Recognizing the Cumulative Burden of Childhood Adversities Transforms Science and Practice for Trauma and Resilience

The Adverse Childhood Experiences (ACEs) studies transformed our understanding of the true burden of trauma. Notable elements of Felitti and colleagues' findings include the influence of adversity on many physical as well as psychological problems and the persistence of impacts decades after th...

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Bibliographic Details
Published in:The American psychologist 2021-02, Vol.76 (2), p.230-242
Main Authors: Hamby, Sherry, Elm, Jessica H. L., Howell, Kathryn H., Merrick, Melissa T.
Format: Article
Language:English
Subjects:
Adolescents
Adverse childhood experiences
Adversity
Biopsychosocial aspects
Bullying
Childhood Adversity
Childhood experiences
Childhood factors
Communities
Discovery
Families & family life
Health Disparities
Human
Mental disorders
Morbidity
Peer Relations
Peer relationships
Psychological problems
Psychological trauma
Racism
Resilience
Resilience (Psychological)
Sciences
Scientific evidence
Trauma
Understanding
Victimization
Violence
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Summary:The Adverse Childhood Experiences (ACEs) studies transformed our understanding of the true burden of trauma. Notable elements of Felitti and colleagues' findings include the influence of adversity on many physical as well as psychological problems and the persistence of impacts decades after the traumas occurred. In this article, we make the case that the most revolutionary finding was the discovery of a strong dose-response effect, with marked increases in risk observed for individuals who reported four or more adversities. Over the past two decades, our understanding of the cumulative burden of trauma has expanded further, with recognition that experiences outside the family, including peer victimization, community violence, and racism, also contribute to trauma dose. Recent research has provided evidence for the pervasiveness of trauma, which we now realize affects most people, even by the end of adolescence. Extensive scientific evidence has documented that more than 40 biopsychosocial outcomes, including leading causes of adult morbidity and mortality, are associated with adverse childhood experiences, measured by dose. We summarize the state of science and explain how ACEs built a movement for uncovering mechanisms responsible for these relationships. Perhaps unexpectedly, the pervasiveness of trauma also expands our understanding of resilience, which is likewise more common than previously recognized. Emerging research on positive childhood experiences and poly-strengths suggests that individual, family, and community strengths may also contribute to outcomes in a dose-response relationship. We close with an agenda for research, intervention, and policy to reduce the societal burden of adversity and promote resilience. Public Significance Statement The Adverse Childhood Experiences (ACEs) studies and related research have revealed that victimization and trauma are more common than previously known, and that trauma dose, in the form of the number of types of adversities, is strongly associated with more than 40 biopsychosocial outcomes. In turn, the recognition of the pervasiveness of trauma is contributing to a reconceptualization of resilience, which is likewise more common than previously recognized. All individuals, families, and communities need to know how to cope with trauma and overcome adversity, as well as recognize the role we all play in prevention.
ISSN:0003-066X
1935-990X
DOI:10.1037/amp0000763