In the general population, prevalence of Adverse Childhood Experiences (ACE) is common. ACEs are the adverse experiences faced before the age of eighteen and include neglect, abuse, and dysfunctional households. These unfortunate circumstances of early years may have negative influence on individuals' later life by affecting one's physical, mental, social and cognitive health. This may result in poor adult life functioning and hampers the overall well-being.

Prevalence

• ACEs affect all communities and cross racial, ethnic, socioeconomic, gender, and geographic boundaries.

• Two-thirds of us have at least one ACE.

• As reported by the Centers for Disease Control (CDC), about 64% of adults in the United States reported experiencing at least one type of ACE before age 18, and nearly 1 in 6 (17.3%) reported having experiencing 4 or more ACE types.

• In a 2014 UK study of ACEs, 47% of people experienced at least one ACE and 9% of the population had 4 or more ACES (Bellis et al, 2014).

• In 2016, Public Health Wales published the first Welsh adverse childhood experiences study showing that 47% of adults in Wales had at least one adverse childhood experience and 14% had four or more adverse childhood experiences.

Impact of ACEs

Physical Health

According to the CDC, adverse childhood experiences can increase the risk of injury, sexually transmitted infections, and maternal and child health problems (including teenage pregnancy, pregnancy complications and fetal death), participation in sex trafficking, and a variety of chronic and serious diseases, leading causes of death such as cancer, diabetes, heart disease and suicide. People with 6 or more ACEs die on average nearly 20 years earlier than people with no ACEs (Brown, et al., 2009). Research indicates that individuals with a history of childhood adversity have increased inflammatory biomarkers (Baumeister, Akhtar, Ciufolini, Pariante, & Mondelli, 2016) (Danese, Pariante, Caspi, Taylor, & Poulton, 2007) and dysregulation of the HPA axis (Strüber, Strüber, & Roth, 2014), which contributes to increased allostatic load and susceptibility to chronic physical health problems such as cardiovascular disease and metabolic disorders (Danese & McEwen, 2012).

Psychological Health

Child maltreatment was significantly associated with a range of later mood, anxiety, and substance use disorders, suggesting that maltreatment, not just memories of maltreatment, has been linked to later subsequent psychopathology (Scott, Smith, & Ellis, 2010). Childhood adversities are differentially associated with PTSD, with the strongest associations in childhood-adolescence and early-middle adulthood (McLaughlin, et al., 2017). Childhood maltreatment, especially emotional abuse and neglect, is a risk factor for severe, early-onset, treatment-resistant, and chronic depression (Nelson, Klumparendt, Doebler, & Ehring, 2017).Exposure to ACE inhibitors is associated with an increased risk of depressive disorders decades after onset (Chapman , et al., 2004). The prevalence of ACEs in SUD (substance use disorders) populations is higher than in the general population, and there is a positive association between ACEs and the development and severity of SUDs in adolescence and adulthood (Leza, Siria, Goñi, & Montalvo, 2021).

Cognitive Health

The CDC reports that ACEs and health-related social factors, such as living in under-resourced or racially segregated neighbourhoods, can cause toxic stress (long-term or prolonged stress). Toxic stress from ACEs can harm a child's brain development, immune system, and stress response system. A child's attention, decision-making, and learning could get affected by these changes. Cognitive decline has been shown to be associated with more ACEs. Higher ACE, especially of the deficit type, is likely associated with poorer cognitive performance (Hawkins, et al., 2021).

Social Health

The CDC reports that ACEs can have negative and lasting impacts on childhood health, well-being, and life opportunities, such as educational and employment potential, into adulthood. Children who grow up exposed to toxic stress may have difficulty forming healthy and stable relationships. They may also have unstable work histories as adults and experience financial and employment difficulties and depression throughout their lives. These effects can also be passed on to their children.

References

Baumeister, D., Akhtar, R., Ciufolini, S., Pariante, C., & Mondelli, V. (2016). Childhood trauma and adulthood inflammation: a meta-analysis of peripheral C-reactive protein, interleukin-6 and tumour necrosis factor-α. Molecular psychiatry, 21(5), 642-649.

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.

Brown, D. W., Anda, R. F., Tiemeier, H., Felitti, V. J., Edwards, V. J., Croft, J. B., & Giles, W. H. (2009, Nov). Adverse childhood experiences and the risk of premature mortality. Am J Prev Med, 37(5), 389-96. doi: 10.1016/j.amepre.2009.06.021

Chapman , D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R., Edwards, V. J., & Anda, R. F. (2004, October 15). Adverse childhood experiences and the risk of depressive disorders in adulthood. Journal of Affective Disorders, 82(2), 217-225.

Danese, A., & McEwen, B. (2012). Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiology & behavior, 106(1), 29-39.

Danese, A., Pariante, C., Caspi, A., Taylor, A., & Poulton, R. (2007). Childhood maltreatment predicts adult inflammation in a life-course study. Proceedings of the National Academy of Sciences, 104(4), 1319-1324.

Hawkins, M. A., Layman, H. M., Ganson, K. T., Tabler, J., Ciciolla, L., Tsotsoros, C. E., & Nagata, J. M. (2021, May). Adverse childhood events and cognitive function among young adults: Prospective results from the national longitudinal study of adolescent to adult health. Child Abuse & Neglect, 115, 105008.

Leza, L., Siria, S., Goñi, J. L., & Montalvo, J. (2021, August 1). Adverse childhood experiences (ACEs) and substance use disorder (SUD): A scoping review. Drug and Alcohol Dependence, 225, 108782.

McLaughlin, K. A. (2016). Future Directions in Childhood Adversity and Youth Psychopathology. Journal of Clinical Child and Adolescent Psychology, 45(3), 361-382. doi:https://doi.org/10.1080/15374416.2015.1110823

McLaughlin, K., Koenen, K., Bromet, E., Karam, E., Liu, H., Petukhova, M., . . . Kessler, R. (2017). Childhood adversities and post-traumatic stress disorder: evidence for stress sensitisation in the World Mental Health Surveys. The British journal of psychiatry, 211(5), 280-288.

Nelson, J., Klumparendt, A., Doebler, P., & Ehring, T. (2017). Childhood maltreatment and characteristics of adult depression. The British Journal of Psychiatry, 210(2), 96-104.

Scott, K., Smith, D., & Ellis, P. (2010). Prospectively ascertained child maltreatment and its association with DSM-IV mental disorders in young adults. Archives of general psychiatry, 67(7), 712-719.

Strüber, N., Strüber, D., & Roth, G. (2014). Impact of early adversity on glucocorticoid regulation and later mental disorders. Neuroscience & Biobehavioral Reviews, 38, 17-37.