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 theinfluence of adversity on many physical as well as psychological problems and the persistenceof impacts decades after the traumas occurred. In this article, we make the case that themost revolutionary finding was the discovery of a strong dose-response effect, with markedincreases in risk observed for individuals who reported four or more adversities. Over the pasttwo decades, our understanding of the cumulative burden of trauma has expanded further,with recognition that experiences outside the family, including peer victimization, communityviolence, and racism, also contribute to trauma dose. Recent research has provided evidencefor the pervasiveness of trauma, which we now realize affects most people, even by the endof adolescence. Extensive scientific evidence has documented that more than 40 biopsychosocialoutcomes, including leading causes of adult morbidity and mortality, are associatedwith adverse childhood experiences, measured by dose. We summarize the state of scienceand explain how ACEs built a movement for uncovering mechanisms responsible for theserelationships. Perhaps unexpectedly, the pervasiveness of trauma also expands our understandingof resilience, which is likewise more common than previously recognized. Emergingresearch on positive childhood experiences and poly-strengths suggests that individual,family, and community strengths may also contribute to outcomes in a dose-responserelationship. We close with an agenda for research, intervention, and policy to reduce thesocietal burden of adversity and promote resilience

Publication Title

American Psychologist