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Even “Mild” Childhood Adversity Matters
The adversity a child faces doesn’t have to be severe abuse in order to create
deep, biophysical changes that lead to chronic health conditions in adulthood.
“Our findings showed that the ten different types of adversity we examined
were almost equal in their damage,” says Felitti. After analyzing more than
eighteen thousand responses, he and Anda found that no single Adverse
Childhood Experience significantly trumped another. This was true even though
some types, such as being sexually abused, are far worse in that society regards
them as particularly shameful, and others such as physical abuse, are more overt
in their violence. Interestingly, recurrent humiliation by a parent caused a
slightly more detrimental impact and was marginally correlated to a greater
likelihood of adult illness and depression. Simply living with a parent who puts
you down and humiliates you, or who is alcoholic or depressed, can leave you
with a profoundly hurtful ACE footprint and alter your brain and immunologic
functioning for life.
According to Anda, the ACE Survey identifies only “the tip of the iceberg.”
Other researchers agree. Over the past several years, scientists have been
looking for ways to screen for types of childhood stressors that aren’t included in
the ACE Study. For instance, in 2014, researchers at the University of
Cambridge asked parents of fourteen-year-olds to recall any negative life events
or difficulties that their children—or that they as a family—had experienced
between birth and the age of eleven. They asked questions about “family-
focused” problems—including significant arguments or tension between parents,
or simply lack of affection or communication between family members.
Brain imaging of these same kids when they were ages seventeen, eighteen,
and nineteen found that even exposure to very common but relatively chronic
forms of family dysfunction, such as lack of familial affection or parental
discord, led to changes in the developing brain, decreasing the brain’s size and
volume.
The Childhood Trauma Questionnaire, or CTQ, is used with individuals ages
twelve and older to screen for the lingering, invisible impact of more subtle
forms of childhood hurt or neglect. The CTQ asks subtle questions such as, it
was “never,” “rarely,” “sometimes,” “often,” or “very often” true that “People in
my family said hurtful and insulting things to me,” or that “People in my family
called me things like ‘stupid,’ ‘lazy,’ or ‘ugly.’ ”
The CTQ also screens for negative answers to positive statements, allowing a
respondent to say that it was “rarely true” that “my family was a source of
strength and support,” or it was only “sometimes true” that “I felt loved.”
Because the CTQ lets respondents paint a more nuanced picture of their
emotional experiences as children, it, too, has allowed researchers to
demonstrate the striking scientific relationship between low-dose parental or
family unkindness or neglect, damage to the young brain, and later negative
health outcomes.
Chronic parental discord; enduring low-dose humiliation or blame and shame;
chronic teasing; the quiet divorce between two secretly seething parents; a
parent’s premature exit from a child’s life; the emotional scars of growing up
with a hypercritical, unsteady, narcissistic, bipolar, alcoholic, addicted, or
depressed parent; physical or emotional abuse or neglect: these happen in all too
many families. Increasingly, it’s understood that nonfamily stressors in
childhood also can affect adult health. These include early medical trauma, being
bullied or hazed, and living amid neighborhood violence. Although the details of
individual experiences of adversity differ from one home to another and from
one neighborhood to another, they are all precursors to the same organic
chemical changes deep in the gray matter of the developing brain.
As Felitti observes, the years of “infancy and childhood are not lost, but, like a
child’s footprints in wet cement, lifelong.” Or, as T. S. Eliot wrote in
Four
Quartets
, “In my beginning is my end.”
Of course, even though these positive correlations exist between early trauma
and later illness, Adverse Childhood Experiences are not the sole contributor to
adult disease. Disease develops for many reasons, including lifestyle, genetics,
environmental toxins, and diet. We are not ill in adulthood simply because of
what happened in our childhood. And we do not heal simply by knowing that
childhood trauma and adversity play a role in adult illness.
But Felitti and Anda’s research tells us that healing is more difficult if we do
not recognize that our childhood plays a strong hand in whatever health
problems we face now.
This is precisely why, today, in labs across the country, neuroscientists are
peering into the once inscrutable brain-body connection, and breaking down, on
a biochemical level, exactly how the early stress we face when we are very
young, or teenagers, catches up with us when we are adults, altering our bodies,
our cells, and even our DNA.
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