Adverse Childhood Events Lead to Persistent Deteriorating Health and Elevated Healthcare Costs

Adverse childhood experiences(ACE’s) impact a child’s short and long term health

written by Anuhya Pulapaka

Adverse Childhood Experiences (ACEs) is a broad term that describes hardships and/or trauma that individuals experience under the age of 18 that encompasses direct and indirect factors. ACEs recorded during a child’s life are categorized by the following: abuse, neglect, household substance abuse, household mental illness, parental divorce, neglect, bullying, childhood illness or injury, childhood hunger, and family financial problems. While this is not a comprehensive analysis of all potential adverse outcomes, these are the events most commonly surveyed among children and young adults. The association of ACE’s with dangerous health behavior, chronic illness, poor utilization of potential, and early death have been well demonstrated in various reviews and meta-analysis studies on the topic.

A child who has experienced maltreatment, such as neglect and abuse, has a higher burden of disease during their developmental years that is distinctly shaped by these ACEs. The consequences of maltreatment appear sooner than . Where abuse is uncovered or reported, these children are more likely to need urgent medical attention. Increased hospitalization and doctor consultation in children who report child maltreatment due to asthma, cardio-respiratory, and infectious disease is seen. Children who reported maltreatment ultimately had a 74-100% higher risk of receiving treatment from a hospital in comparison with children who did not report maltreatment. These distinct consequences have been correlated with chronic stress and increased allostatic load. The adaptive processes to cope with elevated stress include continuous physiological arousal, with measured increases secretion of adrenalin, cortisol, and other chemical mediators in the hypothalamic-pituitary axis. The prolonged dysregulation of these hormones induces strain on organs and compromises the immune system.3,4


This chart represents odds ratios, or how many times more likely an adult with ACEs is to experience a given health outcome compared to those without ACEs. For example, those with four or more ACEs are 4.3 times more likely to have a chronic obstructive pulmonary disease (COPD), 2.4 times more likely to develop asthma, and 2.2 times more likely to have a hearth attack than those without ACEs. (

ACEs cause an increased allostatic load on the child, leading to coping mechanisms found to increase unhealthy behaviors during adolescence. Girls who report experiencing abuse were more likely to have depressive symptoms, smoke, consume alcohol, and use illegal drugs during their lifetime5. Negative impacts on the mental health of the child during early age, adolescence, and adulthood are also observed to be elevated in this population. 47.9% of children investigated by child welfare agencies after maltreatment was reported were found to have significant clinical emotional or behavioral problems.6


As you can see, 2.5 times as many rate their mental health of those with 4 or more ACEs rate their mental health as not good compared to those with zero ACEs.  Iowa adults with four or more ACEs were 6 times more likely to have been diagnosed with depression compared to those with zero ACEs. Depression is one of the most common mental health disorders in the United States today. (

An investigation of long-term health consequences was studied in a meta-analysis conducted in 2017 by Hughes et. al which cross compared individuals who have experienced 0 ACEs and individuals who have experienced 4 or more ACEs. It was found that multiple ACEs are a significant risk factor for unhealthy behaviors and health outcomes. These include outcomes such as physical inactivity, obesity, diabetes, cardiovascular disease, liver disease, cancer, smoking, anxiety and depression, sexually transmitted infections, and drug use. these correlations are attributed to physiological/developmental disruption as well as an increase in behaviors associated with health risks. Indeed, positive correlations are found between the number of ACEs a child experiences and the increased risk of harmful behaviors and the development of disease. Additionally, associations between ACEs and smoking, heavy alcohol use, cancer, heart disease, and respiratory disease. Furthermore, a strong association was found between ACEs, problematic drug use, and violence.1

Current research supports the assertion that ACEs mentally, physiologically, and behaviorally alter the developmental outcome of children attempting to adapt to a hostile environment. The physiologic changes attributed to prolonged stress make the child more susceptible to disease and chronic illness, while exacerbating existing illness. The psychosomatic and behavior adaptations place these individuals in dangerous circumstances for their general health including smoking, alcohol abuse, illicit drugs, and initiating violence. Collectively, these factors require an increased demand for the healthcare system for management, treatment, and prevention while simultaneously limiting their ability to earn resources to access these systems.


  1. Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., … & Dunne, M. P. (2017). The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. The Lancet Public Health, 2(8), e356-e366.
  2. Lanier, P., Jonson-Reid, M., Stahlschmidt, M. J., Drake, B., & Constantino, J. (2010). Child maltreatment and pediatric health outcomes: a longitudinal study of low-income children. Journal of pediatric psychology35(5), 511–522. doi:10.1093/jpepsy/jsp086
  3. Cicchetti, D., & Walker, E.F. E. F. (2001). Stress and development: Biological and psychological consequences. Development and Psychopathology13(3), 413-418.
  4. McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England journal of medicine338(3), 171-179.
  5. Diaz A, Simantov E, Rickert VI. Effect of Abuse on Health: Results of a National Survey. Arch Pediatr Adolesc Med. 2002;156(8):811–817. doi:10.1001/archpedi.156.8.811
  6. Burns, B. J., Phillips, S. D., Wagner, H. R., Barth, R. P., Kolko, D. J., Campbell, Y., & Landsverk, J. (2004). Mental health need and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child & Adolescent Psychiatry, 43(8), 960-970



About the author: Warren Campbell

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