childhood trauma treatment
October 19, 2023 By Leah Malone

Adverse Childhood Experiences and Their Impact on Mental Health


Experiences during childhood shape how people see themselves and interact with others. In addition, physical and emotional development during childhood impacts how they function as adults. Trauma or other adverse childhood experiences (ACEs) can potentially affect the brain’s physical development and a child’s ability to successfully regulate emotions. ACEs, including trauma, violence within the home, neglect, abuse, and parental mental illness or substance abuse, influence how children grow and learn. 

People with a history of ACEs have a higher risk of developing substance abuse and mental health disorders in adulthood. According to the Centers for Disease Control and Prevention (CDC), “Adverse childhood experiences (ACEs) can have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity.” Emerge Recovery TX helps women recover from the effects of ACEs using evidence-based methods, peer support, and trauma treatment.

Defining Adverse Childhood Experiences (ACEs)

Healthcare provider Kaiser Permanente worked alongside the Centers for Disease Control and Prevention (CDC) to conduct the most extensive study on adverse childhood experiences. The initial CDC-Kaiser Permanente ACE Study involved several waves of data collection between 1995 and 1997. Kaiser has continuously collected data related to ACEs since 1995.

The study initially examined the relationships between weight loss and adverse childhood experiences. According to The Permanente Journal, “The ACE Study reveals a powerful relation between our emotional experiences as children and our adult emotional health, physical health, and major causes of mortality in the United States.” 

Three categories of ACEs are recognized in the CDC-Kaiser Permanente ACE Study. Each is broken up into distinct subcategories. Below are brief descriptions of the three primary categories of ACEs and the types of trauma children may experience.

#1. Abuse

The abuse category includes physical, emotional, sexual, and verbal abuse of a child. Often, parental figures are the perpetrators of the abuse. According to the Child Welfare Information Gateway, “Harm caused to a child by others (such as acquaintances or strangers) may not be considered child abuse or neglect; rather, it may be considered a criminal matter.”

#2. Neglect

Physical or emotional neglect can cause permanent health side effects for children and young adults. A few common forms of childhood neglect include: 

  • Lack of emotional support 
  • Not being provided essentials, including housing, food, or clothing 
  • Lack of supervision 
  • Not having access to healthcare services

#3. Household Challenges

Any household factors impacting a child’s physical or mental well-being are considered household challenges, including:

  • The incarceration of a family member 
  • Family history of substance abuse or mental illness
  • Domestic abuse
  • Divorce or parental separation

Children often experience two or more of the categories listed above. Homes with household challenges are more likely to feature abuse and neglect. The prolonged exposure to multiple ACEs may cause some people to develop maladaptive coping skills later in life if the trauma remains unaddressed.

Prevalence of ACEs: A Global Perspective

ACEs are incredibly common worldwide. Countries with more general conflict report higher levels of ACEs. According to the CDC, globally, “61% of adults had at least one ACE and 16% had 4 or more types of ACEs.”

The CDC-Kaiser Permanente ACE Study reported the following statistics for participants with a history of at least one ACE: 

  • 60% from the United States 
  • 47% from Wales 
  • 85% from Brazil 
  • 76% from Vietnam 

Globally, over 60% of all children experience at least one ACE. Often, the trauma remains untreated, leading to a cycle of abuse within multiple generations of families.

The Brain and ACEs

Adverse experiences during childhood change how a person copes with stressors and functions in their day-to-day life. According to Frontiers in Psychiatry, “Converging evidence from epidemiological and neurobiological studies suggest adverse childhood experiences (ACE) such as sexual and physical abuse and related adverse experiences to be closely related to enduring brain dysfunctions that, in turn, affect physical and mental health throughout the lifespan.”

Trauma interrupts normal brain development and causes changes in how the body processes and reacts to stress. According to the previous article by the CDC, “Childhood maltreatment has been linked to reduced grey matter volumes in the hippocampus and the orbitofrontal cortex among other brain regions.”

Flight-Fight-Freeze Response

The human body automatically responds to acute and chronic stress in several ways. A typical stress reaction is the flight-fight-freeze response. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “Everyone has an alarm system in their body that is designed to keep them safe from harm.” An attempt to escape from a stressful situation (flight), an inability to move when threatened (freeze), or fighting against the threat are automatic responses the brain uses to protect the body. “The alarm can be activated at any perceived sign of trouble and leave kids feeling scared, angry, irritable, or even withdrawn.”

The toxic stress response is another reaction children may experience after an ACE. Healthy children have the support, comfort, and guidance of nurturing parental figures to help them manage stressful situations. Children who have no parental support while experiencing chronic stress may reach a point where their body stops the stress response. In most cases, toxic stress in childhood leads to lifelong mental health issues, permanent alterations in a person’s ability to handle stressors and various physical health side effects. 

