007/s10643-017-0869-3
  24. Bethell, C. D., Newacheck, P., Hawes, E., & Halfon, N. (2014). Adverse childhood experiences: Assessing the impact on health and school engagement and the mitigating role of resilience. Health affairs (Project Hope), 33(12), 2106–2115.
    https://doi.org/10.1377/hlthaff.2014.0914
  25. Oral, R., Ramirez, M., Coohey, C., Nakada, S., Walz, A., Kuntz, A., Benoit, J., & Peek-Asa, C. (2016). Adverse childhood experiences and trauma informed care: The future of health care. Pediatric Research, 79(1–2), 227–233.
    https://doi.org/10.1038/pr.2015.197
  26. Haas, S. C., & Ray, D. C. (2020). Child-centered play therapy with children affected by adverse childhood experiences: A single-case design. International Journal of Play Therapy, 29(4), 223–236.
    https://doi.org/10.1037/pla0000135
  27. Craig, E. A., Nieforth, L. & Rosenfeld, C. (2020). Communicating resilience among adolescents with adverse childhood experiences (ACEs) through equine assisted psychotherapy (EAP). Western Journal of Communication, 84(4), 400–418.
    https://doi.org/10.1080/10570314.2020.1754451
  28. Hahusseau, S., Baracat, B., Lebey, T., Laudebat, L., Valdez, Z., & Delorme, A. (2020). Heart rate variability biofeedback intero-nociceptive emotion exposure therapy for adverse childhood experiences. F1000Research.
    https://doi.org/10.12688/f1000research.20776.1.
  29. Korotana, L. M., Dobson, K. S., Pusch, D., & Josephson, T. (2016). A review of primary care interventions to improve health outcomes in adult survivors of adverse childhood experiences. Clinical Psychology Review, 46, 59–90.
    https://doi.org/10.1016/j.cpr.2016.04.007
  30. Touloumakos, A. K., & Barrable, A. (2020). Adverse childhood experiences: The protective and therapeutic potential of nature. Frontiers in Psychology, 11, 597935.
    https://doi.org/10.3389/fpsyg.2020.597935
  31. Lorenc, T., Lester, S., Sutcliffe, K., Stansfield, C., & Thomas, J. (2020). Interventions to support people exposed to adverse childhood experiences: Systematic review of systematic reviews. BMC Public Health, 20(1), 657.
    https://doi.org/10.1186/s12889-020-08789-0
  32. Ranjbar, N., & Erb, M. (2019). Adverse childhood experiences and trauma-informed care in rehabilitation clinical practice. Archives of Rehabilitation Research and Clinical Translation, 1(1–2), 100003.
    https://doi.org/10.1016/j.arrct.2019.100003

Related Articles

Related Quotes

Related Books & Audios

ADVERTISEMENT


Explore Topics

ADVERTISEMENT


Subscribe to our mailing list.