Adverse Childhood Trauma and The ACES Study

Adverse Childhood Trauma and The ACES Study

What is Child Trauma?

Childhood trauma is a significant issue that can deeply affect a person’s physical, emotional, and mental well-being. Instances of physical or sexual abuse are among the traumatic events that can cause mental or physical harm, highlighting the severity and impact of such experiences. Child traumatic stress refers to reactions that impact a child’s daily life after a traumatic event, affecting their behavior, interactions, and even school performance. It includes a range of negative experiences, such as abuse, neglect, and family problems. Understanding the causes, effects, and ways to heal from childhood trauma is crucial for everyone, including mental health professionals, caregivers, and society as a whole. The experience of an event by a child that is emotionally painful or distressful, which often results in lasting mental and physical effects. This article explores the profound effects of childhood trauma on physical, emotional, and psychological health, and emphasizes the importance of addressing these impacts to foster healing and resilience. It also discusses the ACES study about the impact of Adverse Childhood trauma.

What are some Causes of Childhood Traumatic Events?

Childhood trauma refers to experiences that are emotionally painful or distressing and have a lasting negative impact on a child’s well-being. These experiences can be acute, such as when children experience trauma from a single event (e.g., a natural disaster or accident), or chronic, involving repeated exposure to adverse conditions (e.g., ongoing abuse or neglect), and are often referred to as potentially traumatic events. Common sources of childhood trauma include:

There is also a significant link between childhood trauma and chronic obstructive pulmonary disease (COPD) in adulthood.

1. Abuse

  1. Physical Abuse: Physical abuse involves the intentional use of physical force that results in injury, pain, or impairment. Examples of child abuse include hitting, beating, kicking, burning, or other forms of physical harm. Children subjected to physical abuse often live in fear and may suffer from long-term physical and psychological effects.
  2. Emotional Abuse: Emotional or psychological abuse includes behaviors that harm a child’s self-worth or emotional well-being. This can involve verbal abuse, such as yelling, name-calling, and constant criticism, as well as nonverbal behaviors like intimidation, isolation, or rejection. Emotional abuse can severely damage a child’s self-esteem and other mental health conditions, leading to anxiety, depression, and other emotional issues.
  3. Sexual Abuse: Sexual abuse involves engaging a child in sexual acts, including inappropriate touching, molestation, rape, or exploitation. This form of abuse can have devastating and long-lasting effects on a child’s emotional, psychological, and physical health, often resulting in PTSD, trust issues, and difficulties in forming healthy relationships.

2. Neglect

  1. Physical Neglect: Physical neglect occurs when a child's basic physical needs are not met. This includes failing to provide adequate food, clothing, shelter, medical care, and supervision. Children experiencing physical neglect may suffer from malnutrition, poor hygiene, untreated health problems, and developmental delays.
  2. Emotional Neglect: Emotional neglect involves failing to meet a child's emotional needs, such as love, support, and nurturing. This can result in feelings of worthlessness, insecurity, and emotional deprivation. Children who experience emotional neglect may struggle with forming attachments, emotional regulation, and self-esteem.

3. Household Dysfunction

  1. Domestic Violence: Witnessing domestic violence, such as physical fights or verbal abuse between parents or caregivers, can be highly traumatic for children. Exposure to domestic violence can create a sense of fear, helplessness, and insecurity, affecting a child's emotional and psychological development.
  2. Substance Abuse: Living with a family member who has a substance abuse problem can create an unstable and unpredictable home environment. Children in these situations may experience neglect, abuse, and emotional distress. They are also at a higher risk of developing substance use disorders themselves.
  3. Mental Illness: Having a caregiver with untreated mental illness can significantly impact a child's well-being. Children may face neglect, emotional unavailability, and an inability to form secure attachments. The stress and unpredictability associated with living with a mentally ill caregiver can contribute to anxiety, depression, and other mental health issues.
  4. Incarceration of a Family Member: The incarceration of a parent or close family member can be a traumatic experience for a child. It can lead to feelings of abandonment, shame, and stigma. Children may also face financial instability and changes in living arrangements, further contributing to their emotional and physical illnesses and psychological stress.
  5. Parental Separation or Divorce: While not inherently traumatic, parental separation or divorce can be a source of significant stress for children. The process often involves conflict, changes in living situations, and disruptions to the child's routine. Children may experience feelings of loss, insecurity, and confusion, which can impact their emotional well-being and development.

