Four ways that adverse childhood experiences affect adults

Medically reviewed by April Brewer
Updated January 9, 2024by BetterHelp Editorial Team
Content Warning: Please be advised, the below article might mention trauma-related topics that include suicide which could be triggering to the reader. If you or someone you love is having suicidal thoughts, contact the 988 Suicide & Crisis Lifeline at 988. Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

A pivotal study conducted with the CDC and Kaiser Permanente between 1995 and 1997 first described the term Adverse Childhood Experiences. In the study’s follow-up phase, more than 17,000 people answered questions about their childhood experiences. The study found a tight association between Adverse Childhood Experiences (ACEs) and various adverse outcomes in adulthood.

ACEs can seriously impact adult mental health

The Adverse Childhood Experience study

The original Adverse Childhood Experiences study used a questionnaire evaluating three categories of adverse experiences: abuse, household challenges, and neglect. The ACEs scale is used to measure an individual experience of:

  • Emotional abuse: being regularly belittled, humiliated, insulted, or demeaned, all of which may lead one to fear for their physical safety.
  • Physical abuse: being struck, pushed, grabbed, etc., with enough force to injure or leave marks.
  • Sexual abuse: being forced to engage in a sexual interaction.
  • Mother treated violently: mother or stepmother subjected to violence by a male partner.
  • Parental separation or divorce.
  • Emotional neglect: lack of love and support. 
  • Physical neglect: lack of physical necessities and basic needs like food, shelter, or clothing; parental incompetence.

The ACE scale is readily available for public use. You can take a version of the test here, and the actual questionnaire used in the study is available here.

How many people are affected by ACEs?

The original study found that around two-thirds of the people who took the questionnaire had experienced one or more ACEs. About one-fifth of the respondents had experienced three or more ACEs.

The results of the Adverse Childhood Experiences study were clear and sobering, and are as follows:

1. Adults with high ACE scores are less physically healthy

Life is full of regular stressors; long lines, frustrating coworkers, new jobs, and bad traffic, to name a few. These are generally dealt with easily by healthy adults. But adults with a high ACE score, who may have their physiological stress responses stuck in overdrive, may not be able to control their stress response as effectively.

As a result of this physiological strain, heart disease, liver disease, diabetes, cancer, and strokes are all more common in adults with high ACE scores. Also, high scores (usually considered as a score of three and above) often predict autoimmune diseases in women. This correlation may be partly because of chronic stress on the participants’ developing brains during childhood.

Getty/Vadym Pastukh

Genetic switches

Childhood is a time of incredible physical growth and cognitive development. Leaving behind the old nature versus nurture debate, we now know that the genes we are born with respond to the environment in which we develop. That environment, in turn, responds to us. And when our environment is chronically stressful, it inhibits the development of genes that manage stress. Chronic stress can change a child's development at the genetic level, setting their stress response into permanent overdrive.

More genetic connections

However, the physical health consequences of ACEs are not all caused by unmanaged adult stress. There is some evidence that constant, unregulated childhood stresses trigger changes within the genes that are directly related to the development of many of the adult diseases to which this population is prone. Hence, a high ACEs score doesn't just potentially set the bomb of chronic adult stress but can sneak into the genes responsible for physical health and alters them.

Stress toxicity

Being in a constant high-stress response mode can promote chronic inflammation, dampen a person's immune system, and impair their bodies' regular maintenance and rebuilding. Stress hormones themselves can be disruptive to physical function in the long term. In addition, high-stress responses exhaust a great deal of energy, which, in turn, compromises other physiological functioning and routine processes.

2. Adults with high ace scores are less mentally healthy

The effects of ACEs on adult mental health are perhaps less surprising than those on physical health. Many of us are familiar with the idea that our early experiences play a part in our adult mental health. However, it may be surprising that ACEs affect mental health in much the same way they affect physical health—that is, by triggering actual physiological changes in our bodies.

Brain changes

When a child experiences chronic, unsupported stress, it affects their genes, as we previously discussed. It also changes the physiological architecture of the brain. Excessive and ongoing exposure to stress hormones can trigger several changes at the cognitive level, including shrinkage of the parts of the brain responsible for learning and memory, under-development of the part of the brain that processes fear, and deficits in decision-making and impulse control centers.


