Photo: Rodion Kutsaiev-for unsplash
Author: Demetria Rutledge, APRN-C, FNP, CCM
Abstract
Adverse Childhood Experiences (ACEs) refer to a range of potentially traumatic events that occur during childhood and can have lasting effects on health and behavior. These early adversities are associated with chronic physical and mental health conditions, social difficulties, and increased healthcare costs across the lifespan. Evidence-based therapies and trauma-informed care provide effective pathways toward healing and resilience. This article reviews the impact of ACEs and explores how therapy supports recovery and prevention.
Introduction
Adverse Childhood Experiences encompass situations such as physical, emotional, or sexual abuse, neglect, and exposure to violence, mental illness, or substance use within the home (Centers for Disease Control and Prevention [CDC], 2024a). These experiences can disrupt emotional development and alter biological stress responses. The original CDC–Kaiser Permanente study demonstrated a direct, graded relationship between the number of ACEs and a higher likelihood of chronic disease, mental illness, and early mortality (Hughes et al., 2017).
Prevalence and Societal Impact
ACEs are widespread. Nearly two-thirds of adults in the United States report at least one adverse experience, and about one in six have experienced four or more (Swedo et al., 2023). Beyond individual suffering, the economic burden of ACE-related health outcomes is estimated to exceed $14 trillion annually, due to healthcare costs and productivity losses (Peterson et al., 2023). These findings highlight the urgency of prevention and early intervention.
Pathways Linking ACEs to Health Outcomes
Exposure to chronic childhood stress affects neurobiological development, emotion regulation, and attachment. This toxic stress increases vulnerability to heart disease, depression, substance misuse, and suicidality later in life (Merrick et al., 2019). Research consistently shows that the greater the number of ACEs, the greater the likelihood of poor health outcomes, demonstrating a cumulative “dose-response” pattern (Hughes et al., 2017).
Trauma-Informed Care and Screening
Trauma-informed care involves understanding, recognizing, and responding to the effects of trauma while promoting safety, trust, empowerment, and collaboration. These principles guide healthcare professionals in creating supportive environments that prevent re-traumatization (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). Screening for ACEs can be valuable, but it should always occur within a system prepared to provide follow-up resources and emotional support (CDC, 2024b).
Therapeutic Interventions and Recovery
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
TF-CBT is one of the most well-supported treatments for children and adolescents exposed to trauma. It helps individuals process distressing memories, manage anxiety, and develop healthy coping strategies (Thielemann et al., 2022).
Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE)
For adults, therapies such as CPT and PE are strongly recommended by the American Psychological Association for the treatment of PTSD. These approaches encourage re-evaluation of unhelpful beliefs and safe re-engagement with avoided memories (American Psychological Association [APA], 2017).
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR has been shown to reduce symptoms of PTSD by integrating traumatic memories in a more adaptive way, promoting emotional balance and reducing physiological arousal (U.S. Department of Veterans Affairs, n.d.).
Positive Childhood Experiences (PCEs)
Recent research also highlights that fostering positive experiences—such as feeling supported and safe within relationships—can significantly buffer the negative impacts of ACEs on adult mental health (Bethell et al., 2019).
Implications for Healthcare Providers
Providers play a vital role in addressing ACEs by:
- Normalizing discussions of trauma and emphasizing resilience.
- Using trauma-informed principles to promote safety and empowerment in clinical settings.
- Referring to evidence-based therapies appropriate for each patient’s age and situation.
- Supporting prevention, including family stability, community connection, and positive parenting programs.
Ethical and Cultural Considerations
Respect for cultural background, patient autonomy, and confidentiality are fundamental when addressing ACEs. A trauma-informed system recognizes the broader context of systemic and historical trauma, ensuring care that is inclusive, respectful, and person-centered (SAMHSA, 2014).
Conclusion
Adverse Childhood Experiences have deep and long-term effects, yet recovery is always possible. Early intervention, trauma-informed care, and access to evidence-based therapies can transform pain into resilience. Encouraging individuals to seek help—and ensuring supportive systems are ready to receive them—remains one of the most powerful tools in promoting lifelong wellness.
References (APA 7th Edition)
American Psychological Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. https://www.apa.org/ptsd-guideline
Bethell, C., Jones, J., Gombojav, N., Linkenbach, J., & Sege, R. (2019). Positive childhood experiences and adult mental and relational health in a statewide sample: Associations across adverse childhood experiences levels. JAMA Pediatrics, 173(11), e193007. https://doi.org/10.1001/jamapediatrics.2019.3007
Centers for Disease Control and Prevention. (2024a). About adverse childhood experiences (ACEs). https://www.cdc.gov/aces/about/index.html
Centers for Disease Control and Prevention. (2024b). Risk and protective factors for ACEs. https://www.cdc.gov/aces/risk-factors/index.html
Hughes, K., Bellis, M. A., Hardcastle, K., et al. (2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet Public Health, 2(8), e356–e366. https://doi.org/10.1016/S2468-2667(17)30118-4
Merrick, M. T., Ford, D. C., Ports, K. A., & Guinn, A. S. (2019). Vital signs: Estimated proportion of adult health problems attributable to adverse childhood experiences and implications for prevention—25 states, 2015–2017. MMWR, 68(44), 999–1005. https://doi.org/10.15585/mmwr.mm6844e1
Peterson, C., Aslam, M. V., Niolon, P. H., et al. (2023). Economic burden of health conditions associated with adverse childhood experiences among U.S. adults. JAMA Network Open, 6(12), e2346323. https://doi.org/10.1001/jamanetworkopen.2023.46323
Substance Abuse and Mental Health Services Administration. (2014). Trauma-informed care in behavioral health services (TIP 57). https://library.samhsa.gov/sites/default/files/sma14-4816.pdf
Swedo, E. A., et al. (2023). Prevalence of adverse childhood experiences among U.S. adults. MMWR, 72(26), 710–716. https://www.cdc.gov/mmwr/volumes/72/wr/mm7226a2.htm
Thielemann, J. F. B., Malgaroli, M., Reitano, K. N., & Muran, J. C. (2022). A systematic review and meta-analysis of trauma-focused cognitive behavioral therapy for children and adolescents. Journal of Affective Disorders, 311, 13–22. https://doi.org/10.1016/j.jad.2022.04.013
U.S. Department of Veterans Affairs, National Center for PTSD. (n.d.). Eye movement desensitization and reprocessing (EMDR) for PTSD. https://www.ptsd.va.gov/professional/treat/txessentials/emdr_pro.asp
