“There are many developmental paths that may lead from ACEs to dysfunction in early adulthood, including a complex set of genetic, neurobiological, cognitive, emotional, social, and moral mechanisms,” said Mersky. His study makes a contribution toward filling the gap in understanding “why the effects of ACEs manifest 40 or 50 years down the road. Some of the outcomes we examine in early adulthood, including substance use and poor mental health, are likely pathways through which ACEs lead to deleterious health outcomes.”

A 2015 paper in the journal Sleep Medicine5 reviewed research on one particular negative outcome that has been associated with ACEs: Sleep disorders. Of the 30 studies reviewed, all but three found significant associations between multiple sleep disorders and childhood adversity. The authors report that two prospective studies “have documented statistically significant associations between family conflict at 7-15 years of age and insomnia at 18 years of age […] and between childhood sexual abuse and sleep disturbances 10 years later in adult women.” (The review focused on studies involving women.)


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“The most prominent biological mechanism that is theorized to explain the association involves cortisol,” co-author Sandhya Kajeepeta, MSc, a researcher at the Harvard T.H. Chan School of Public Health, told Psychiatry Advisor. “Exposure to ACEs may increase cortisol reactivity, which leads to hypothalamic-pituitary-adrenal (HPA) axis hyperactivity, which in turn can cause sleep disruption.”

Addressing ACEs and the multitude of related issues requires a multi-faceted approach. It is important that mental health clinicians consider sleep disorders as a symptom that may suggest a history of abuse so that proper treatment, including trauma-informed care, can be provided,” said Kajeepeta

Mersky and colleagues advocated for an increased investment in policies and program that could help to prevent ACEs and minimize their impact.

“On a clinical level, I’m a fan of two-generation models that target parents with young children — e.g. home visiting, parent management training,” said Mersky. “These interventions can help to mitigate the effects of ACEs on parents, which, in turn, may reduce the likelihood that their children are exposed to ACEs.”

Tori Rodriguez, MA, LPC, is a psychotherapist and freelancer writer based in Atlanta.

References

  1. Felitti VJ et al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine. 1998; 14(4):245-58.
  2. Brown DW et al. Adverse childhood experiences and the risk of premature mortality. American Journal of Preventive Medicine; 2009; 37(5):389-96. 
  3. Kelly-Irving M et al. Adverse childhood experiences and premature all-cause mortality. European Journal of Epidemiology; 2013; 28(9):721-34. 
  4. Mersky JP et al. Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: a cohort study of an urban, minority sample in the U.S. Child Abuse & Neglect; 2013; 37(11):917-25. 
  5. Kajeepeta S. Adverse childhood experiences are associated with adult sleep disorders: a systematic review. Sleep Medicine; 2015; 16(3):320-30.