Simple Summary
Bad things that happen to you as a kid, called adverse childhood experiences (ACEs), can hurt you even when you're all grown up. These can be things like being hit or yelled at, or seeing your parents fight or do drugs. These terrible experiences can mess with your brain's growth, your body's defenses, and make you sick more often. They can also cause heart diseases, lung diseases, and make you feel sad or depressed when you're an adult. Some other problems can be having difficulties at school, feeling hyper, or having a hard time making friends. There are lots of types of these ACEs, and many kids might have more than one type happen to them. These terrible experiences can happen to anybody, no matter where they live, and are more common than we might think. Studies have found that they can even change how people react to important information, like about COVID-19. The most important thing is that if bad things happened in childhood, it can affect the health and happiness of people when they become adults.
Adverse childhood experiences (ACEs)
Adverse childhood experiences (ACEs) include childhood emotional, physical, or sexual abuse and household dysfunction during childhood. The categories are verbal abuse, physical abuse, contact sexual abuse, a battered mother, household substance abuse, household mental illness, incarcerated household members, and parental separation or divorce. The experiences chosen were based upon prior research that has shown to them to have significant negative health or social implications, and for which substantial efforts are being made in the public and private sector to reduce their frequency of occurrence. Scientific evidence is mounting that such adverse childhood experiences (ACEs) have a profound long-term effect on health. Research shows that exposure to abuse and to serious forms of family dysfunction in the childhood family environment are likely to activate the stress response, thus potentially disrupting the developing nervous, immune, and metabolic systems of children. ACEs are associated with lifelong physical and mental health problems that emerge in adolescence and persist into adulthood, including cardiovascular disease, chronic obstructive pulmonary disease, autoimmune diseases, substance abuse, and depression.
Definition and types
The concept of adverse childhood experiences refers to various traumatic events or circumstances affecting children before the age of 18 and causing mental or physical harm. There are 10 types of ACEs:
Physical abuse: Any intentional act that causes physical harm through bodily contact.
Sexual abuse: Any forceful, unwanted, or otherwise abusive sexual behavior.
Psychological abuse: Any intentional act that causes psychological harm, such as gaslighting, bullying, or guilt-tripping.
Physical neglect: Failure to help meet the basic biological needs of a child, such as food, water, and shelter.
Psychological neglect: Failure to help meet the basic emotional needs of a child, such as attention and affection.
Witnessing domestic abuse: Observing violence occurring between individuals in a domestic setting, such as between parents or other family members.
Witnessing drug or alcohol abuse: Having a close family member who misused drugs or alcohol.
Mental health problems: Having a close family member or otherwise important individual experience mental health problems.
Imprisonment: Having a close family member or otherwise important individual serve time in prison.
Parental separation or divorce: Parents or guardians separating or divorcing on account of a relationship breakdown.
The different adverse childhood experiences are not isolated and in many cases multiple ACEs impact someone at the same time.
Prevalence
Adverse childhood experiences are common across all parts of societies, in 2009 the CDC started collecting data on the prevalence of ACEs as part of the Behavioral Risk Factor Surveillance System (BRFSS). In the first year data was collected across five US states and included over 24,000 people. The prevalence of each ACE ranged from a high of 29.1% for household substance abuse to a low of having an incarcerated family member (7.2%). Approximately one quarter (25.9%) of respondents reported verbal abuse, 14.8% reported physical abuse, and 12.2% reported sexual abuse. For ACEs measuring family dysfunction, 26.6% reported separated or divorced parents; 19.4% reported that they had lived with someone who was depressed, mentally ill, or suicidal; and 16.3% reported witnessing domestic violence. Men and women reported similar prevalences for each ACE, with the exception of sexual abuse (17.2% for women and 6.7% for men), living with a mentally ill household member (22.0% for women and 16.7% for men), and living with a substance-abusing family member (30.6% for women and 27.5% for men). Younger respondents more often reported living with an incarcerated and/or mentally ill household member. For each ACE, a sharp decrease was observed in prevalence reported by adults aged ≥55 years. For example, the prevalence of reported physical abuse was 16.9% among adults aged 18--24 years compared with 9.6% among those aged ≥55 years.
Non-Hispanic black respondents reported the lowest prevalence of each ACE category among all racial/ethnic groups, with the exception of having had an incarcerated family member, parental separation or divorce, and witnessing domestic violence. Hispanics reported a higher prevalence than non-Hispanic whites of physical abuse, witnessing domestic violence, and having an incarcerated family member (p<0.05). Those respondents with less than a high school education compared with those with more than a high school education had a greater prevalence of physical abuse, an incarcerated family member, substance abuse, and separation/divorce. Among the five states, little variation was observed.