4. Community and Environmental Factors

  1. Violence in the Community: Exposure to violence in the community, such as gang violence, shootings, and crime, can be highly traumatic for children. Living in a violent environment can lead to chronic traumatic stress reactions,, fear, and a heightened sense of vulnerability.
  2. Natural Disasters: Natural disasters like earthquakes, hurricanes, floods, and wildfires can be traumatic experiences for children. The sudden disruption, loss of home, and potential loss of loved ones can have lasting emotional and psychological effects.
  3. Poverty: Growing up in poverty can expose children to various stressors, including food insecurity, inadequate housing, lack of access to healthcare, and limited educational opportunities. The chronic stress associated with poverty can negatively impact a child's development and well-being.
  4. Discrimination and Social Marginalization: Children who experience discrimination based on race, ethnicity, gender, sexual orientation, or disability can face chronic stress and trauma. Social marginalization and prejudice can lead to feelings of worthlessness, isolation, and insecurity, affecting a child's mental health and self-esteem.

5. Loss and Bereavement

  1. Death of a Loved One: The death of a parent, sibling, or close family member can be a profoundly traumatic experience for a child. Grief and loss can trigger intense emotions and significantly impact a child's sense of security and stability.
  2. Separation from Caregivers: Separation from primary caregivers, whether due to illness, incarceration, or other circumstances, can be deeply traumatic for children. Such separations can lead to attachment issues, emotional distress, and long-term psychological effects.

Childhood trauma can arise from various sources, each contributing to a complex web of adverse experiences that can impact a child's development and well-being. Recognizing and understanding these causes is crucial for developing effective prevention and intervention strategies. By addressing the root causes of childhood trauma and providing supportive, trauma-informed care, we can help mitigate the long-term effects experienced childhood trauma and promote healing and resilience in affected children.

Physical Health Effects of Childhood trauma

The impact of childhood trauma extends beyond emotional and psychological well-being, affecting physical health in several significant ways:

  1. Chronic Health Conditions: Childhood trauma is linked to a higher risk of developing chronic health conditions such as heart disease, diabetes, and autoimmune disorders. The stress response system, when overactivated during critical developmental periods, can lead to long-term physiological changes that predispose individuals to these conditions (Felitti et al., 1998). Higher ACE scores are correlated with an increased risk of these chronic health conditions.
  2. Immune System Dysfunction: Prolonged stress from trauma can weaken the immune system, making individuals more susceptible to infections and illnesses. The body’s constant state of alert due to trauma can impair its ability to fight off diseases effectively (Danese & McEwen, 2012).
  3. Poor Health Behaviors: Individuals with a history of childhood trauma are more likely to engage in risky health behaviors such as smoking, overeating, substance abuse, and unsafe sexual practices. These behaviors can further contribute to the development of chronic illnesses and reduce overall life expectancy (Anda et al., 2006).

Mental Health Effects of Childhood Trauma

Childhood trauma significantly impacts mental health conditions, often leading to the development of various psychological disorders:

  1. Anxiety and Depression: Children who experience trauma are at an increased risk of developing anxiety and depression. These conditions can persist into adulthood, affecting daily functioning and overall quality of life (Chapman et al., 2004).
  2. Post-Traumatic Stress Disorder (PTSD): Exposure to traumatic events can lead to PTSD, characterized by intrusive memories, flashbacks, avoidance behaviors, and heightened arousal. PTSD can severely disrupt a person’s ability to function in daily life (American Psychiatric Association, 2013).
  3. Substance Use Disorders: Trauma can increase the likelihood of substance abuse as individuals may turn to drugs or alcohol to cope with their distress. This maladaptive coping mechanism can lead to addiction and further complicate mental health issues (Dube et al., 2003).

Seeking help from a mental behavioral health services professional is a crucial step in healing from childhood trauma, offering therapeutic options and support from reputable organizations.

Behavioral and Social Effects of Childhood Trauma

The effects of the early childhood trauma itself are also evident in behavioral and social domains:

  1. Aggression and Delinquency: Trauma can result in behavioral issues such as aggression, defiance, and delinquency. Exposure to community violence is a significant factor that can lead to aggression and behavioral issues in children, as it is associated with negative mental health outcomes, academic problems, substance abuse, and suicidal ideation. These behaviors often stem from an inability to regulate emotions and manage stress effectively (Ford et al., 2012).
  2. Academic Challenges: Children who experience trauma often face difficulties in school, including lower academic performance, higher absenteeism, and an increased risk of dropping out. Trauma can impair concentration, memory, and cognitive function, hindering learning and academic achievement (Perfect et al., 2016).
  3. Interpersonal Relationships: Trauma can affect a person’s ability to form and maintain healthy relationships. Trust issues, difficulty with emotional intimacy, and fear of abandonment are common among those with a history of childhood trauma. These challenges can impact friendships, romantic relationships, and interactions with colleagues (Herman, 1992).

