The Study that Shook the World of Mental Health

A pivotal study conducted at Kaiser Permanente between 1995 and 1997 under the direction of Dr. Vincent Felitti and Dr. Robert Anda shook the world of Mental Health. That study, in which more than 17,000 people answered questions about their adverse childhood experiences, came to be known as the ACEs study.

The study consisted of a questionnaire that asked about 10 kinds of adverse childhood experiences. These experiences ranged from having a parent who was either an addict, alcoholic or depressed; parental death or divorce; being bullied or some other form of humiliation; or being either physically, emotionally, or sexually abused.

Unfortunately, the results of the study were as clear as they were sobering. It was found that around two-thirds of the respondents had experienced one or more ACEs, and about one-fifth of them had experienced three or more ACEs.

A Disturbing Connection

But aside from the sheer number of children who suffered these traumas was the nearly direct correlation between the number of ACEs and the predictability of the amount of medical care that the same child would require in adulthood.

  • Those who had suffered from four categories of ACEs were twice as likely to contract cancer in adulthood than those who had no ACEs in their past.

  • For women, the risk of becoming hospitalized with an autoimmune disease jumped 20% with each ACE.

  • Anyone who had an ACEs score of 4 was more than 400% more likely to be afflicted with depression than an individual with an ACEs score of 0.

  • Those with an ACEs score of at least 6 had a reduced life span by nearly 20 years.

Researchers and health professionals discovered that early trauma, especially recurring trauma and toxic stress, and continuous activation of the stress response system, could accurately predict chronic health problems in adults with compromised immune systems and accelerated processes of disease and aging.

Perhaps Dr. Robert W. Block, past president of the American Academy of Pediatrics, put it best when he declared, “Children’s exposure to adverse childhood experiences is the greatest unaddressed public health threat of our time.”

The Lifelong Impact on a Child’s Brain

Children experience trauma differently than adults do. Adults can regulate initial reactions to trauma using coping mechanisms and previous experience. But young children don’t have the benefit of these adult complex thinking processes.

Continual stress for children appears to be more damaging than a one-time event. Without the reassurance of a compassionate adult, stress and trauma remain unresolved and stores of stress-related hormones continue to be released by the brain’s activated amygdala which stimulates disease.

1. Shifting Epigenetically

Epigenetics describes the way that our genes are turned on and off – whether a specific gene is used or not. Research has shown that our life experiences change our epigenetic profile or, in other words, our gene expression. Not only does this affect the individual, but can also be passed from one generation to the next through those genes.

The child who is consistently thrust into stressful situations is thrown into a physiological response that shifts her into overdrive. This incessant stress ultimately compromises her ability to respond appropriately and effectively to other stressors, even years later.

In neuroscience, this impact on the genes is known as gene methylation. The consequence is a predisposition to several chronic conditions, including autoimmune disease, heart disease, cancer, and depression.

2. Altering the Shape and Size of the Brain

MRI studies show that there is a direct relationship between a high ACEs score and a reduction of the gray matter in vital areas of the brain, including the prefrontal cortex, the seat of decision-making and self-regulatory skills, and the amygdala, or fear-processing center.

Also, scientists have discovered that chronic brain stress causes the release of a hormone that shrinks the size of the hippocampus. The hippocampus is that area of the brain responsible for processing emotion and memory, and managing stress.

As a result, those whose brains have been altered by their Adverse Childhood Experiences are generally more likely to become adults who will overreact to stressors that others consider minor and handle with relative ease, due to their compromised brain physiology.

3. Connectivity in the Brain

Children who have experienced chronic childhood adversity have weaker neural connections between the prefrontal cortex and the hippocampus, impairing several functions of the brain.

Girls, in particular, displayed weaker connections between the prefrontal cortex and the amygdala. The relationship of the prefrontal cortex and the amygdala plays a crucial role in determining how emotionally reactive a person is to those regular occurrences that happen in daily life, and how likely they have perceived these events as stressful.

What’s more, girls with these compromised neural connections were at a higher risk for developing anxiety and depression in later adolescence. This may partially explain why females suffer from mood disorders nearly twice as often as males at that age.

Lifelong Consequences

1. Compromised Physical Health and Shortened Lifespan

Medical Challenges

Heart disease, liver disease, diabetes, cancer, and strokes are far more common in adults with high ACEs scores. What’s more, high ACEs scores often predict autoimmune diseases in women. This correlation is thought to be at least partly due to the effect of chronic stress on developing brains.

Living in a constant high-stress response mode often promotes chronic inflammation, dampens the immune system, and compromises their bodies’ regular maintenance and rebuilding.

Stress hormones have proven to be disruptive to physical function over the long run. Additionally, high-stress responses expend a great deal of energy, which, consequently, impairs other physiological functioning and routine processes.

Early Death

All of the aforementioned challenges above point to one very disturbing fact: adults with high ACEs scores have a life expectancy that is 20 years shorter than those with lower ACEs scores.

These adults often succumb to the effects to which they are prone: suicide, alcoholism, and drug use, to name but a few.

ACEs, by laying the foundation for impaired brain development, essentially contribute to mental health disorders, risky behaviors, and social instability. Often, any one of these factors ultimately causes an increased risk of early death.

2. Suffering from Poor Mental Health

Depression

Studies have shown that the most significant mental health risk for adults with high ACEs scores is depression. Not only do those with high ACEs scores experience more depressive episodes, but they also take longer to recover from these episodes.

Anxiety

Aside from depression, adults with high ACEs scores are also more likely to suffer from generalized mental distress and anxiety than the general population. And ACEs have been found to be an active ingredient in the development of post-traumatic stress disorder.

3. Less Socially Stable and Likely to Engage in Risky Behavior

Risky Behaviors

Because of their disrupted brain development, those with high ACEs scores are more likely to participate in personally and socially risky behaviors. There is a direct correlation between high ACEs scores and earlier and riskier sexual activities, higher rates of unintended pregnancy, smoking, alcoholism, and substance abuse.

Stability

Aside from engaging in risky behaviors, those with high ACEs scores more often report poor work performance or unemployment. They are more likely to have multiple sexual partners, and have been found to be at higher risk of sexual violence and intimate partner violence.

Resilience is a Powerful Antidote to ACEs

However, ACEs are only one-half of any equation when attempting to predict a child’s future course as an adult. Although the intensity of each child’s trauma is different, they also possess their own unique set of protective characteristics that can shield them from that trauma, known as resilience.

A high ACEs score is by no means a guarantee to a life of suffering as an adult. While it is certainly a big warning sign, a child is not necessarily doomed by the ACEs score.

In determining what will be, there are two critical factors at play:

  1. The child’s biological and developmental characteristics (Nature)

  2. External influences from their family, community, and support systems. When these influences are positive they become “protective factors.” The protective factors explain why adults with high ACEs scores succeed as adults. (Nurture)

A 2017 “ACEs and Resilience” study conducted by the National Health Service in Wales found that, overall, having supportive friends, opportunities to engage with their community, people to look up to, and other sources of resilience in childhood more than halved the current mental illness in adults with four or more ACEs from 29% to 14%.

And the good news for every child is that resilience is like a muscle — the more it is exercised, the stronger it grows, particularly in very young children whose neural pathways are still forming and thinking patterns are elastic. The neuroplasticity of the brain allows for healing, rewiring, and new coping skills to develop.

Perhaps when ACEs meet resilience, they have met their match!