Approximately 41% of respondents reported having no ACEs, 22% reported one ACE, and 8.7% reported five or more ACEs. Men (6.9%) were less likely to report five or more ACEs compared with women (10.3%). Respondents aged ≥55 years reported the fewest ACEs, but the younger age groups did not differ from one another. Non-Hispanic blacks were less likely to report five or more ACEs (4.9%) compared with non-Hispanic whites (8.9%), Hispanics (9.1%), and other non-Hispanics (11.7%). However, non-Hispanic black respondents were not significantly more likely to report zero ACEs compared with other racial/ethnic groups. Respondents with the lowest educational attainment were significantly more likely to report five or more ACEs compared with those with higher education levels (14.9% versus 8.7% among high school graduates and 7.7% in those with more than a high school education). Overall, little state-by-state variation was observed in the number of ACEs reported by each respondent.
There are no reliable global estimates for the prevalence of child maltreatment. Data for many countries, especially low- and middle-income countries, are lacking. Current estimates vary widely depending on the country and the method of research used. Approximately 20% of women and 5–10% of men report being sexually abused as children, while 25–50% of all children report being physically abused.
Health outcomes due to ACEs
Childhood
With one in four children experiencing or witnessing a potentially traumatic event, the relationship between ACEs and poor health outcomes has been established for years. With multiple adverse childhood experiences being equal to various stresses, and adversity. Children who grow up in an unsafe environment are at risk for developing adverse health outcomes, affecting brain development, immune systems, and regulatory systems. Adverse childhood experiences can alter the structural development of neural networks and the biochemistry of neuroendocrine systems and may have long-term effects on the body, including speeding up the processes of disease and aging and compromising immune systems. Further research on ACEs determined that children who experience ACEs are more likely than their similar-aged peers to experience challenges in their biological, emotional, social, and cognitive functioning. Also, children who have experienced an ACE are at higher risk of being re-traumatized or suffering multiple ACEs. The amount and types of ACEs can cause significant negative impacts and increase the risk of internalizing and externalizing in children. Additionally behavioral challenges can arise in children who have been exposed to ACEs including juvenile recidivism, reduced resiliency, and lower academic performance.
Adulthood
Adults with ACE exposure report having worse mental and physical health, more serious symptoms related to illnesses, and poorer life outcomes. Across numerous studies these effects go beyond behavioral and medical issues, and include damage to DNA, higher levels of stress hormones, and reduced immune function. The effects of ACEs goes beyond just physical and behavioral health with studies reporting that people with high ACEs scores showed less trust in government COVID-19 information and policies.
It is thought that all adult depression results from something happening in childhood. That could be things like aversive childhood experiences that lead to depression, or if something that happens in adulthood that leads to depression tends to stem from something that happened in childhood as well. It seems that the main things that led children to have adult depression is that of their parent's mental health issues and childhood neglect.
Biological changes
Due to many of the early life stressors caused by exposure to ACEs there are noted changes the body in people with ACE exposures compared to people with little to no ACE exposure. This is most evident in structural changes in the brain with the hippocampus, the amygdala, and the corpus callosum being important targets of study. These areas of the brain are more vulnerable than others due to the higher density of glucocorticoid receptors in these regions of the brain. Multiple effects have been noted including diminished thickness, reduced size, and reduced size of connective networks in the brain.
Physical health
ACEs have been linked to numerous negative health and lifestyle issues into adulthood across multiple countries and regions including the United States, the European Union, South Africa, and Asia. Across all these groups researchers have reported seeing the adoption of higher rates of unhealthy lifestyle behavior including sexual risk taking, smoking, heavy drinking, and obesity. The associations between these lifestyle issues and ACEs shows a dose response relationship with people having four or more ACEs have significantly more of these lifestyle problems. Physical health problems arise in people with ACEs with a similar dose response relationship. Chronic illnesses such as asthma, arthritis, cardiovascular disease, cancer, diabetes, stroke, and migraines show increased symptom severity in step was exposure to ACEs.
Mental health
Mental health issues have been well known in the face of childhood trauma and exposure to ACEs is no different. According to a large study conducted in 21 countries nearly one in three mental health conditions in adulthood are directly related to an adverse childhood experience.
A study of high school students in Chicago showed significantly elevated levels of school problems, hyperactivity, and lower levels of personal adjustment as number of ACEs increased.
Multiple mental health conditions found to have a dose response relationship with symptom severity and prevalence including depression, attention-deficit/hyperactivity disorder, anxiety, suicidality, bipolar disorder and schizophrenia. Depressive symptoms in adulthood showed one of the strongest dose response relationships with ACEs, with an ACE score of one increasing the risk of depressive symptoms by 50% and an ACE score of four or more showing a fourfold increase. Later research also demonstrated that ACE scores are related to increased rates and severity of psychiatric and mental disorders, as well as higher rates of prescription psychotropic medication use.