Generational Transmission of Trauma

Generational transmission of trauma refers to the way trauma experienced by one generation can affect subsequent generations. When parents or caregivers have unresolved trauma, it can influence their parenting styles and behaviors, leading to emotional dysregulation, unhealthy coping mechanisms, and unstable home environments. These patterns can create a cycle of trauma, where children experience similar stress and adversity. Additionally, emerging research in epigenetics suggests that trauma can cause biological changes that are passed down, affecting how future generations respond to stress. Addressing generational trauma involves providing trauma-informed care, strengthening support systems, and implementing policies that support family stability and resilience.

For more Information about generational trauma see our blog post about generational transmission of trauma.

Healing from Childhood Trauma

While the effects of childhood trauma can be severe, healing is possible. Here are some approaches that can support recovery:

  1. Therapeutic Interventions: Therapy can help individuals process their trauma and develop coping strategies. Approaches such as cognitive-behavioral therapy (CBT), trauma-focused CBT, and eye movement desensitization and reprocessing (EMDR) have proven effective in treating trauma-related symptoms (Bisson et al., 2007).
  2. Support Systems: Building a strong support network of family, friends, and community resources is crucial for recovery. Support groups and peer networks can provide a sense of understanding and shared experience, which is essential for healing (Porges, 2011).
  3. Self-Care and Mindfulness: Encouraging self-care practices such as regular exercise, healthy eating, adequate sleep, and mindfulness can help individuals manage stress and improve their overall well-being. Mindfulness practices, in particular, can enhance emotional regulation and resilience (Guendelman et al., 2017).
  4. Trauma-Informed Care: Implementing trauma-informed care practices in healthcare, education, and social services can help identify and support individuals affected by trauma. This approach emphasizes understanding, recognizing, and responding to the effects of all types of trauma (Substance Abuse and Mental Health Services Administration, 2014).
  5. Education and Awareness: Increasing awareness about the impacts of childhood trauma and educating caregivers and professionals about trauma-informed care can create environments that support healing and resilience.

For those seeking additional resources and interventions related to trauma in children and adolescents, the National Child Traumatic Stress Network (NCTSN) is a valuable resource.

The Adverse Childhood Experiences (ACEs) Study: Understanding the Impact of Early Traumatic Events

The Adverse Childhood Experiences (ACEs) Study is a groundbreaking project that has changed how we think about adverse childhood experiences and their long-term effects. Conducted by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente, the ACEs study reveals how early life stress and trauma can impact health and well-being throughout a person’s life. Additionally, the study investigates traumatic experiences, including their psychological and physiological responses, and sociological impacts, as well as the epigenetic effects of child traumatic stress on gene expression and the potential for transmitting trauma-related effects to subsequent generations.

What Is the ACEs Study?

The ACEs study, which began in the mid-1990s, surveyed over 17,000 people to explore the long-term effects of childhood trauma. Participants answered questions about ten types of adverse experiences they might have faced before turning 18. These experiences fall into three categories: abuse, neglect, and household dysfunction (Felitti et al., 1998).

  1. Abuse: This includes physical, emotional, and sexual abuse.
  2. Neglect: This involves physical and emotional neglect.
  3. Household Dysfunction: This category covers things like witnessing domestic violence, living with family members who have substance abuse problems or mental illness, and experiencing parental separation or having a family member in jail.

