The Impact of Adverse Childhood Experiences on Mental Health

Adverse childhood experiences research summary

Researchers adjusted for family history of mental illness and genetics to tease out the relative importance of ACES compared to family/genetic influence.  Study involved Swedish twin study – compared fraternal and identical twins.  Total of 25,000 twins aged 18-57 born between 1959 and 1998.  With a follow up time of 39 years. 

Considered 7 Adverse Childhood Experiences

• Family violence,
• Emotional abuse or neglect
• Physical neglect
• Physical abuse
• Sexual abuse
• Rape
• Hat crime

Compared rates of psychiatric disorders including depression, anxiety, drug use, stress related disorders.

• 39% reported at least one ACE
• ACES increased odds of psychiatric disorder
• Sexual abuse and multiple ACEs increased the odds the most
• 8% had three or more ACES
• 9% diagnosed during study period
• That included 6% with no ACES and 25% with three or more
• Every increased ACE increased risk of diagnosis by 52%
• Depression, anxiety, stress not strongly genetic – but alcohol/drugs more so
• However, genetics played a role in all cases (identical vs fraternal twins)

CONCLUSIONS AND RELEVANCE This study found that associations between ACEs and adult mental health outcomes remained after controlling for shared genetic and environmental factors, which was particularly evident after multiple ACEs or sexual abuse. These findings suggest that targeted interventions may be associated with reduced risks of future psychopathology.

Previous twin studies suggested that 40-60% of vulnerability to depression, anxiety and PTSD are genetically based. 

Conclusions This cohort study using twin data found that the association between ACEs and adult mental health outcomes remained after adjusting for familial confounding due to shared genetic and environmental factors. This  suggests that interventions targeting ACEs, including primary prevention and enhanced access to evidence-based trauma therapies to individuals who experiencedACEs,maybeassociatedwithreducedriskoffuturepsychopathology.However,ourfindingsadditionallyindicate that family-wide risk factors (eg, genetic predisposition and socioeconomic disadvantage in childhood) also  contributed  to adult mental health outcomes among individuals who experienced ACEs, suggesting that there may be added value in addressing risk factors within the whole family.

Impact of adverse childhood experiences on the symptom severity of different mental disorders: a cross-diagnostic study

Study involved 1,500 people a older than 18, including 229 substance use disorder, 125 schizophrenia, 342 depression, 136 bipolar, 431 obsessive compulsives, 140 healthy controls.  Use early trauma inventory self report and diagnosis specific forms/surveys. 

ACEs differed significantly by disorder but overall much higher than in general population.

• 26% of patients with substance use disorder reported childhood trauma – higher than other disorders
• Emotional abuse score correlated with severity
• Sthe higher the trauma score – the more severe the mental disorder.
• Emotional abuse closely connected to many mental disorders.
• Incidence and severity can be died to reducing adverse childhood experience and timely intervention in childhood trauma.

Summary /key messages

• ACEs closely related to development of many mental disorders.
• ACEs affect psychology, cognition, behavior, psychology  and mental disorder risk
• Cumulative ACEs increase risk of psychopathology in adulthood and poor social functioning.
• This study found childhood trauma common in those with mental disorders.
• Emotional abuse affects severity of schizophrenia, depression and bipolar – and is a major risk factor for obsessive compulsive disorder severity.
• Previous studies found psychological abuse, sexual abuse and physical neglect significantly associated with reduced scores in working memory, executive functioning, verbal tasks.
• The greater severity of ACES, the greater the severity of schizophrenia – especially emotional neglect.
• Sexual and physical abuse associated with lifetime risk of heroin use – while cocaine use only correlates with severe physical abuse.
• Depression linked to ACEs – maybe due to changes in biological stress regulation systems including cortisol and cognitive function. 
• ACEs increase odds of biopolar, also linked to poorer response to treatment, higher numbers of psychiatric hospitalizations, lower premorbid functioning.
• ACE linked to emergence of OCD , disease progress, severity of symptoms, suicide probability, resistance to treatment. Emotional abuse and neglect increase odds of developing OCD.
• ACEs may increase odds of smoking behavior – substance abuse – ACEs and cannabis, etc. 
• In this study 25% experienced sexual trauma in childhood – childhood emotional abuse also had significant impact on severity for schizophrenia and OCD. 
• Children experiencing abuse and neglect have lower self esteem, negative self-evaluation, 
• Depression not linked to general trauma – but is related to physical, emotional and sexual trauma. 
• More severe childhood traumas predict more severe adult disorders.
• Sexual trauma more common in substance abuse than in other disorders.
• 68% pf women with substance abuse disorders suffered childhood sexual trauma.

