Hannah Robinson

Dr. Workman

Literature Review

22 March 2021

ACEs travel into Adulthood

Adverse Childhood Experiences (ACEs) are negative events that happen between ages 0-

17 and are fairly common. Approximately 61% of adults have reported experiencing at least one

type of ACE, and 1 in 6 adults have reported experiencing at least 4 ACEs (Adverse Childhood

Experiences (ACEs)). About 39% of females and 21% of males in the United States experience

multiple ACEs prior to 18 years of age (Haahr-Pedersen et al.). Some examples of ACEs

include: instability, experiencing violence or seeing violence at home or within the community,

substance misuse, witnessing death, parents having a divorce and experiencing mental health

problems, among others. Since many adults experience ACEs, this leads to the question of in

what ways do ACEs affect adult lives?

Defining childhood exposures can be a tricky task. Most studies use a questionnaire that

was used in the CDC-Kaiser Permanente Adverse Childhood Experiences Study. This study

breaks down adverse childhood events into 3 categories of childhood abuse: physical abuse,

psychological abuse, and sexual abuse and 4 categories of household dysfunction: exposure to

substance abuse, mental illness, violent treatment of mother or stepmother, and criminal behavior

(Felitti et al.). There are a total of 17 yes or no questions across this questionnaire. If a person

responds “yes” then they receive one point. The higher the score, the more ACEs someone has

experienced. The purpose of this study was to create such a questionnaire that could be used

within research. This study is cited multiple times throughout research that has used this exact
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measure when gathering information, making it a reliable way to introduce and discuss what

ACEs are. With this high rate of incidence, it is important to understand what parts of life ACEs

affect.

ACEs impact all facets of life. They can have an impact on health, well being,

relationships, and opportunities. (Linda & Felitti). Most studies have focused on the health and

well-being of adults and how ACEs affect physical, and emotional and mental well being. Beal

et al. showed that as one particular ACE, family violence exposures, increased, adolescents

reported more days with mental health challenges such as depression, anxiety, and social

support, as well as other physical health challenges. However, this pattern appears to continue

into adulthood with adults who experienced household dysfunction, which includes family

violence, were more likely to have poor health and have greater mental distress (crouch et al.).

This shows that ACEs create a lifelong impact on mental and physical well being. Both of these

studies serve the same purpose: to find out the effect of childhood trauma later in life. These two

having similar findings in two different groups: adolescents and adults means that the issue of

ACEs does continue from childhood into adulthood. The two studies by themselves make a

strong, reliable argument, but together they show a similar pattern that continues into later years.

Substance abuse following multiple ACEs is also common. This is another instance where

substance abuse is seen in adolescence as well as into adulthood (Beal et al.; Espeleta et al.).

Beal et al. found that adolescents are more likely to smoke cigarettes and marijuana if they

experience family instability. Espeleta et al. had a different goal. The latter researchers while

also finding a relationship between ACEs and substance abuse, were trying to see when and why

that substance abuse occurs. They found that emotional dysregulation likely due to instability

and poor modeling of emotional regulation was the factor that influenced substance abuse. The
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substance abuse was used to enhance or prolong the feeling of positive emotions that those with

multiple ACEs may not have felt when they were younger. These two pieces of research, while

similar in their aim were slightly different in the relationships that they looked into. Therefore,

the purposes of each of these studies affected the conclusions that were able to be drawn from

them.

The last aspect that is affected in adulthood is relationships. Most research into

relationships focuses on women with ACEs (Haahr-Pedersen et al.; Schütze et al.). Haahr-

Pedersen et al. found that females with an unstable home life reported not being in committed

relationships more often than others. This is in part due to emotional dysregulation which is what

the study aimed to look at. Schütze et al. found that women who reported more emotional and

sexual abuse reported lower partnership quality, lower rating of partnership happiness, and

reported experiencing a higher number of conflicts with their partner. These two studies again

had two different aims. The first looked to explain the why of the relationship between ACEs

and lower partnership quality, whereas the second was simply looking to find the relationship

between ACEs and relationships in general. This aim of the research is the reason why the

results, while both valid and reliable, are slightly different.

