Unseen Scars of Childhood Trauma

Twenty years of research have established the connection between adverse childhood experiences and long-term health. Now researchers are looking for ways to measure the biology behind the correlation and try to reverse it.

Before you were 18, did a parent or other adult in your household ever push, grab, shove or slap you?

Was a household member depressed or mentally ill?

Did a household member go to prison?

These are just a sampling of the questions asked in a landmark study of 17,337 middle-aged adults that began in the late 1990s. The work showed researchers for the first time just how common adverse childhood experiences, as they’re termed, truly are: Nearly two-thirds of the group of mostly white, middle-class people from the San Diego area had experienced at least one type of physical or psychological trauma included in the survey. Twelve percent had been through four or more.

But the biggest surprise from the study was that adverse childhood experiences, or ACEs, didn’t just lead to emotional and psychological ill effects, such as depression, later in life: People who had more traumatic experiences were also more likely as adults to have heart disease, cancer and a host of other health problems. And though people with higher ACE scores are more likely to smoke and suffer from alcoholism and drug abuse, behavioral factors don’t fully account for these increased disease risks.

Follow-up studies over the last 20 years have confirmed these findings and found links to other conditions, including type 2 diabetes and autoimmune disorders. Recent work has shown that ACEs can start to affect health even in childhood, increasing risks for asthma, cognitive delays, hormone imbalances, sleep disturbances, obesity and frequent infections.

Such work reveals that childhood adversity is a major public health issue. “Once you start understanding the prevalence of adversity in the general population, you can’t unsee it,” says Phil Fisher, a psychologist at the University of Oregon.

Fisher and other researchers are now working to understand why ACEs have such impacts on physical health. Childhood adversity, they are finding, has lasting effects on stress hormones, inflammation, brain development and gene regulation. By identifying such measurable physical changes, or biomarkers, the scientists hope to be able to pinpoint which kids are at greatest risk of long-term health effects — and provide a metric for studying the effects of treatments such as specialized therapies.

“The biomarkers can really help us to have a lot more precision in the ways that we provide support,” Fisher says. Already, the evidence has led many pediatricians to screen all their patients for ACEs.