Key Findings

The ACEs study uncovered several important findings about the impact of childhood trauma:

  1. It’s Common: The study found that adverse childhood experiences are surprisingly common. Nearly two-thirds of participants reported experiencing at least one ACE, and more than one in five reported three or more (Felitti et al., 1998). This prevalence underscores the national child traumatic stress issue, highlighting how widespread these experiences are and their potential to overwhelm a child's ability to cope.
  2. More ACEs, More Problems: There’s a strong link between the number of ACEs and the risk of negative health outcomes. The more ACEs someone experiences, the higher their risk for a wide range of health problems, including chronic diseases, mental health issues, and substance abuse (Anda et al., 2006).
  3. Serious Health Effects: The study connected ACEs with many health problems, including heart disease, lung disease, liver disease, depression, suicide attempts, and drug and alcohol abuse (Felitti et al., 1998). ACEs are also linked to risky behaviors, such as smoking and unsafe sexual practices.
  4. Impact on Life Success: ACEs can lead to problems in school, work, and relationships. This can result in lower educational achievement, job performance, and economic stability, creating a cycle of trauma and poverty (Bellis et al., 2014).

How to Prevent and Help Childhood Trauma Survivors

The findings from the ACEs study highlight the need for prevention and early intervention. Here are some ways to help:

  1. Trauma-Informed Care: Using trauma-informed care practices in healthcare, education, and social services can help identify and support people affected by ACEs. This approach involves understanding, recognizing, and responding to the effects of all types of trauma (Substance Abuse and Mental Health Services Administration, 2014).
  2. Early Childhood Programs: Investing in early childhood programs that promote safe, stable, and nurturing relationships can help prevent ACEs. Programs like home visits, parent education, and early education can reduce the risk of trauma and support healthy development (Shonkoff et al., 2012).
  3. Community Support: Strengthening community resources and support systems can help lessen the effects of ACEs. This includes providing access to mental and substance abuse treatment, and social support networks (Bethell et al., 2017).
  4. Advocacy and Policy: Pushing for policies that address the root causes of ACEs, such as poverty, discrimination, and lack of healthcare access, is essential. Policies that support families, like paid family leave and affordable childcare, can also reduce the incidence of ACEs (Anda et al., 2010).

The ACEs study has revealed the deep and lasting impact of childhood trauma. By understanding the connections between adverse childhood experiences and health outcomes, we can better support individuals affected by trauma and work towards healthier, more resilient communities. Through trauma care, early intervention, community support, and effective policies, we can help break the cycle of trauma and promote healing and well-being for future generations.


  1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
  2. Anda, R. F., Butchart, A., Felitti, V. J., & Brown, D. W. (2010). Building a framework for global surveillance of the public health implications of adverse childhood experiences. American Journal of Preventive Medicine, 39(1), 93-98.
  3. Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., ... & Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience, 256(3), 174-186.
  4. Bellis, M. A., Lowey, H., Leckenby, N., Hughes, K., & Harrison, D. (2014). Adverse childhood experiences: retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population. Journal of Public Health, 36(1), 81-91.
  5. Bethell, C. D., Newacheck, P., Hawes, E., & Halfon, N. (2017). Adverse childhood experiences: assessing the impact on health and school engagement and the mitigating role of resilience. Health Affairs, 36(11), 2106-2115.
  6. Bisson, J. I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007). Psychological treatments for chronic post-traumatic stress disorder. The British Journal of Psychiatry, 190(2), 97-104.
  7. 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.
  8. Danese, A., & McEwen, B. S. (2012). Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiology & Behavior, 106(1), 29-39.
  9. Dube, S. R., Felitti, V. J., Dong, M., Chapman, D. P., Giles, W. H., & Anda, R. F. (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The Adverse Childhood Experiences Study. Pediatrics, 111(3), 564-572.
  10. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., ... & 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.
  11. Ford, J. D., Chapman, J. F., Mack, M., & Pearson, G. (2012). Pathways from traumatic childhood adversity to interpersonal violence offending. Psychological Trauma: Theory, Research, Practice, and Policy, 4(3), 314-328.
  12. Guendelman, S., Medeiros, S., & Rampes, H. (2017). Mindfulness and emotion regulation: Insights from neurobiological, psychological, and clinical studies. Frontiers in Psychology, 8, 220.
  13. Herman, J. L. (1992). Trauma and Recovery. Basic Books.
  14. Perfect, M. M., Turley, M. R., Carlson, J. S., Yohanna, J., & Saint Gilles, M. P. (2016). School-related outcomes of traumatic event exposure and traumatic stress symptoms in students: A systematic review of research from 1990 to 2015. School Mental Health, 8(1), 7-43.
  15. Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. Norton.
  16. Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach.
  17. Shonkoff, J. P., Garner, A. S., Siegel, B. S., Dobbins, M. I., Earls, M. F., McGuinn, L., ... & Wood, D. L. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232-e246.
  18. Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach.