Childhood Adversity & Adulthood

Adverse Childhood Experiences (ACE) is a term introduced from a pivotal study in 1998 by Felitti et al, that identified the profound link between childhood adversity (abuse, neglect, and household stressors) and adult health, wellbeing, and social functioning.

Continuation of such research has consistently demonstrated that the more ACE’s a child experiences, the higher the probability in adulthood that they will experience adverse physical health, mental health (such as complex PTSD, PTSD, depression, anxiety or other major mental illnesses), social and behavioural problems, with increased risk of self-harm/suicidal ideation/behaviour, substance misuse, incarceration/contact with the justice system, lower educational attainment and eating disorders.

Children exposed to ACE’s experience a triggering of a chronic stress response (‘toxic’ stress), affecting brain development and functioning.  These changes, trigger a chronic inflammatory response that contributes / and elevates the risk of onset of ACEs-related diseases, and adverse lifetime experiences (see illustration below).

Exposure to ACE’s elevates the person’s risk to further adverse events in later life, re-traumatising (or creating new trauma) for the person.

Adults that were exposed to 5 or more ACE’s as a child experience increased rates or prescribed psychotropic medications:

• Twofold increase in anti-anxiety prescriptions

• Tenfold increase in anti-psychotic prescriptions

• Seventeen-fold in mood stabilising prescriptions

Importantly, it is not 'cause and effect', whilst exposure to ACE's increases the risk of adverse outcomes, it is not inevitable.

Protective factors, such as consistent, responsive and predictable support, validation, nurturing etc. in childhood can act as a ‘buffer’, potentially building resilience, healthier brain development, improved social engagement and reducing the associated longer-term risks.

Critically, research indicates that a single, nurturing, supportive, consistent relationship can have a significant, positive effect on the child and their longer-term prognosis. Many adults that experienced significant childhood adversity lead successful lives and enjoyed positive relationships. These adults commonly report having had another person in their life that helped them feel safe, protected and supported their resilience. (Emerging Minds. January 2020).

As a therapist, (and mental health nurse), many people whom I have spoken with express their negative experiences of engaging with therapists that used an unsuitable approach, invalidated their experiences, did not have the necessary skills, knowledge or experience and, though unintentionally, caused more distress, with poor (or counter-therapeutic) outcomes

Concerningly, people have expressed to me that they have been directly blamed by health professionals for not achieving the identified goals/outcomes. Comments such as "you are too complex" or that they "didn't fully engage in the process" have been commonly reported. These 'throw away comments' blaming the individual (whilst not reflecting on the practitioner's own competence) have had dire consequences, increasing sense of hopelessness, self-blame, shame, guilt etc.

If a person may benefit from therapy because of trauma and or ACE’s, then it is essential the therapist specialises in trauma therapies, with advance skills and knowledge on the subject (and is not just ‘trauma informed’). 

Important note, there are many highly skilled, effective, specialist therapists that provide effective, evidence bases trauma focused treatment, with positive outcomes. My hope is that people accessing therapy, engage with such therapists on their first contact with services. My expression of the aforementioned concerns is based on biased experience - the people that I see and provide services for, are the people that have either not accessed services before, or, more commonly, have engaged with therapists/mental health professionals that, as expressed above, did not have the appropriate skillset or experience.

To enhance your knowledge on trauma, adversity, PTSD and complex PTSD, register for our 2-day masterclass workshop at www.vistatherapy.com.au and click on Training Workshops.

If you would like an appointment with a therapist that specialises in trauma focused therapy, then visit our website for more information and to book your appointment.

References & Bibliography

• Baglivio, M. T., Epps, N., Swartz, K., Sayedul Huq, M., Sheer, A., & Hardt, M. S. (2014). The prevalence of adverse childhood experiences (ACE) in the lives of juvenile offenders. Journal of Juvenile Justice, 3(2).

• Crouch, E., Radcliff, E., Strompolis, M., & Srivastav, A. (2019). Safe, stable, and nurtured: Protective factors against poor physical and mental health outcomes following exposure to Adverse Childhood Experiences (ACEs). Journal of Child and Adolescent Trauma 12, 165–173. doi:10.1007/s40653-018-0217-9

• Emerging Minds & The National Workforce Centre for Child Mental Health.  2020.  Adverse Childhood Experiences (ACEs): Summary of evidence and impacts.  January 2020.  Sourced from ACES-Summary-of-Evidence-and-Impacts-V2.pdf.  Sourced on 14.12.2024

• Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J. S. (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(4), 245-258. doi: 10.1016/s0749-3797(98)00017-8

• Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., … Dunne, M. P. (2017). The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. The Lancet Public Health, 2(8), e356-e366. Doi: 10.1016/S2468-2667(17)30118-4

• Kerker, B.D., Zhang, J., Nadeem, E., Stein, R. E. K., Hurlburt, M. S., Heneghan, A., … McCue Horwitz, S. (2015). Adverse childhood experiences and mental health, chronic medical conditions, and development in young children. Academic Pediatrics, 15(5), 510-517. doi: 10.1016/j.acap.2015.05.005

• Zubrick, S., Silburn, S. R., Lawrence, D., Mitrou, F. G., Dalby, R. B., Blair, E., … Li, J. (2005). The Western Australian Aboriginal Child Health Survey: The social and emotional wellbeing of Aboriginal children and young people. Perth, Western Australia: Curtin University of Technology and the Telethon Institute for Child Health Research.