The results of the research, which were published in AAN’s journal Neurology: Clinical Practice, provide more evidence on how stress and traumatic events endured in childhood can have a lasting effect on physical and mental wellbeing.
The Study
The researchers gave 198 outpatient adults being seen for neurological symptoms at the University of Pennsylvania the ACE questionnaire as well as screenings for anxiety and depression.
When they looked at the results of the questionnaire and screenings, the researchers found that 23.7% of the patients had high ACE scores—much higher than those of the general population (12.6%).
The high-scoring patients were being treated for neurological conditions such as stroke, headaches, and epilepsy. The researchers also noted that these patients had higher:
Rates of emergency room visits and hospitalizationsRates of co-existing medical and/or psychiatric risk factorsAnxiety and depression scores
Adys Mendizabal, MD, a neurologist with the University of California Los Angeles and an author of the study, tells Verywell that researchers are becoming more aware of how ACEs affect health.
Mendizabal was prompted to undertake the study because they had observed that a lot of patients who were getting a neurological consultation had a history of trauma. Having “noticed a bit of an association,” Mendizabal says that they “wanted to look into it.”
ACEs and Long-Term Health
Research has shown that the environment that a child grows up in influences their development into an adult.
For example, in the mid-1990s, Kaiser Permanente conducted a trail-blazing study that showed abuse and dysfunction in a child’s home was linked to risk factors for several leading causes of death in adults.
The researchers developed a questionnaire that asked adults about specific adverse events or experiences that they had endured as children, including:
Psychological, physical, or sexual abuseViolence against motherHousehold substance abuse, mental illness, suicide attemptsIncarcerated family members
The participants that had experienced four or more adverse events in childhood had a higher risk of developing lifestyle factors and habits as adults that contributed to poor health outcomes, such as:
Alcoholism/SmokingDrug abuseSuicide attemptsDepressionObesitySexually transmitted diseasesPhysical inactivity
Toxic Stress
Children who experience one or two of these adverse events for a short time usually recover and grow up without experiencing lasting harmful effects. However, children who live in dysfunctional households for long periods—especially during the early years of development—experience “toxic stress.”
Long-term exposure to high “doses” of stress (chronic toxic stress) triggers the body to produce high levels of the stress hormone cortisol.
When a person has elevated cortisol levels for a long time, it can contribute to health conditions such as:
DiabetesChronic obstructive pulmonary disease (COPD)Cardiovascular diseaseStrokeCancerPost-traumatic stress disorder (PTSD)
Brain Changes
Research has also shown that exposure to high levels of cortisol over long periods can also change a child’s brain chemistry. These changes can contribute to learning delays, behavioral difficulties, and mood disorders, which can place kids at risk for academic and social challenges during their school years.
A 2009 study published in the American Journal of Preventive Medicine found that adults with an ACE score of six or more died an average of 20 years earlier than people who did not have a history of ACEs.
“The trends are true,” Ryan Matlow, PhD, child clinical psychologist, Stanford School of Medicine, tells Verywell. “The burden of chronic stress and complex trauma in childhood has a large impact emotionally, psychologically, and affects their behavior.”
Identifying ACEs Early
As the medical community becomes more aware of how trauma can shape a child’s future physical and mental wellbeing, experts are developing processes to identify and support children with high ACE scores before the negative health consequences can develop.
For example, many doctor’s offices are starting to screen patients using the ACE Quiz assessment, which can help them identify children at high risk and provide early interventions and resources.
According to the Center for Disease Control and Prevention (CDC), highly effective interventions and prevention tools include:
Strengthening a family’s financial securityResources on giving young kids a good start with schoolConnecting children with caring adults and activitiesTherapy and mental health supportSupporting and educating parents on positive parenting tactics
Normalizing Mental Health
In the last couple of years—and especially after a year of lockdown during the COVID-19 pandemic—Americans have experienced an attitude shift toward mental health awareness and the negative downstream effects that it can cause if left untreated.
Mental health is now being recognized as a public health emergency, and governments and organizations are prioritizing initiatives in policy creation and making resources accessible to everyone.
Normalizing mental health can also help prevent the negative outcomes of childhood trauma and children with high ACE scores.
“An impactful intervention for children with a history of complex trauma would be to normalize the negative emotions we feel as natural,” says Matlow. “And combine this with the psycho/educational piece and skill-building to support them.”
In a culture that has systematically undervalued and stigmatized the importance of mental health resources and the effects that they can have on our long-term health, we are beginning to see progress.
What Can We Do?
Awareness and prevention are key for helping children and adults who have experienced childhood trauma become more resilient and counteract the risk factors and health conditions that can show up later in life.
Adopting a trauma-informed care mindset is a starting point for getting schools, government systems, healthcare facilities, and organizations to change how they communicate with people who may have a history of childhood trauma.
“It doesn’t take a professional to help a child with the skills and tools to build resilience,” says Matlow. “Establishing safety, encouraging storytelling, and creating an exposure narrative are the core components of supporting children with childhood trauma.”
Taking steps to normalize these conversations—including the realization that negative emotions are part of being human—can help communities shift toward being more mental health-centered.
We can normalize the mental health conversation in our daily lives by:
Digging deeper in our conversations with friends and familySpeak openly if we are struggling with negative emotionsPolitely point out if someone says something about mental health that is stigmatizing or incorrectBecome educated on trauma-informed care and how to change our language around mental health
