An Introduction to Adverse Childhood Experiences

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We are all touched by trauma, in one way or another.

Every day, behavioral health professionals are talking to people affected by trauma. 

In the Connecticut Women’s Consortium training, The Long Reach of Childhood Trauma: Using the ACE Study to Inform Practice, Colette Anderson, LCSW and Shannon Perkins, LMSW, define trauma, provide an overview of the groundbreaking adverse childhood experience (ACE) study, and discuss effective treatment for trauma survivors.

What is trauma and what is the connection between adverse childhood experiences (ACEs) and the lifelong consequences of trauma?

Trauma Basics

Trauma is what happens when the extreme stress of an event or circumstances overwhelm a person’s ability to cope.

Those circumstances vary, but they are all threats to physical or emotional health: violence, hate crimes, sexual abuse, or anything that causes extreme stress.

Living in under‑resourced neighborhoods, moving a lot, and experiencing racism are all stressors that have lasting effects on bodies and minds.

Unfortunately, trauma is all too common. According to the Centers for Disease Control (CDC), 61% of people report experiencing at least one type of ACE before age 18, with 1 in 6 experiencing 4 or more types of ACEs.

What Happens When a Person Experiences Trauma?

Trauma wreaks havoc on the brain and body, keeping people on high alert and making them sense danger all around.

When humans experience trauma, their ability to distinguish between the past and present can be compromised. They might also have trouble interpreting context. The part of the brain that responds to threats—the amygdala—makes it hard to tell when they are safe or unsafe. 

Even normal stressors or stimuli can cause them to become agitated, and they may experience flashbacks or intrusive recollections of traumatic events.

Signs and Symptoms

There are numerous signs and symptoms of living with trauma. Some of them are emotional, while others are physical. The following are just a few of many:

  • Numbness
  • Anxiety/severe fear
  • Guilt
  • Sadness
  • Difficulty focusing
  • Feeling overwhelmed
  • Memory problems
  • Sleep problems
  • Detachment
  • Substance use
  • Hyperarousal
  • Flashbacks
  • Long‑term health effects like reduced immunity and autoimmune problems

The ACE Study—and Why It’s Important

The CDC‑Kaiser Permanente adverse childhood experiences (ACE) study is one of the largest studies ever conducted to try to determine the effect of trauma on individuals. 

The study was based on research by Dr. Vincent Felitti and Dr. Robert Anda, and it provided evidence that childhood exposure to violence, especially harm done by caretakers, has a lasting impact on mental and physical health.

The researchers developed a confidential survey, the ACE Score Questionnaire, which is still used today. They gathered answers from more than 17,000 participants from 1995‑1997. The participants all received a physical examination and answered detailed questions about how they were treated (or mistreated) by adults. It also included questions designed to determine whether abuse of others was occurring in the home, and whether they grew up feeling like they didn’t have enough to eat, or if their parents were too impaired by drugs and alcohol to take care of them. 

What Is Considered an ACE?

  • Physical, sexual, or verbal abuse
  • Physical or emotional neglect
  • Witnessing your mother being abused
  • Losing a parent
  • Having a family member who is
    • Depressed or diagnosed with another mental illness
    • Addicted to alcohol or another substance
    • Incarcerated

The Long-Term Effects of Trauma

Some of the major findings of the ACE study include the following:

  • Almost two-thirds of the participants reported at least one ACE.
  • More than 1 in 5 reported more than 3 ACEs.
  • Women are slightly more likely to have a high ACE score than men.
  • Some social and economic conditions made certain populations more likely to experience ACEs.
  • As the number of ACEs increased, so did the risk for negative outcomes.

The negative outcomes of ACEs are numerous, including injury, mental health conditions, maternal health concerns, infectious and chronic disease, risky behaviors, and missed opportunities in school and life.

And the fact is many people who experience ACEs struggle throughout their lifetimes.

IIn this TedMed Talk, pediatrician Nadine Burke Harris discusses the connection between the trauma of ACEs and brain development. In her TedMed Talk, Burke Harris points out that the effects of untreated trauma across a lifetime are devastating. For example, people who grew up with high levels of trauma are three times more likely to get cancer or heart disease.

Trauma-informed and Trauma-specific Treatment

Thanks to the pioneering work of the ACE study and many others, we are learning more about how to address trauma to help people heal from the events of the past. There are two main types of trauma treatment:

  • Trauma‑informed treatment, which incorporates knowledge of trauma even though the treatment focuses on substance use, mental health disorders, or other issues.
  • Trauma‑specific treatment, which is specifically designed to address trauma.

There are many approaches to treating trauma in behavioral health settings. Sometimes group therapy is an affordable option that offers a chance to develop bonds with others in similar situations. For some folks, individual therapy provides a more intimate space for focusing on their specific experiences.

The following are some well‑known trauma‑specific treatment models for individual treatment:

  • Trauma Affect Regulation: Guide and Education Therapy (TARGET) by Julian Ford, ages 10+
  • Eye Movement Desensitization and Reprocessing Therapy (EMDR) by Francine Shapiro 
  • Accelerated Resolution Therapy (ART) by Laney Rosenzweig

And there are group models, too, including:

  • Seeking Safety by Lisa Najavits
  • Trauma Recovery and Empowerment Model (TREM) by Maxine Harris
  • M‑TREM by Roger Fallot
  • Beyond Trauma by Stephanie Covington
  • Exploring Trauma by Stephanie Covington with Roberto Rodriguez
  • Healing Trauma by Stephanie Covington with Eileen Russo

Healing from Trauma

With over half of the population reporting at least one traumatic experience—and others experiencing multiple ACEs throughout their lifetimes—we clearly have our work cut out for us.

We can start by understanding trauma’s long reach, and its effect on the brain, body, and soul. 

We can tap into the inner strength and resilience that exists in all of us.

Then we can work together toward behavioral health solutions rooted in science and compassion.


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