Psychological Impacts of ACEs

Violence, abuse, neglect, and toxic home environments significantly impact a child’s psychological health. Often, children are forced to navigate a home life where they must live with the side effects of multiple emotionally distressing issues occurring simultaneously for prolonged periods. For example, a parent abusing alcohol may lead to job loss, financial instability, and divorce. Most children with a history of trauma experience more than one ACE. 

Individuals who live through adverse childhood experiences have a significantly higher risk of developing mental health disorders later in life. Difficulties regulating emotions or coping with stressors may negatively affect personal and professional relationships. However, children who receive treatment for their trauma before symptoms become severe often build resiliency and have a lower risk of mental illness, substance abuse, and relationship issues.

Long-Term Mental Health Outcomes

Children who experience trauma have a greater risk of developing depression, anxiety disorders, substance abuse, post-traumatic stress disorder (PTSD), and other mental health issues. Self-harming behaviors are also more common in adults with a history of ACEs. According to Child Abuse and Neglect, “Exposure to childhood adversity has an impact on adult mental health, increasing the risk for depression and suicide.”

Clients diagnosed with complex PTSD related to ACEs may face unique challenges in recovery, including:  

  • Difficulty identifying, processing, and controlling emotions
  • Feeling “damaged” or ashamed of ACEs, making it difficult to accept help 
  • Trust issues interfering with collaboration between them and their care team 
  • Feelings of hopelessness, emptiness, or dread reducing motivation during recovery

Many women attending substance abuse treatment programs at Emerge Recovery TX have untreated trauma. Some may have relied on alcohol or drugs to self-medicate and cope with symptoms of adverse childhood experiences. The underlying trauma must be addressed alongside treatment for substance misuse to ensure the best possible outcome. Other co-occurring issues, including complex trauma, require personalized care to reduce the risk of re-traumatization. 

The Social and Relational Impact of ACEs

Children and adults with a history of adverse childhood experiences often find it more challenging to form and maintain healthy relationships. Attachment disorders and trauma in childhood are known risk factors for adult mental health issues affecting relationships. Often, people who have lived through ACEs have difficulty setting clear boundaries or respecting the boundaries of others. A lack of social skills also contributes to unhealthy relationship dynamics. 

Adults who report severe ACEs, including physical or sexual abuse, neglect, or domestic abuse, have a higher risk of becoming perpetrators of violence against their own children or partners. Individuals charged with crimes related to physical or sexual assault report a higher incidence of adverse childhood experiences in their childhood. According to The Permanente Journal, “Every negative event queried by the ACE Questionnaire, with the exception of a history of neglect, was found at significantly higher rates in the histories of . . . offenders.”

The cycle of victims becoming perpetrators is common in families with intergenerational trauma. Children living in homes with multigenerational substance misuse, mental health issues, or abuse often face social isolation, putting them at further risk. Social isolation is the leading cause of loneliness. According to the Department of Health and Human Services (HHS), “Loneliness . . . is associated with a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death.” Children who grow up in social isolation also generally have fewer healthy relationships in adulthood.

The Economic Cost of ACEs

ACEs cost families, individuals, and communities billions of dollars every year. According to the CDC, “[T]he estimated annual U.S. population economic burden of child maltreatment alone, a major contributor to ACEs, was $428 billion.”

The economic impact of ACEs includes the following: 

  • Direct costs: Healthcare services, including therapy, counseling, psychiatry, medical support, medications, and treatment programs 
  • Indirect costs: Loss of productivity, decreased education, higher community health burden, increased criminal behaviors, and increased welfare needs

Early intervention and treatment is the best way to reduce direct and indirect costs related to ACEs.

Healing and Recovery

Children and adults with a history of ACEs benefit from attending individual, group, and family therapy or counseling. Therapy teaches children how to reach out for help if they encounter stressors or feel unsafe. In addition, children learn essential coping skills and ways to manage stress, reducing their risk of developing substance abuse or mental health disorders later in life. Therapy and other forms of mental health treatment help children build resiliency and establish healthy coping mechanisms during adolescence and young adulthood. 

Adults who have lived through ACEs also benefit from processing their experiences in a safe and controlled setting. Emerge Recovery TX uses evidence-based and alternative holistic therapies to help women recover from substance use disorder (SUD) and mental health issues related to adverse childhood experiences. 

Prevention and Intervention

ACEs are not always easy to identify. However, community members, including teachers, religious leaders, and childcare workers, have a responsibility to educate themselves about the warning signs of ACEs. 

Some of the most common signs a child may have been exposed to an ACE include: 

  • Unusual aggression
  • Age-inappropriate behaviors 
  • Mood swings 
  • Obvious attachment issues surrounding parental figures 

Schools and communities should have policies and procedures to prioritize child safety and mental health. Community leaders must work with parents to create strategies for identifying safety issues affecting child health. 

