the InMind blog

Adverse Childhood Experiences and its lifelong consequences

• written by Marly van Oirschot

Unfortunately, some children grow up with maltreatment and household dysfunction. In this post, I will explain how these adverse childhood experiences (ACEs) not only have a negative influence during childhood, but later on in life as well, and I will give some advice about how to prevent these long-lasting negative outcomes.

What are ACEs?
Many children have a hard time at home and don’t grow up in loving, stable households. Therefore they don’t receive the love and care they need to grow up happy and healthy. Sometimes this results in potentially traumatic events that can have negative and lasting effects on both the health and the well-being of the child (Felitti et al., 1998). These potentially traumatic events are called adverse childhood experiences (ACEs), and range from physical, emotional, or sexual abuse, to parental divorce, or substance abuse by a parent.

The occurrence of an ACE, unfortunately, is common, and experiencing one ACE increases the probability of experiencing another one (Felitti et al., 1998). Therefore, these childhood experiences rarely occur in isolation but often co-occur (Anda et al., 1999; Felitti et al., 1998; Lu, Mueser, Rosenberg, & Jankowski, 2008). As a result, children experience multiple ACEs repeatedly, or simultaneously, such as a child who is abused by a divorced parent with a mental illness.

What’s the role of stress?
You can imagine that one or multiple ACEs can lead to a lot of tension and stress for a child. This stress can be so severe, that it can even disrupt the physiological response to stress (Danese, et al., 2009; Gunnar & Quevedo, 2007; Heim et al., 2000) and lead to chronic overactivation. Because of this, even non-threatening incentives can now be interpreted as threatening, such as an unexpected sound or touch. Therefore, many of these children experience stress, even when there’s no apparent reason to be stressed at that moment. For instance, a child who has repeatedly witnessed his mom being treated violently can still feel stressed when he’s in a safe environment such as in school, or at a baseball practice.

These extreme, repetitive, and abnormal patterns of stress during childhood can be toxic and alternate or impair the child’s brain (Bremner 2003; Weiss & Wagner, 1998). There are multiple studies which have documented brain-wave abnormalities, and neurological changes among people who experienced one or more ACEs (DeBellis et al., 1999; Driessen, et al., 2000; Stein, Koverola, Hanna, Torchia, & McClarty, 1997; Teicher et al., 1997). These neurological changes during early childhood are really important, because the neurological development is the foundation on which future experiences are processed. Therefore, when this development is altered due to early traumatic experiences, these neurological changes can result in emotional, social, or cognitive impairments. This may affect the child’s learning ability and social skills, and it can result in long-term health problems (Perry & Pollard, 1998; Weiss & Wagner, 1998).

What negative impact have ACEs?
Until now, little research has directly measured the immediate impact of ACEs on a child’s life. But there is a recent study conducted in the Netherlands, which shows that children in the age of 11-12 who have experienced one or more ACEs are feeling less happy and healthy than children who did not experience an ACE (Vink, Van der Pal, Eekhout, Pannebakker, & Mulder, 2016).

In contrast, there is an expanding body of research about the effects well into adulthood. Indeed, research shows that ACEs can lead to health problems such as autoimmune or pulmonary diseases (Anda et al., 2008; Danese et al., 2009), and mental health problems such as depression, post-traumatic stress disorder, and anxiety disorders (Anda et al., 2006; Chapman et al., 2004; DeBellis & Thomas, 2003).

Besides these (mental) health problems, ACEs can also result in social or behavioral problems, such as increased use of illicit drugs, tobacco, and alcohol (Mersky, Topitzes & Reynolds, 2013), risky sexual behavior (Ramiro, Madrid, & Brown, 2010), antisocial behavior (Schilling, Aseltine, & Gore, 2007), increased risk of attempting suicide (Felitti et al., 1998) and even unemployment (Liu et al., 2013). It is therefore really important that we try to help children cope with their traumatic experiences, and prevent these negative outcomes.

What can we do to help children and prevent these negative outcomes?
Child maltreatment and household dysfunction are serious problems that may have lasting harmful effects. The primary goal in prevention should therefore be, of course, to stop the ACE from happening in the first place. To do this, we have to create a safe environment where the child is nurtured and loved.

However, although this is very important, this is almost impossible to achieve on your own without professional help. First of all, the signaling of ACEs can be really difficult, therefore making it hard to stop the ACE from happening. Furthermore, because the stress response of the child is altered, the child can still experience high levels of stress when the ACE has already stopped. So, although it is really important to stop the ACE from happening, it is necessary that we help these children in a different way as well. Fortunately, there is actually a pretty easy way to help a traumatized child, and all of us can do this. You might wonder what I’m talking about. Well, just being there for the child, and showing that you are a reliable, supportive adult to whom they can come to can prevent the lasting negative outcomes of child maltreatment and household dysfunction. Indeed, experiencing high levels of stress in a supportive environment may not be toxic. There is an abundance of research which shows that support from a reliable adult in the direct environment of the child can act as a buffering protection (Shonkoff, et al., 2012). So whether you’re a teacher, a soccer coach, or a just a caring neighbor, as long as you’re involved and show them that you are supportive, it can help them cope and feel less stressed. As a result, it may prevent the lifelong negative consequences. 

