Adverse Childhood Experiences (ACEs) describes all types of abuse, neglect, and other traumatic experiences that occur to people under the age of 18. ACEs harm a child’s developing brain and body so profoundly that the effects can be seen decades later. ACEs often show up in adults as chronic disease, mental illness, addiction, and violence.
Of course, emotional, physical, and sexual abuse qualify as ACEs. However, did you know that a child doesn’t have to be exposed to extreme abuse for them to have an ACE? Unfortunately, common life experiences can prove traumatic to a young brain. Adverse childhood experiences include:
- emotional abuse
- physical abuse
- sexual abuse
- emotional neglect
- physical neglect
- mother treated violently
- household substance abuse
- household mental illness
- parental death, separation, or divorce
- incarcerated household member.
Such experiences change how a child’s brain responds to stress. ACEs puts them at much higher risk for negative mental and physical health conditions and life outcomes as adults.
Early Adversity Has Lasting Impacts
The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study, one of the largest investigations of childhood abuse and neglect and household challenges and later-life health and well-being, found that the more categories of trauma experienced in childhood, the greater the risk of negative consequences. In other words, as the number of ACEs increases so does the risk for the negative life outcomes. For a comprehensive listing of research for each outcome see selected journal publications.
The total number of ACEs in specific categories has a strong association with drug use. This makes sense, as the more continuous or more frequent the ACEs in a child’s life, the more damage is done. Also, more likely are co-occurring illnesses, such as substance abuse + mental health issues.
image source: https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/about.html
According to the American Academy of Pediatric’s paper “Adverse Childhood Experience and the Lifelong Consequences of Trauma“, physical or mental trauma interferes with the normal maturation of a child’s brain. These alterations occur at a deep level where the most basic needs originate and a person’s identity is formed. Trauma can significantly alter the primitive parts of the brain that govern how a person responds emotionally. Early childhood trauma also impacts the more evolved parts of the brain that guide the ethical and moral guidelines of society. Because of this, a person’s ability to control their behavior, impulses, and primitive urges is compromised. This can detrimentally affect every part of a person’s life as an adult.
For an in-depth explanation of how this happens, see the article The Developing Brain & Adverse Childhood Experience (ACEs). An excerpt is below:
The impacts of these ACEs are related to toxic stress, which is the repeated activation of the brain’s fight-or-flight stress response system (FFSR) within the Limbic System. Like other instinctual neural network wiring – puberty, for example, the FFSR is an instinctually wired system built into the human species. It is a system that was intended to kick into gear when mankind was faced with physical danger. This makes sense when we recall that back in the day the primary danger humans faced was physical danger, as in, “Run or Fight,” but don’t just stand there!
Thus, this system is designed to prepare the body to do just that – fight or run, or if necessary, freeze. And it’s a two-part system. One part is the activation — the part that gets the FFSR going fast and without thought. It’s called the Sympathetic Nervous System (SNS). The second part is the tamping down — returning to normal. This is called the Parasympathetic Nervous System (PNS).
…There are two big problems with chronic activation of the FFSR if one does not have solid, self-soothing practices also mapped — practices they engage to stop the escalation of the SNS. The first is that a child/teen/adult rarely does the physical running or fighting these changes are meant to support. Instead, all of that “stuff” (increased glucose, shutting down of the digestive system, increased heart rate, and high levels of stress hormones) “sits” and builds up in various body tissues until (or if) it is reabsorbed or used. In other words, it becomes toxic stress because the PNS never gets to fully do its part.”
When a Good Hormone Goes Bad
So, the negative impact of ACEs basically comes down to stress. On a biological level, stress is a normal physical response. You experience stress anytime you ask your body to adapt or respond in some way. It’s not all bad and actually accompanies good things too, like a wedding or promotion. Stress is an essential part of living.
Cortisol, the stress hormone is produced by the adrenal glands, and released, along with adrenaline, in situations that invoke the flight or fight response. Initially, cortisol helps tone down the immune system during crises and acts as an anti-anxiety hormone. Ironically, cortisol is both anti-inflammatory and anti-anxiety at first. The problem arises when stress becomes an almost constant state and chronic condition.
When a crisis is ongoing — as in ACEs —cortisol will convert into an inflammatory substance, which exaggerates a person’s perception of pain and leads to psychological issues, such as anxiety, depression, and even brain damage. When the crisis doesn’t really end, neither does the stress, which causes cortisol secretion to be continuous.
Research shows that chronic stress decreases the volume of the brain’s limbic system, including the amygdala and hippocampus, associated with memory and emotions, as well as the pre-frontal cortex, which is responsible for higher-level thinking and decision making. This can lead to a decreased ability to manage emotions and make healthy life’s decisions, high-risk behaviors, as well as deficits in IQ, memory, attention, and response inhibition, which makes a person vulnerable to both mental illness and substance abuse.
Where Anatomy Meets Behavior
The human brain is an amazing collection of neurons that interconnect in complex networks to allow for countless functions. Your brain controls everything from the regulation of heart rate and breathing to intelligent reasoning and humor. The daily encounters with the world around us require a web of activations, deactivations, stimulations, and inhibitions. When these go awry, mental health and behavioral issues emerge.
In young adults who have suffered the effects of ACEs, high-risk behavior, loss of inhibition, poor executive decisions, and inability to delay instant gratification conspire to lead to mental health issues and substance abuse. These conditions are made worse by a brain with poor emotional and impulse control. If you add chronic pain, which is more easily invoked by cortisol damage to the brain, to the mix, you can get a seriously dysfunctional individual on many levels. But the good news is that the brain can change again and heal.
It’s Never Too Late to Rewire the Brain
One of the many powerful findings of recent brain research is neuroplasticity — the brain’s ability to reorganize and form new neural networks throughout one’s life based on input. Neuroplasticity is how the brain gets altered by childhood experiences in the first place, and it is how it can heal.
The presence of an ACE does not guarantee a mental health issue or poor life outcome. Positive experiences or protective factors can protect children from experiencing adversity and can prevent some of the negative physical and mental outcomes even after trauma has occurred. It is possible to break the cycle of stress.
Incredible and promising work being is being done with trauma-informed practices and therapies utilizing neuroplasticity. These practices can help children (by helping their parents, pediatricians, caregivers, neighborhoods, schools, communities…) who have or may experience ACEs to protect, rewire or repair their brains from the consequences of ACEs-related toxic stress during their brain’s development. Check out these resources to aid in recovery from the article The Developing Brain & Adverse Childhood Experience (ACEs):
- ACEs Connections Resources Center, specifically “Trauma-informed guides, presentations & self-assessment tools”
- The National Child Traumatic Stress Network
- Jane Steven’s article, “Growing Resilient Communities 2.0“
- ACEs Connection Communities
- Center for Youth Wellness
Medical Reviewer – Dr. Gerard M. DiLeo, MD, CLCP
Dr.Gerard M. DiLeo is a medical doctor and Certified Life Care Planner. Dr.DiLeo is also a published health author for McGraw-Hill, as well as has contributed health articles to newspapers and regional magazines for over 30 years. He was in private practice in the New Orleans area during these years, serving as Chief-of-Staff at a regional hospital twice. He is currently writing full time for professionals and laypersons alike, backed by his lengthy experience in pelvic dysfunction specifically and pain management in general. Read more here.