Four Ways That Adverse Childhood Experiences Affect Adults

A pivotal study conducted with the CDC and Kaiser Permanente between 1995 and 1997 first described the term Adverse Childhood Experiences. In the study’s follow-up phase, more than 17,000 people answered questions about their childhood experiences. The study found a tight association between Adverse Childhood Experiences (ACEs) and various adverse outcomes in adulthood, helping professionals better understand how adverse childhood experiences may contribute to mental health outcomes, greater risk factors for mental illness, and chronic health conditions.

This article provides an overview of adverse childhood experiences, demographic characteristics, how they might impact adult health, and how mental healthcare providers might be able to help.

The Adverse Childhood Experience study on mental health

The original Adverse Childhood Experiences (ACEs) study, a pioneering investigation into the lifelong impacts of adverse childhood experiences, used a questionnaire evaluating three categories of adverse experiences: abuse, household challenges, and neglect. 

These adverse childhood experiences encompass a range of potentially traumatic events, from emotional abuse to physical abuse. Additionally, the study identified sexual abuse, witnessing domestic violence (such as a mother being treated violently by a male partner), and parental separation or divorce as significant factors contributing to childhood adversity and subsequent mental illness and physical health outcomes.

The ACEs scale is used to provide an ACE score that measures the individual’s experience of the following:

• Emotional abuse: Being regularly belittled, humiliated, insulted, or demeaned, all of which may lead one to fear for their physical safety.

• Physical abuse: Being struck, pushed, grabbed, etc., with enough force to injure or leave marks.

• Sexual abuse: Being forced to engage in a sexual interaction.

• Mother treated violently: Mother, stepmother, or maternal family member subjected to violence by a male partner.

• Divorce: Parental separation or parental divorce

• Emotional neglect: Lack of love and support. 

• Physical neglect: Lack of physical necessities and basic needs like food, shelter, or clothing; parental incompetence or substance use* (formerly referred to as substance abuse)

The ACE scale can help quantify an individual's exposure to adverse childhood experiences, with higher ACE scores correlating with increased risk of mental and physical health conditions later in life. Research stemming from the ACEs study has linked adverse childhood experiences to a myriad of health conditions, including mental illness, heart disease, substance use, and high-risk behaviors. By understanding the profound impact of childhood trauma and toxic stress on health and well-being, professionals in various fields, from healthcare to education, can implement early interventions and support systems to mitigate the long-term effects of adverse childhood experiences on individuals and communities. 

The ACE scale is readily available for public use. You can take a version of the test here, and the actual questionnaire used in the study is available here. The questions encompass a range of childhood experiences starting from a very young age and spanning through high school. 

About 64% of people in the United States have an ACE Score of 1. The higher your ACE score, which ranges from 1 to 10, the greater the risk for chronic disease and mental illness. 

How many people are affected by ACEs and childhood trauma?

The original study found that around two-thirds of the people who took the questionnaire had experienced at least one ACE. About one-fifth of the respondents had experienced four or more ACEs. Whether they have a score of one or more, adverse childhood experiences can completely alter an individual’s life course.

Understanding the ways that adverse childhood experiences affect adulthood

According to the Centers for Disease Control and Prevention, “adverse childhood experiences (ACEs) can have a tremendous impact on future violence, victimization, perpetration, lifelong health, and opportunity.” The results of the Adverse Childhood Experiences study were clear and sobering, and are as follows:

1. Adults with high ACE scores are less physically healthy

Life is full of regular stressors; long lines, frustrating coworkers, new jobs, and bad traffic, to name a few. These are generally dealt with easily by healthy adults. But adults with a high ACE score, who may have their physiological stress responses stuck in overdrive, may not be able to control their stress response as effectively, which can result in poor health outcomes.

As a result of this physiological strain, chronic health conditions, such as heart disease, liver disease, diabetes, cancer, and strokes are all more common in adults with high ACE scores. Also, high scores (usually considered as a score of three and above) often predict autoimmune diseases in women. This correlation may be partly because of chronic, toxic stress on the participants’ developing brains during childhood.

Genetic switches

Childhood is a time of incredible physical growth and cognitive development. Leaving behind the old nature versus nurture debate, we now know that the genes we are born with respond to the environment in which we develop. That environment, in turn, responds to us. And when our environment is chronically stressful, it inhibits the development of genes that manage stress. Chronic stress can change a child's development at the genetic level, setting their stress response into permanent overdrive.

More genetic connections

However, the physical health consequences of ACEs are not all caused by unmanaged adult stress. There is some evidence that constant, unregulated childhood stresses trigger changes within the genes that are directly related to the development of many of the adult diseases to which this population is prone. Hence, a high ACEs score doesn't just potentially set the bomb of chronic adult stress but can sneak into the genes responsible for chronic conditions and alter them.

Stress toxicity

Being in a constant high-stress response mode can promote chronic inflammation, dampen a person's immune system, and impair their bodies' regular maintenance and rebuilding. Stress hormones themselves can be disruptive to physical function in the long term. In addition, high-stress responses exhaust a great deal of energy, which, in turn, compromises other physiological functioning and routine processes.