Some policies and initiatives currently improving communities nationwide include the ACEs Aware Initiative. In addition, each state has its own initiatives and local policies designed to protect children from adverse childhood experiences. For example, Washington State has the Washington State Essentials for Childhood Initiative. Texas also has the Texas Statewide Behavioral Health Strategic Plan to address mental health issues statewide, ensuring children have safe communities and access to essential care. 


The environments children are raised in and their everyday experiences affect how they develop and grow. Traumas and abuse leave an imprint on young minds. Without the proper support, ACEs may lead to mental health issues later in life. Adults with a history of ACEs often struggle to function in their personal and professional lives. 

Women are at a higher risk of developing mental health disorders related to trauma and ACEs. According to the European Journal of Psychopharmacology, “21% of males and 39% of females in the US population have been exposed to multiple ACEs in their first 18 years of life.” Trauma-focused treatment programs at Emerge Recovery TX help women process ACEs and heal from the effects of substance misuse or other co-occurring disorders. 


Below are some frequently asked questions regarding ACEs, childhood emotional development, and how adults should support children vulnerable to adverse experiences. 

What are the most common types of ACEs? 

Some of the most common types of ACEs include: 

  • Economic hardship 
  • Divorce or parental separation
  • Family members with active substance abuse or mental health disorders
  • Physical or emotional neglect 
  • Verbal abuse
  • Physical abuse 
  • Sexual abuse 

Children who report ACEs have a higher risk of experiencing other traumatic events later in life. 

How can teachers and caregivers identify signs of ACEs in children? 

Trauma affects a child’s behaviors and moods. Teachers and caregivers may notice abrupt changes in temperament, thoughts, speech, or social interactions. Each age group reacts differently to ACEs. 

Preschool-aged children may display attachment issues, including:

  • Unusual anxiety when apart from parental figures
  • Frequent crying, screaming, or acting out when separated from loved ones
  • Nightmares or other sleep disturbances
  • Poor appetite and weight loss

Elementary-aged children may show the following warning signs of ACEs: 

  • Sleep disturbances 
  • Difficulty concentrating 
  • Anxiety 
  • Depressive symptoms
  • Strong feelings of guilt or shame

Middle and high school-aged children may have more extreme emotional reactions to ACEs, including: 

  • Self-harming behaviors
  • Suicidal ideation
  • Disordered eating 
  • Depressive episodes
  • Risk-taking behaviors, including unsafe sex 
  • Substance abuse

Children and young adults exhibiting some or all of these warning signs may have experienced ACEs. 

Are there any protective factors that can mitigate the impact of ACEs? 

A loving, nurturing relationship with parental figures helps children build resiliency and a positive sense of self. Parents and guardians should provide a safe and supportive space where children can grow and learn. 

Other critical protective factors include: 

  • Nurturing healthy family attachments 
  • Parental figures with a firm understanding of parenting and child development
  • Opportunities to build healthy social relationships 
  • Access to parental support and resources 

How can adults who have experienced ACEs seek help? 

Lack of resources or support often means ACEs go unacknowledged until a person reaches adulthood. Adults who struggle with the effects of unaddressed ACEs benefit from undergoing a clinical mental health assessment and participating in professional mental health treatment. Community support groups for adults who have experienced ACEs also motivate and inspire clients in recovery to make healthy lifestyle changes. 

What role does genetics play in the impact of ACEs on mental health? 

Genetics plays a role in how ACEs affect children and their risk of developing mental health issues in adulthood. According to Frontiers in Public Health,” [E]xposure to ACEs might impact the immune system, structural and functional brain changes and genetic and epigenetic changes, and these changes can be observed as early as childhood.” Researchers have identified specific genetic markers in individuals who report having experienced ACEs. Frontiers in Public Health goes on to state at least three “genes seem to play an active role in the biological embodiment of exposure to ACEs:” 

  • NR3C1: a gene linked with violence in children 
  • SLC6A4: a gene related to depression-susceptibility in individuals who have experienced trauma 
  • FKBP5: a gene contributing to basic cell processes and immunoregulation 

Research into the effect of trauma is still ongoing. Other genes may impact how children respond to trauma and ACEs. 

Childhood experiences have a profound effect on adult mental and physical health. Adverse childhood experiences (ACEs) can impact all areas of a person’s life, including their ability to function and maintain personal or professional responsibilities. People with untreated ACEs have an increased risk of developing substance abuse and mental health disorders. Communities, families, and individuals all have a role to play in reducing ACEs by ensuring children have access to loving and nurturing home environments. Emerge Recovery TX helps women process mental health issues related to ACEs and educates them on how to identify and manage trauma responses. To learn more about our programs and services, call our office today at (737) 237-9663.

About Author

Leah Malone

Learning to sit with uncomfortable feelings can be painful and disturbing at times. When Leah was able to see her behavior patterns and decided there was enough pain to be disturbed, she became motivated to make changes and accept the work that needed to be done to heal. She needed direction and had no clue how to heal on her own. Through a connection with God, authentic connection with others, honesty, willingness, and humility, Leah is now in recovery from addiction and trauma.

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