It is now over 20 years since the publication of the seminal research by Fellitti and colleagues (Fellitti et al 1998) ‘The Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study.’ By 2016 Hughes and her colleagues (Hughes et al 2016) were able to carry out a systematic review and meta-analysis of 37 studies reporting risks of health outcomes, for a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs.
This Annual Review of ACEs research and practice reflects the changing face of current developments.
Kat Ford (Bellis et 2025) will present research measuring childhood experience of physical and/or verbal abuse and current mental well-being. Interestingly there has been a significant drop in the prevalence of child physical abuse however verbal abuse rose which has similar associations with lower mental wellbeing during adulthood.
David Blanchflower’s research (Blanchflower and Bryson 2025) maps changes in the mental health of young people in the United States, starting after the Great Recession, particularly among the young. Mental Health continued to deteriorate during COVID, Multivariate analyses captured the independent correlation between young people’s mental health and difficulties experienced in childhood – Adverse Child Experiences (ACE)s – together with the role played by social media, including via cyber-bullying.
Athena Chow’s research (Chow et al 2024) explores nuances of how different types of adversity shape psychopathology from a large-scale, data-driven study involving over 30,000 children. By investigating a wide range of ACEs, they found that these experiences are best captured by core underlying dimensions: parental threat, deprivation, and victimisation – distinct and potent adversities that requires specific attention in clinical and policy-based interventions.
Eamon McCrory’s research (McCrory et al 2017) describes core responses to adversity such as Dissociation, Hypervigilance, Strategic Avoidance which carry adaptive value in early adverse caregiving environments but confer long-term risk to mental health ‘Latent vulnerability.’ They can also shape how individuals build their social architecture over time (McCrory et al 2022) including “social thinning” (reduction in the quality / number of affiliative or supportive relationships) and “stress generation” (more frequent interpersonal stressor events)
Franziska Meinck’s research (Meinck et al 2025) explores the way early experiences of adversity are transmitted intergenerationally. 28 studies were analyzed thematically, underlying mechanisms of intergenerational violence perpetration included, normalization of violence and harmful gender norms, modelling and imitation, high vulnerability, and impaired relationships.
Jessie Baldwin’s research (Chow 2025 ) explores the fact that many children exposed to ACEs do not develop mental health difficulties. Identifying genuine resilience factors that promote resilience to adversity is therefore critical for informing preventative interventions. Social Support, and Increased Economic resources are explored.
Charles A. Nelson III’s research (Nelson et al 2025) attempts to explain how brain architecture and circuitry are affected by exposure to early adversity, and increased susceptibility to mental health disorders. He discusses critical periods when the brain is particularly receptive to experience, neuroimaging research how the circuitry of the brain is affected by early-life adversity, subsequent neural network development and the the mental health consequences and specific dimensions of psychopathology.
Shanta R. Dube’s research (Dube et al 2023) examined the relationship between illicit drug use and 10 categories of adverse childhood experiences (ACEs) and total number of ACEs (ACE score) in a retrospective cohort study of 8613 adults attending a primary care clinic. The ACE score had a strong graded relationship to the risk of drug initiation from early adolescence into adulthood and to problems with drug use, drug addiction, and parenteral use, accounting for one half to two third of serious problems with drug use. Prioritizing screening for childhood trauma is essential to develop effective public health prevention
Patricia Bianca Torres’s research (Bianca Torres et al 2026 ) explores how protective relationships can foster well-being—defined as flourishing—in children and young people with ADHD. From a nationally representative sample of 4,847 children aged 6–17 diagnosed with ADHD, they examined whether PCEs predict flourishing in the presence or absence of comorbid mood disturbances. Higher PCEs and the absence of mood disturbance significantly increased the likelihood of flourishing, even when ACEs are present. Among PCEs, family resilience, caregiver connection, and opportunities for community engagement emerged as the strongest predictors of positive adjustment.
Angela Narayan’s research (Narayan et al 2017) examined the psychometric properties of the Benevolent Childhood Experiences (BCEs) scale, an instrument designed to assess positive early life experiences in adults with histories of childhood maltreatment and other adversities. It was developed to be multiculturally sensitive and applicable regardless of socioeconomic position, urban-rural background, or immigration status. Higher levels of BCEs were hypothesized to predict lower levels of psychopathology and stress beyond the effects of ACES in a sample of ethnically diverse, low-income pregnant women. Higher levels of BCEs predicted less PTSD symptoms and Person-oriented analyses also showed that higher levels of BCEs offset the effects of ACEs on prenatal stress and psychopathology. Favourable childhood experiences may counteract long-term effects of childhood adversity.