2. Adults with high ACE scores are less mentally healthy

The effects of ACEs on adult mental health are perhaps less surprising than those on physical health. Many of us are familiar with the idea that our early experiences play a part in our adult mental health. However, it may be surprising that ACEs affect mental health in much the same way they affect physical health—that is, by triggering actual physiological changes in our bodies.

Brain changes

When a child experiences chronic, unsupported stress, it affects their genes, as we previously discussed. It also changes the physiological architecture of the brain. Excessive and ongoing exposure to stress hormones can trigger several changes at the cognitive level, including shrinkage of the parts of the brain responsible for learning and memory, under-development of the part of the brain that processes fear, and deficits in decision-making and impulse control centers.

Depression

The most significant mental health risk for adults with an ACEs score of three or more is depression. People with high ACEs scores can experience more depressive episodes, and it takes them longer to recover from them. They are also more likely to commit suicide than the general population*. The physical challenges of chronic stress in childhood and adulthood that we looked at earlier help to explain some of the prevalence of depression. While major depressive disorder may be a risk factor, it’s not the only one. Adults with high ACE scores may also develop other mood disorders, such as bipolar disorder.

Anxiety

In addition to depression, people with high ACEs scores are more likely to experience generalized mental distress than the general population. ACEs can contribute to the development of post-traumatic stress disorder.

3. Adults with high ACEs scores and a history of sexual abuse are less socially stable and more likely to engage in risky behavior

Partially due to disrupted brain development, people with high ACE scores are more likely to engage in personally and socially risky behaviors. High ACE scores are associated with earlier and riskier sexual activities, higher rates of unintended pregnancies, smoking, alcoholism, and illegal drug use.

Why?

As discussed in the physical and mental health sections, chronic, unsupported stress among ACEs can cause physical changes to our brains. Chronic stress can inhibit the development of decision-making and impulse control centers. This can leave adults with high ACE scores more susceptible to potentially unsafe activities, such as excessive drug and/or alcohol use.

Social issues

In addition to these risky behaviors, adults with high ACE scores are more likely to report poor work performance or unemployment. They are more likely to have multiple sexual partners and are at higher risk of sexual violence and intimate partner violence.

Attachment styles

It's not always clear how ACEs are related to these results. Some of the social issues may stem from the impacts of stress on decision-making and impulse control. Also, research on childhood trauma shows that early relationships and attachment style carries over into adulthood. If the ACEs indicate unhealthy patterns relating to authority figures or family members, these can often be difficult (but certainly not impossible) to break later.

Stress sensitivity

Brain development and learned behavioral patterns seem to play a part in the social instability of adults with high ACE scores. In addition to these, heightened sensitivity to stress can make managing challenges in the workplace or intimate relationships more difficult. As we saw earlier- chronic unsupported childhood stress can cause excessive stress reactions later as adults.

4. Adults with high ACEs scores die earlier

Adults with high ACE scores have a life expectancy that is 20 years shorter than that of the average adult when compared to the general population. Adults with high ACE scores often die of the diseases to which they are prone; suicide, alcoholism, and drug use, to name a few. ACEs lay the foundation for impaired brain development, which essentially contributes to specific mental health disorders, risky behaviors, and social instability. Often, this can ultimately result in an increased risk of early death.

ACE scores and predictability

If your scores reflect a high level of exposure to ACEs, it doesn’t necessarily mean that you can expect a lifetime of low achievement, sickness, and instability followed by early death.

While the ACE scale measures particularly difficult childhood circumstances that can stack the deck against us in adulthood, it doesn't measure everything. Positive childhood circumstances can mitigate a lot of the damage of a high ACEs score. Loving, supportive relationships with adults like teachers, grandparents, or friends can go a long way toward helping children cope with trauma. And as an adult, self-knowledge is only a tool, like your ACE score. It can help you to identify and better understand what you went through in childhood, and aid in recognizing and changing your own detrimental behaviors. It can motivate you to get help when needed. 

How online therapy might help 

According to a study published in the Journal of Public Health (J. Public Health), all ACEs are associated with lower odds of being currently insured and receiving a physician checkup in the past year. Research shows that online therapy is a powerful tool for improving mental health and can result in similar success in treating anxiety and depression. It may also be a viable option for individuals whose health insurance doesn’t cover treatment for household dysfunction and other mental health concerns. 

For instance, this study found that online therapy was even more effective for treating depression than traditional in-person sessions, with 100 percent of participants in the online group showing continued symptom reduction three months after treatment. 

If you're looking for a therapist that fits your busy lifestyle or have trouble finding the motivation to attend in-person therapy sessions, consider using a platform like BetterHelp. BetterHelp’s online counselors are available anytime, anywhere, making it highly convenient to quickly connect with a licensed professional from the comfort of your own home. You’ll connect to a counselor who matches your objectives and preferences and has experience treating the type of issues you are living with.