The Impact of Adverse Childhood Experiences on Health and Development in Young Children

In recent years, there have been advances in research regarding the prevalence of Adverse Childhood Experiences (ACEs) and resulting poor outcomes for children who have experiences ACES. ACE exposure has been connected with poor academic performance, poor health outcomes, and certain diseases. However, there is still relatively little known about the prevalence and impact of ACE exposure in early childhood. Using the 2016 National Survey of Children’s Health, this study assessed the prevalence of adverse childhood experiences for children under the age of six years. This research measured the impact of individual ACEs on health and developmental outcomes and found that financial hardship and parental mental illness both had increased odds of having health and developmental difficulties. Furthermore, this work finds that there is a dose-response relationship between ACE count and increased risk of health and developmental difficulties. Conversely, children who were reported as affectionate with their parent had decreased risk for health and developmental problems. Programs supporting families with young children should focus efforts on enhancing quality of attachment, especially for children experiencing ACEs.

The initial ACE study found a strong relationship between exposure to abuse or household dysfunction during childhood and multiple health risk factors for the leading causes of death in adulthood. In their research Felitti et al 4 found that adults who had experienced 4 or more ACEs showed a 12 times higher prevalence of health risks such as alcoholism, drug use, depression, and suicide attempts. These findings raised awareness about the connection between childhood experiences and outcomes as an adult.

A more recent study examined over 700 medical records of youth receiving medical services at an inner-city pediatric clinic. Researchers found a 30-fold increase in learning or behavior problems (as reported by parents) between children with high ACE scores (4 or more) compared to children with no ACEs. This work helps to connect the dots between social risk factors and educational outcomes.

Overall, higher ACE scores were significant in predicting grades, school achievement, and drug abuse. Average ACE scores for schools were associated with state test scores, graduation rates, and college attendance rates.

In a nationally representative study, children with higher ACE exposure were less likely to be engaged in school and more likely to repeat a grade. Furthermore, children with more than 2 aces were more likely to have attention deficit hyperactivity disorder (ADHD), behavior problems, and to bully others. 1 The ACE studies have been helpful in connecting cumulative risks with academic, health, and social outcomes.

This study screened 140,000 households and processed 50,000 surveys – focused on children younger than five. 

Aces analyzed: 

• Poverty
• Divorce
• Death of parent
• Parent in jail
• Domestic violnce
• Neighborhood violen
• Parent metnially ill/suicidal
• Parent drug alcohol
• Victim of discrimination
• 15% of children with two or more aces had special health needs – three times overall average.
• The most powerful predictor for whether a child would need special health services was poverty and a parent with a mental illness.

This study highlights the risk cascade associated with early childhood exposure to ACEs and health and developmental outcomes. 

Lastly, this study contributes to the growing body of literature around resilience in examining the role of secure attachment in altering the impact of ACEs on health and development. Children who were reported showing affection to their parent had a decreased risk for health and developmental difficulties when compared to children with the same number of ACEs who did not frequently show affection toward their parent.

Conclusion

This study enriches the rapidly expanding literature on adverse childhood experiences and developmental implications, by narrowing the focus to early childhood where children are most reliant on their families and therefore may be most susceptible to family dysfunction and other ACEs. This study uses a nationally representative sample to confirm the risk cascade relationship between increased ACEs and risk for health and developmental difficulties. Furthermore, this study begins to examine the role parent-child attachment can play in promoting resilience in the face of adversity. The findings from this study underscore the importance of tailored interventions to prevent further risks and promote positive developmental trajectories during early childhood.

Gila county community risk assessment – 2021

Arizona ACES

• 0 – 52%
• 1- 18%
• 2: 12%
• 3: 6%
• 4: 8%
• 5: 5%

Includes: 

• Violence, abuse or neglect
• Witnessing violence in home or community
• Family suicide
• Divorce or separation
• Witnessing drug or alcohol use by parent
• Living with parents/guardians with mental health disorder.
• Imprisoned parent or guardian
• Adverse Child Experiences (ACEs) are negative experiences or traumas that occur during childhood. Evidence shows that ACEs can profoundly impact health outcomes and overall well-being across the lifespan. ACEs are linked to risky health behaviors, health conditions, and early death (ADHS, 2019). Children and adolescents with a high number of ACEs are at increased risk of experiencing chronic health issues such as depression, heart disease, obesity, and substance use disorder. Protective Childhood Experiences (PCEs) such as a safe and stable home and nurturing relationships and environments are known factors that help protect children from experiencing negative outcomes (ADHS, 2019).
• ACEs data for Gila County could not be located on the ADHS website or other reliable sources of information.