There are common misconceptions about what ACEs are. An article from Dr. Eric Ball on

the effects of trauma tries to compare the ACEs to losing a pet. While losing a pet in a difficult

way, who feels as though they are your family, can be hard, it is different than the traumatic

events that are being assessed in the ACEs questionnaire. Losing a pet may happen once or twice

while you are under 18, but ACEs looks at patterns of trauma as well as single events. He

claimed that his kids were going to “carry that trauma for years” because their dog passed In an

unusual manner, but something like that is easier to work though than actual ACEs. For example,
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losing a pet is not the same as losing a parent to jail time or experiencing violence more often

than not in your home. The trauma is different and long lasting for the latter. Misconceptions like

these lead to people thinking they have experienced trauma and can lead them to almost brush

off other people’s deep trauma.

Luckily, there are ways to help protect against ACEs. According to the Centers for Disease

Control, there are 6 ways that ACEs can be prevented: strengthening economic supports for

families, promote social norms that protect against violence, providing a strong start for children,

teaching skills, connecting youth to caring adults, and intervening early. These strategies are

considered the best ways to prevent ACEs according to the CDC and the CDC is a credible

source, however, some people may not agree with all of these ways especially when it comes to

the idea of giving families money through tax breaks. Even though not everyone may agree with

ways to protect against and prevent ACEs, it is nonetheless an important part of the conversation

given the outcomes due to ACEs.

There are many possible answers to how ACEs affect adulthood. On the one hand, they

can affect mental and physical well being. Physical well being needs to be researched more

because what exactly is meant by physical well being? Another factor is that ACEs can play into

substance abuse as an adult, and ACEs can also affect relationships with others. Personally, I

need to do further research into the mental and physical well being of adults who have

experienced ACEs in order to understand better how physical health is being affected and what

about mental health other than the one source that mentioned depression and anxiety.
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Bibliography

“Adverse Childhood Experiences (ACEs).” Centers for Disease Control and Prevention, Centers

for Disease Control and Prevention, 3 Apr. 2020,

www.cdc.gov/violenceprevention/aces/index.html.

Ball, Eric. “How Trauma Affects the Body: Reflections from Dr. Eric Ball.” ACEs Aware, 2021,

www.acesaware.org/blog/how-trauma-affects-the-body-reflections-from-dr-eric-ball/.

Beal, Sarah J., et al. “Childhood Adversity and Associated Psychosocial Function in Adolescents

with Complex Trauma.” Child & Youth Care Forum, vol. 48, no. 3, 2018, pp. 305–322.,

doi:10.1007/s10566-018-9479-5.

Centers for Disease Control. “Preventing Adverse Childhood Experiences (ACEs): Leveraging

the Best Available Evidence.” Centers for Disease Control, National Center for Injury

Prevention and Control, 2019.

Crouch, Elizabeth, et al. “Examining Exposure to Adverse Childhood Experiences and Later

Outcomes of Poor Physical and Mental Health among South Carolina Adults.” Children

and Youth Services Review, vol. 84, 2018, pp. 193–197.,

doi:10.1016/j.childyouth.2017.11.031.

Espeleta, Hannah C., et al. “Childhood Adversity and Adult Health-Risk Behaviors: Examining

the Roles of Emotion Dysregulation and Urgency.” Child Abuse & Neglect, vol. 82,

2018, pp. 92–101., doi:10.1016/j.chiabu.2018.05.027.

Felitti, Vincent J, et al. “Relationship of Childhood Abuse and Household Dysfunction to Many

of the Leading Causes of Death in Adults.” American Journal of Preventive Medicine,

vol. 14, no. 4, 1998, pp. 245–258., doi:10.1016/s0749-3797(98)00017-8. 

Haahr-Pedersen, Ida, et al. “Females Have More Complex Patterns of Childhood Adversity:

Implications for Mental, Social, and Emotional Outcomes in Adulthood.” European

Journal of Psychotraumatology, vol. 11, no. 1, 2020, p. 1708618.,

doi:10.1080/20008198.2019.1708618.

Karen Linda, and Vincent Felliti. “The Adverse Childhood Experiences Study.” PESI, PESI,

2018, catalog.pesi.com/sq/bh_051500_acefreece_email-15908. Accessed 27 Mar. 2021.

Schütze, Ina, et al. “The Association between Adverse Childhood Experiences and Quality of

Partnership in Adult Women.” Child Abuse & Neglect, vol. 108, 2020, p. 104653.,

doi:10.1016/j.chiabu.2020.104653.