“Childhood trauma increases the risk for seven out of ten of the leading causes of death in the United States. In high doses, it affects brain development, the immune system, hormonal systems, and even the way our DNA is read and transcribed. Folks who are exposed in very high doses have triple the lifetime risk of heart disease and lung cancer and a 20-year difference in life expectancy.”  

— Dr. Nadine Burke Harris, Founder of Center for Youth Wellness and current Surgeon General of California

Trauma and PTSD

When most people think about trauma and mental health, they think about Post-traumatic Stress Disorder (PTSD).

PTSD is a set of intense and prolonged negative responses to a traumatic event.

Overall, about 6% of adult Americans will experience PTSD in their lifetimes. This lifetime rate is higher for cis women (8%), Veterans of the most recent military operations (29%), cis lesbian, gay, or bisexual people (48%), and transgender/gender diverse individuals (42%), and 63% of autistic adults.

Image of a group of blurry people walking across a wide median in a large city.

Antshel et al (2013) found that adults with ADHD had a lifetime prevalence of PTSD of 10% compared to the non-ADHD group’s lifetime rate of 1.6%. This study also found that the presence of ADHD and PTSD at the same time had worse ADHD and PTSD symptoms as well as higher rates of other mental health issues like major depression, generalized anxiety disorder, and oppositional defiant disorder.

These numbers are alarming.

Regardless of the nature of the traumatic events, military service, your community, or your identity, PTSD is a serious issue and is treatable.

Toxic Stress and Adverse Childhood Experiences

Side view of a distressed child who is pulling their t-shirt up to hide their face.

As alarming as PTSD statistics are, they only tell a partial story about trauma and its impacts on people.

What is not included as “traumatic” for a PTSD diagnosis are events or series of events (including in childhood) that are known to cause “toxic stress.” Experiencing bullying, racism, sexism, ableism, chronic illness, war, poverty, etc. are among the possible sources of toxic stress, especially when protective factors like family and community support are not present.

Our understanding of toxic stress really started with research done from 1995-1997 by the Kaiser Permanente Health Appraisal Clinic in San Diego, where they studied over 17,000 of their patients.

That study started a long and very robust set of research about the impact of ACEs on children and adults. You can find out more here.

a bubble answer sheet

Original Study (published in 1998)

This study took place between 1995 and 1997. 17,421 patients in the Kaiser Permanente program answered a 10-question survey. Each positive answer is 1 ACE. (Original questionnaire).

  • 5 questions about personal experiences of verbal, emotional or physical neglect and physical and sexual abuse

  • 5 questions about family members including parent substance abuse, domestic violence, incarcerated family member, family diagnosis of mental illness, and parental divorce

So, a child who has experienced parental divorce, an alcoholic parent, and physical neglect has 3 ACEs.

The participants tended to be white, college-educated, middle- to upper-middle class, middle aged, and employed with good health care.

On a solid yellow background there are various pills, capsules, and tablets next to a partially visible mercury thermometer and blue, surgical mask

Original Study Results

  • 2/3 of participants had at least 1 ACE

  • People who had ACEs were more likely to have more than 1

  • Only 13% of people who had an ACEs only had 1 ACE

So, ACEs often occur together

There was a clear correlation between ACEs and negative physical and mental health outcomes for adults, as well as negative social outcomes.

Individuals with 4+ ACEs, when compared to 0 ACEs had:

  • 400% increased risk of COPD

  • 1200% increased likelihood of attempting suicide

  • double the likelihood of cigarette smoking

  • seven times the risk of alcoholism

A child wearing a zippy hoodie and over-the-ear headphones, possibly giving a bemused side-eye to someone out of view

Neurodivergence and ACEs

Wilson et al 2024 found that 30.1% of neurodivergent children experienced 4+ ACEs while 9.8% of their neurotypical peers had experienced 4+ ACEs.

Person sitting on bare, concrete floor with knees bent and bare feet on the ground. The person's head is facing down and resting on their crossed arms which are laying across the tops of the knees. Person's back is against a bare cinder block wall.

Toxic Stress, ACEs, and Adult Health and Well-being

Scientists now believe that ACEs are detrimental to health across the lifespan, because they generate toxic stress. Toxic stress occurs when a person experiences prolonged stress without the chance to fully recover. People of all ages can experience toxic stress; however, toxic stress during childhood (ACEs) may lead to long-lasting changes in the brain and body.

Research suggests the toxic stress from ACEs can impact the immune system, and also makes adult survivors of ACEs more susceptible to stress-related diseases and disorders like stroke, cancer, heart disease, type 2 diabetes, arthritis, mood and anxiety disorders, and addiction.

Grummitt et al 2021 did a review of multiple studies looking at the connection between childhood adversity and mortality rates in the U.S. According to that study, in 2019, 15% of total deaths in the U.S, (439,072 deaths) were accounted for by childhood adversity. That does not include the 22 million cases of STIs, 21 million cases of drug abuse, and 19 million cases of inflammatory issues.