Adverse Childhood Experiences

Adverse Childhood Experiences

Although adverse childhood experiences (ACEs) increase a person’s risk of certain health conditions and behaviors in adulthood, they do not guarantee them. With support, children who face adverse events can learn to manage their experiences and lead meaningful lives.

Table Of Contents


What Are Adverse Childhood Experiences?

According to the Mind Journal, adverse childhood experiences (ACEs) refer to a series of traumatic events that occur during childhood. Such traumatic or negative events in a child’s life tend to leave a significant impact into the adulthood years in regards to the person’s physical, emotional, and mental health that stays for the rest of his/her life. A 2019 study 1 explains “Adverse childhood experiences (ACEs) are potentially traumatic events that can have negative and persistent effects on health later in life.” The researchers explain that such experiences may include physical, psychological and sexual abuse, alongwith “household dysfunction, such as substance abuse, mental illness, and violence.”

Another 2018 study 2 found that ACEs resulting from neglect and physical or sexual abuse are common in children and include “a massive stressor” with long-term negative effects on mental, emotional and physical well-being. The study adds “In adulthood, the history of ACE can result in complex clinical profiles with several co-occurring mental and somatic disorders such as posttraumatic stress disorder, depression, borderline personality disorder, obesity and diabetes.”

Understanding Adverse Childhood Experiences

The World Health Organization (WHO) explains that adverse childhood experiences refer to some of the most “intensive and frequently occurring sources of stress that children may suffer early in life.” Such traumatic experiences are defined by recurring abusive events, like –

  • Neglect, violence between parents or caregivers
  • Other serious household dysfunction
  • Alcohol and substance abuse
  • Peer, community or collective violence

WHO also states that ”considerable and prolonged stress” in childhood leaves life-long consequences in terms of a person’s health and well-being. ACE can disrupt the brain development process at a young age, as a result, compromising the functions of the nervous and immune systems. Additionally, the stress that comes with adverse childhood experience can also lead to serious problems such as depression, alcoholism, eating disorders, HIV/AIDs, unsafe sexual behavior, heart disease, cancer, and other chronic diseases.

The popular CDC-Kaiser ACE Study consists of an ACE pyramid that portrays the mechanism by which adverse childhood experiences influence health and well-being throughout the patient’s life. This mechanism is defined by the following order:

Generational embodiment/historical trauma–>Social conditions/local context–>Adverse Childhood Experiences(ACE)–>Dirturbed Neurodevelopment–> Social, emotional & cognitive damage–> Adoption of health risk behavior–>Disease, disability & social problems–> Early death.

This sequence uncovers how adverse childhood experiences are strongly related to the development of risk factors associated with diseases, and well-being throughout an individual’s life courses.

Prevalence Of Adverse Childhood Experiences

In 2014, the World Health Organization had conducted a survey in Russia to evaluate the prevalence of ACE. In that survey, 1580 students in higher education institutions and colleges were tested. As per the results, the prevalence of child maltreatment in this survey was found to be high –

  • Sexual abuse was 5.7%
  • Physical abuse was 14%
  • Emotional abuse was 37.9%
  • Emotional neglect was 57.9%

Household dysfunction was also prevalent, and among these, 11.1% observed their mother being treated violently. Adverse childhood experiences were common and 84.6% reported at least one. Respondents most often faced two such experiences (28.2%), and as many as 17.5% reported at least four or more such experiences. According to a 2016 study 3 , the prevalence of adverse childhood experiences was surveyed in adolescents of a Brazilian birth followed by associations between ACEs and sociodemographic factors.The study found that the most common ACE was parental separation (42%). This was followed by emotional neglect (19.7%) and domestic violence (10.3%). Approximately 85% of the adolescents experienced at least one ACE, and females reported a higher number of adversities.

According to the CDC-Kaiser ACE study, a survey among 17,337 individuals was conducted. Among these, the following was observed –

  • Emotional abuse accounted for 10.6%
  • Physical abuse accounted for 28.3%
  • Sexual abuse accounted for 20.7%
  • Abusive treatment from mother accounted for 12.7%
  • Substance abuse accounted for 26.9%
  • Mental illness accounted for 19.4%
  • Parental separation or divorce accounted for 23.3%
  • Incarcerated household member accounted for 4.7%
  • Emotional neglect accounted for 14.8%
  • Physical neglect accounted for 9.9%

ACE Questionnaire

To measure the prevalence of adverse childhood experiences worldwide, the ACE International Questionnaire (ACE-IQ) is designed, which also measures the risk behaviors later in life. The questionnaire is designed to evaluate people 18 years and above. The questions mainly cover areas associated with family dysfunction, physical, sexual, and emotional abuse and negligence by parents or caregivers, peer violence, witnessing community violence, and exposure to collective violence. Findings from ACE-IQ surveys are of potential value in supporting the increased investments to reduce childhood adversities and to evaluate the design of prevention programs.