The most significant mental health risk for adults with an ACEs score of three or more is depression. People with high ACEs scores can experience more depressive episodes, and it takes them longer to recover from them. They are also more likely to commit suicide than the general population*. The physical challenges of chronic stress in childhood and adulthood that we looked at earlier help to explain some of the prevalence of depression.

*If you or a loved one is experiencing suicidal thoughts, reach out for help immediately. The 988 Suicide and Crisis Lifeline can be reached at 988 and is available 24/7.


In addition to depression, people with high ACEs scores are more likely to experience generalized mental distress than the general population. ACEs can contribute to the development of post-traumatic stress disorder.

3. Adults with high ACEs scores are less socially stable and more likely to engage in risky behavior

Partially due to disrupted brain development, people with high ACE scores are more likely to engage in personally and socially risky behaviors. High ACE scores are associated with earlier and riskier sexual activities, higher rates of unintended pregnancies, smoking, alcoholism, and illegal drug use.


As discussed in the physical and mental health sections, chronic, unsupported stress among ACEs can cause physical changes to our brains. Chronic stress can inhibit the development of decision-making and impulse control centers. This can leave adults with high ACE scores more susceptible to potentially unsafe activities, such as excessive drug and/or alcohol use.

Social issues

In addition to these risky behaviors, adults with high ACE scores are more likely to report poor work performance or unemployment. They are more likely to have multiple sexual partners and are at higher risk of sexual violence and intimate partner violence.

Attachment styles

It's not always clear how ACEs are related to these results. Some of the social issues may stem from the impacts of stress on decision-making and impulse control. Also, research on childhood trauma shows that early relationships and attachment style carries over into adulthood. If the ACEs indicate unhealthy patterns relating to authority figures or family, these can often be difficult (but certainly not impossible) to break later.

Stress sensitivity

Brain development and learned behavioral patterns seem to play a part in the social instability of adults with high ACE scores. In addition to these, heightened sensitivity to stress can make managing challenges in the workplace or intimate relationships more difficult. As we saw earlier- chronic unsupported childhood stress can cause excessive stress reactions later as adults.

4. Adults with high ACEs scores die earlier

Adults with high ACE scores have a life expectancy that is 20 years shorter than that of the average adult when compared to the general population. Adults with high ACE scores often die of the diseases to which they are prone; suicide, alcoholism, and drug use, to name a few. ACEs lay the foundation for impaired brain development, which essentially contributes to specific mental health disorders, risky behaviors, and social instability. Often, this can ultimately result in an increased risk of early death.

ACE scores and predictability

If your scores reflect a high level of exposure to ACEs, it doesn’t necessarily mean that you can expect a lifetime of low achievement, sickness, and instability followed by early death.

While the ACE scale measures particularly difficult childhood circumstances that can stack the deck against us in adulthood, it doesn't measure everything. Positive childhood circumstances can mitigate a lot of the damage of a high ACEs score. Loving, supportive relationships with adults like teachers, grandparents, or friends can go a long way toward helping children cope with trauma. And as an adult, self-knowledge is only a tool, like your ACE score. It can help you to identify and better understand what you went through in childhood, and aid in recognizing and changing your own detrimental behaviors. It can motivate you to get help when needed. 

ACEs can seriously impact adult mental health

Research shows that online therapy is a powerful tool for improving mental health and can result in similar success in treating anxiety and depression. For instance, this study found that online therapy was even more effective for treating depression than traditional in-person sessions, with 100 percent of participants in the online group showing continued symptom reduction three months after treatment. 

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Many people with high ACE scores live long and productive lives. But if you are concerned that your ACEs may interfere with the life you want to live, consider consulting a caring, trained professional. A mental health professional can help you identify and overcome problematic behaviors. They may be able to help you heal the wounds of your childhood experiences or identify ways that patterns built in childhood are inhibiting your ability to function as an adult.

Explore how childhood influences behavior

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