References
Anda, R. F., Brown, D. W., Dube, S. R., Bremner, J. D., Felitti, V. J., & Giles, W. H. (2008). Adverse childhood experiences and chronic obstructive pulmonary disease in adults. American journal of preventive medicine, 34, 396-403.

Anda, R. F., Croft, J. B., Felitti, V. J., Nordenberg, D., Giles, W. H., Williamson, D. F., & Giovino, G. A. (1999). Adverse childhood experiences and smoking during adolescence and adulthood. Journal of the American Medical Association, 282, 1652-1658.

Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C. H., Perry, B. D., Dube, S. R., & Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood. European archives of psychiatry and clinical neuroscience, 256, 174-186.

Bremner, JD. (2003). Long-term effects of childhood abuse on brain and neurobiology. Child and Adolescent Psychiatric Clinics of North America, 12, 271–292.

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, 217-225.

Danese, A., Moffitt, T. E., Harrington, H., Milne, B. J., Polanczyk, G., Pariante, C. M., . . . & Caspi, A. (2009). Adverse childhood experiences and adult risk factors for age-related disease: depression, inflammation, and clustering of metabolic risk markers. Archives of pediatrics & adolescent medicine, 163, 1135-1143.

DeBellis, M. D., Keshavan, M. S., Clark, D. B., Casey, B. J., Giedd, J. N., Boring, A. M., Frustaci, K, & Ryan, N. D. (1999). Developmental traumatology part II: brain development. Biological psychiatry, 45, 1271-1284.

DeBellis, M., & Thomas, L. (2003). Biologic findings of post-traumatic stress disorder and child maltreatment. Current Psychiatry Reports, 5, 108–117.

Driessen, M., Herrmann, J., Stahl, K., Zwaan, M., Meier, S., Hill, A., Osterheider, M, & Petersen, D. (2000). Magnetic resonance imaging volumes of the hippocampus and the amygdala in women with borderline personality disorder and early traumatization. Archives of general psychiatry, 57, 1115-1122.

Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., & Koss, M. P. (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,  245-258.

Gunnar, M., & Quevedo, K. (2007). The neurobiology of stress and development. Annual Review of Psychology, 58, 145-173.

Heim, C., Newport, D. J., Heit, S., Graham, Y. P., Wilcox, M., Bonsall, R., . . . Nemeroff, C. B. (2000). Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. Journal of the American Medical Association, 284, 592-597.

Liu, Y., Croft, J. B., Chapman, D. P., Perry, G. S., Greenlund, K. J., Zhao, G., & Edwards, V. J. (2013). Relationship between adverse childhood experiences and unemployment among adults from five US states. Social psychiatry and psychiatric epidemiology, 48, 357-369.

Lu, W., Mueser, K. T., Rosenberg, S. D., & Jankowski, M. K. (2008). Correlates of adverse childhood experiences among adults with severe mood disorders. Psychiatric Services, 59, 1018-1026.

Mersky, J. P., Topitzes, J., & Reynolds, A. J. (2013). Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: A cohort study of an urban, minority sample in the US. Child abuse & neglect, 37, 917-925.

Perry, B. D., & Pollard, R. (1998). Homeostasis, stress, trauma, and adaptation: A neurodevelopmental view of childhood trauma. Child and adolescent psychiatric clinics of North America, 7, 33-51.

Ramiro, L. S., Madrid, B. J., & Brown, D. W. (2010). Adverse childhood experiences (ACE) and health-risk behaviors among adults in a developing country setting. Child abuse & neglect, 34, 842-855.

Schilling, E. A., Aseltine, R. H., & Gore, S. (2007). Adverse childhood experiences and mental health in young adults: a longitudinal survey. BMC public health, 7, 30.

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, e232-e246.

Stein, M. B., Koverola, C., Hanna, C., Torchia, M. G., & McClarty, B. (1997). Hippocampal volume in women victimized by childhood sexual abuse. Psychological medicine, 27, 951-959.

Teicher, M. H., Ito, Y., Glod, C. A., Andersen, S. L., Dumont, N., & Ackerman, E. (1997). Preliminary evidence for abnormal cortical development in physically and sexually abused children using EEG coherence and MRIa. Annals of the New York Academy of Sciences, 821, 160-175.

Vink, R., Van der Pal, S., Eekhout, I., Pannepakker, F., Mulder, T. (2016). Ik heb al veel meegemaakt. Ingrijpende jeugdervaringen (ACE) bij leerlingen in groep 7/8 van het regulier basisonderwijs (TNO Report No. R11157). Retrieved from TNO website: https://www.tno.nl/nl/over-tno/nieuws/2016/11/ingrijpende-jeugdervaringe...

Weiss, M. J. S., & Wagner, S. H. (1998). What explains the negative consequences of adverse childhood experiences on adult health. American Journal of Preventive Medicine, 14, 356-360.