Types Of Adverse Childhood Experiences

Adverse Childhood Experiences (ACEs) are classified into three groups- abuse, neglect, and household challenges. Each category is further divided into multiple subcategories. The subcategories are as follows.

1. Abuse

This section consists of the adverse childhood experiences as mentioned below.

A. Emotional Abuse

Emotional abuse type of ACE occurs when a parent, step-parent, or an adult living in a home constantly criticizes, swears at or insults a child, puts him/her down, or acts in a way to make a child feel afraid, resulting in physical injury.

B. Physical Abuse

This type of ACE occurs when a parent, a stepparent, or an adult living in the home pushes, slaps, grabs, or throws something at the child to hit him/her hard enough to leave injury marks and bruises.

C. Sexual Abuse

When an adult, a relative, family friend, or a stranger, who is at least 5 years older than the child or adolescent, touches or fondles with the child’s/adolescent’s body or makes a child/adolescent sexually touch his/her body with an attempt to have any type of sexual intercourse results in sexual abuse type of ACE.

2. Household Challenges

The household challenge(s) of adverse childhood category consists of the following subtypes:

A. Treating Mother Violently

When a child/adolescent’s mother or stepmother is treated roughly in form of pushing, grabbing, slapping, throwing something at her, kicking or biting her, hitting with a fist, or ever threatening or hurting her by a knife or gun by the father (or stepfather) or mother’s boyfriend, may give rise to this type of ACE.

B. Substance Abuse in the Household

This type of adverse childhood experience is defined by a situation when a family member happens to be a problem drinker or alcoholic or when a household member uses street drugs.

C. Mental Illness in the Household

This type of household ACE challenge occurs when a household member is depressed or mentally ill or a household member attempts suicide.

D. Parental Separation or Divorce

When a household situation leads to separation or divorce between the parents, a household ACE challenge occurs.

E. Incarcerated Household Member

This subtype is defined by a situation when a household member goes to prison.

3. Neglect/Negligence

This section consists of the following types of adverse childhood experiences as mentioned below –

A. Emotional Negligence

Emotional negligence is felt by a child with the sudden change of situation or atmosphere within the family. A child or an adolescent may feel emotionally neglected if he/she lacks the emotion of feeling cared for or the special, quite contrary to the earlier situation in the family.

B. Physical Negligence

When there was someone to take care of the child or the teenager, protect him/her, and take him/her to the doctor unlike the present situation when the child/teenager didn’t have enough to eat, parents were too drunk or too high to take care of him/her, and when the child/teenager had to wear dirty clothes, this type of ACE occurs.

Causes Of Adverse Childhood Experiences

According to a 1991 study 4 , childhood psychic trauma appears to be a crucial etiological factor in the manifestation of a number of serious disorders both in childhood and in adulthood. The study states, ”like childhood rheumatic fever, psychic trauma sets a number of different problems into motion, any of which may lead to a definable mental condition.” The researchers recommend four aspects related to childhood trauma that appear to last for long periods of life, no matter what diagnosis the patient eventually receives. These are envisioned or otherwise repeatedly observed as –

  • Memories of the traumatic event
  • Repetitive behaviors
  • Trauma-specific fears, and
  • Changed attitudes about people, life, and the future

Another 2013 study 5 states that most traumatic experiences in children and adolescents occur in their immediate social environment. Families with ignored, ill-treated or abused children often carry a number of additional risk factors, such as mental disorders in parents, poverty, cramped living conditions, or social isolation. Moreover, childhood traumatization results in a notably higher risk of suffering from other ordeals in adult life.

The study states that ”repeated traumatized patients tend to display a typical pattern of successive disorders, i.e., regulatory disorder during infancy, attachment disorders with or without disinhibition at preschool age, hyperkinetic conduct disorder at school age, or combined conduct and emotional disorders during adolescence”. In later years, personality disorders are common and often followed by substance abuse, self-harm, and affective disorders.

Effects Of Adverse Childhood Experiences

Adverse childhood experiences are potentially problematic issues because children are particularly exposed and weak to the effects of trauma. At this stage, a child’s brain is still developing and trauma can disrupt normal brain development. A 2012 study 6 states that ACEs can induce critical biological changes in children (biological embedding), thus modifying the maturation and the operating balance of allostatic systems. The chronic activation can lead to progressive wear and tear, resulting in long-term effects on biological aging and health.

The continued stress from Adverse Childhood Experiences can affect:

  • Attention
  • Decision making
  • Learning
  • Stress management

While childhood trauma increases the risk of the effects of future trauma, a study mentions that individuals can also ”pass on” these effects to their children. Research 7 has linked adverse childhood experiences to various negative health effects such as physical health issues, psychological conditions, risky behaviors, developmental disruption, increased use of healthcare services. Furthermore, the condition can also have other indications, such as problems with education, work, and relationships. The more such childhood experiences, the higher their risk of negative outcomes.

The consequences of ACEs can be divided into the following categories.

1. Physical Health Problems

ACEs increase the risk of physical health problems, such as:

  • Cancer
  • Maternal and child health problems
  • Heart disease
  • Diabetes
  • Injury
  • Sexually transmitted infections (STIs)

According to a 2018 study 8 , ACEs also increases the risk of obesity and poor outcomes following weight-loss efforts. ACEs are also connected with addictive behaviors and, potentially, food addiction (FA). 19.2% of those seeking bariatric surgery had reported being the victim of childhood sexual abuse, and 22.1% had stated being the victim of childhood physical abuse. An elevated ACE score resembled the increased likelihood of screening positive for FA and more critical FA.

2. Mental Health Issues

Children who experience ACEs may go on to develop mental health issues, such as:

  • Depression
  • Anxiety
  • Post-traumatic stress disorder (PTSD)
  • Substance use disorder
  • Suicidal behaviors or tendency for self-injury
  • Addictive behaviors, including food addiction

3. Personal Issues

Individuals suffering from ACEs may also suffer from other challenges in their lives such as:

  • Being a perpetrator of violence or being subject to it
  • Issues relating to education and job opportunities
  • Involvement in sex trafficking 9
  • Teen pregnancy

A study says that the century in the United States had begun with infectious diseases, controlling the top ten causes of death. This has resulted in life expectancy under 50 years of age and infant mortality rates between 100 and 150 deaths per 1,000 live births. Forty percent of deaths were due to 3 factors alone, namely tobacco, diet, and alcohol.

As per another study, adverse childhood experiences are related to premature mortality as well. In men, the risk of death estimated before the age of 50 is about 57% higher among those who experienced two or more ACEs compared to those who experienced none. In women, the risk is 80% higher. Additionally, an English study had suggested that the effects of this condition are associated with the following prevalence –

  • 12% of binge drinking
  • 14% of poor diet
  • 23% of smoking
  • 52% of violence perpetration
  • 59% of heroin/crack cocaine use
  • 38% of unintended teenage pregnancy

Thus, this indicates creating a clear need for prevention- for personal, societal and economic reasons.

Prevention Of Adverse Childhood Experiences

While adverse childhood experiences deserve more awareness, it is completely possible to prevent many instances pertaining to this condition. For instance, taking care of social inequalities may help as people suffering from acute deprivation, falling under lower economic strata are more likely to experience ACEs. However, it occurs in all areas of society.

Here are some strategies that may help prevent adverse childhood experiences. These are as follows.

  • Increasing economic supports to families
  • Developing social norms that will provide protection against violence and adversity
  • Ensuring an influential start to a child’s life
  • Teaching skills to parents, caregivers, children, and families
  • Enabling youths to connect with caring adults and activities
  • Taking steps to lessen both immediate and long-term harm

A 2017 article 10 demonstrates the Health Outcome from the Positive Experiences (HOPE) framework to prevent toxic stress. The study explains that positive childhood experiences fall into four broad categories as follows.

  • Being in nurturing, supportive relationships
  • Living, growing, playing, and learning in secure, stable, protective, and equitable environments
  • Getting opportunities for effective social engagement and developing a sense of connectedness
  • Learning social and emotional competencies

Additionally, resilience is a powerful antidote to fight the effects of adverse childhood experiences. It is a positive adaptation within the context of significant adversity. It is the result of a dynamic set of communications between the affected person and his or her protective factors. This communication is the main determining factor of the developmental path towards health and well-being or towards illness and dysfunction. No child is automatically resilient or invulnerable to ACEs, just as no individual child is automatically doomed in the face of ACEs. The protective factors can include a person’s own biological and developmental characteristics. However, it can also include characteristics of the family, community, and systems that decrease the negative impacts of ACEs.

Protective factors help explain how some people who have maintained a great deal of adversity as children have fared relatively well in adulthood.

1. Childhood Protective Factors

A 2017 study had found that the presence of supportive friends, engagement with their society, relying on someone, and other such sources of resilience in childhood has reduced mental illness in adults with four or more ACEs from 29% to 14%. Adults who admitted having childhood protective factors reported a reduced rate of suicidal thoughts and self-harming of 19% versus those without protective factors, who reported 39%.

2. Therapeutic Treatment

A study states that there are several evidence-based, effective clinical treatments to treat children who have experienced trauma and adversity, including Trauma-Focused Cognitive-Behavioral Therapy and Parent-Child Interactive Therapy. Each of these programs involves attention to parenting ability and works on building behaviors that promote resilience in the child and parent. Proactive initiatives like home visiting programs for high-risk families, though not widely disseminated, have incredible promise for the preventing or lessening of parent- and environment-mediated ACEs, particularly because they are focused on critical periods in human development, prenatal through the first 2 to 3 years of life.

With Growing Awareness, Comes Hope

The presence of protective factors, ensuring safe, stable, and nurturing relationships, can often reduce the consequences of ACEs. Individuals, families, and communities together influence the development of many protective factors throughout a child’s life, thereby positively impacting his or her development.

According to a study 11 , growing awareness and preventive measures should at least reduce up to 21 million cases of depression, nearly 1.9 million cases of heart disease, and approximately 2.5 million cases of obesity/overweight. It must be noted that adverse experiences and other trauma in childhood, however, do not dictate the future of the child. Children survive and even flourish despite the trauma in their lives as their adverse experiences are counterbalanced with protective factors.

References:
  1. Chang, X., Jiang, X., Mkandarwire, T., & Shen, M. (2019). Associations between adverse childhood experiences and health outcomes in adults aged 18-59 years. PloS one, 14(2), e0211850. https://doi.org/10.1371/journal.pone.0211850 []
  2. Herzog, J. I., & Schmahl, C. (2018). Adverse Childhood Experiences and the Consequences on Neurobiological, Psychosocial, and Somatic Conditions Across the Lifespan. Frontiers in psychiatry, 9, 420. https://doi.org/10.3389/fpsyt.2018.00420 []
  3. Soares, A. L., Howe, L. D., Matijasevich, A., Wehrmeister, F. C., Menezes, A. M., & Gonçalves, H. (2016). Adverse childhood experiences: Prevalence and related factors in adolescents of a Brazilian birth cohort. Child abuse & neglect, 51, 21–30. https://doi.org/10.1016/j.chiabu.2015.11.017 []
  4. Terr LC. Childhood traumas: an outline and overview. Am J Psychiatry. 1991 Jan;148(1):10-20. doi: 10.1176/ajp.148.1.10. PMID: 1824611. []
  5. Schmid, M., Petermann, F., & Fegert, J. M. (2013). Developmental trauma disorder: pros and cons of including formal criteria in the psychiatric diagnostic systems. BMC psychiatry, 13, 3. https://doi.org/10.1186/1471-244X-13-3 []
  6. Danese, A., & McEwen, B. S. (2012). Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiology & Behavior, 106(1), 29-39. https://doi.org/10.1016/j.physbeh.2011.08.019 []
  7. Kalmakis, K. A., & Chandler, G. E. (2015). Health consequences of adverse childhood experiences: A systematic review. Journal of the American Association of Nurse Practitioners, 27(8), 457-465. https://doi.org/10.1002/2327-6924.12215 []
  8. Holgerson AA, Clark MM, Ames GE, Collazo-Clavell ML, Kellogg TA, Graszer KM, Kalsy SA, Grothe K. Association of Adverse Childhood Experiences and Food Addiction to Bariatric Surgery Completion and Weight Loss Outcome. Obes Surg. 2018 Nov;28(11):3386-3392. doi: 10.1007/s11695-018-3370-1. PMID: 29982973. []
  9. Reid, J. A., Baglivio, M. T., Piquero, A. R., Greenwald, M. A., & Epps, N. (2017). Human Trafficking of Minors and Childhood Adversity in Florida. American journal of public health, 107(2), 306–311. https://doi.org/10.2105/AJPH.2016.303564 []
  10. Sege, R. D., & Harper Browne, C. (2017). Responding to ACEs with HOPE: Health outcomes from positive experiences. Academic Pediatrics, 17(7), S79-S85. https://doi.org/10.1016/j.acap.2017.03.007 []
  11. Jones, C. M., Merrick, M. T., & Houry, D. E. (2020). Identifying and preventing adverse childhood experiences. JAMA, 323(1), 25. https://doi.org/10.1001/jama.2019.18499 []
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