Conclusion
The range and scope of the research to be presented in this annual review of ACEs research illustrates the way current research illustrates the way that detailed information is being developed about the way Adverse Childhood Experiences affects the individual’s life span of mental health, and the way these impacts may be mitigated through Positive Life Experiences – a move to prevention to offset the rather fatalistic view that the impacts of adversity are immovable!
Where next?
Webinar: Adversity, Protection, and Prevention: Rethinking Childhood Experiences Through New Evidence – Explore how adversity, protection, and prevention shape child and adolescent mental health at this ACAMH expert conference on Adverse Childhood Experiences (ACEs). Learn evidence-based strategies to reduce risk and build resilience in children and families. 30 September
ACAMH Learn: FREE Talks, podcasts, and lectures
Topic Guide: Each mental health Guide contains evidence based research. Whether you are new to the Topic or want to find the latest research, here is your starting point. ACE’s
References
Bellis MA, Hughes K, Ford K, et al. Comparative relationships between physical and verbal abuse of children, life course mental well-being and trends in exposure: a multi-study secondary analysis of cross-sectional surveys in England and Wales. BMJ Open 2025;15:e098412. doi:10.1136/ bmjopen-2024-098412
Bianca Torres, P., Ignacio, D.A, Griffith, N.M., Emick, J.(2026) Predicting Flourishing in ADHD Youth: Positive Childhood Experiences and Mood Disturbances in Context of Adversity. J Atten Disord doi: 10.1177/10870547251375513. Epub 2025 Sep 28
Blanchflower DG, Bryson A (2025) The consequences of abuse, neglect and cyber-bullying on the wellbeing of the young. PLoS One 20(8): e0327456. https://doi.org/10.1371/journal.pone.0327456
Chow, A.R.W., Baldwin J.R., Bowes, L. (2024) Do meaningful dimensions of childhood adversity exist? Data-driven evidence from two prospective cohort studies Journal of Child Psychology and Psychiatry https://doi.org/10.1111/jcpp.14098
Chow, A.R.W., (2025) Strengthening causal inference in understanding the relationship between childhood adversity and adolescent psychopathology. DPhil Oxford University ORA – Oxford University Research Archive https://ora.ox.ac.uk › objects
Dube, S., Felitti, V, Dong,M., Chapman, D.P., Files. W., Anda, R.A, (2003) Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study Pediatrics 111 (3): 564–572. DOI: 10.1542/peds.111.3.564
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8
Hughes, K., Bellis, M.A., Hardcastle, K.A., Sethi, D., Butchart, A., Mikton, C., Jones, L., Dunne, M.P. (2017) The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis Lancet Public Health Aug;2(8):e356-e366.
McCrory, E., Foulkes, L., & Viding, E. (2022). Social thinning and stress generation after childhood maltreatment: A neurocognitive social transactional model of psychiatric vulnerability. The Lancet Psychiatry, 9(10), 828-837 doi: 10.1016/S2215-0366(22)00202-4. Epub 2022 Aug 1
McCrory, E., Gerin, M.I., Viding, E., (2017) Annual Research Review: Childhood maltreatment, latent vulnerability and the shift to preventative psychiatry – the contribution of functional brain imaging J Child Psychol Psychiatry. Apr;58(4):338-357. doi: 10.1111/jcpp.12713. Epub 2017 Mar 13
Meinck, F., Lu, M., Suresh.D., Cetin, M., Neelakantan, L., Hemady, C., Franchino-Olsen, Woollett, N., Menedez-Torres, G.J., Gonzalez A., Christofides N. (2025) What Are the Mechanisms Underpinning Intergenerational Transmission of Violence Perpetration? A Realist Review. Trauma Violence and Abuse doi: 10.1177/15248380251361468.
Narayan A.J., Rivera L.M., Bernstein R.E., Harris, W.W., Lieberman, A.F. (2018) Positive childhood experiences predict less psychopathology and stress in pregnant women with childhood adversity: A pilot study of the benevolent childhood experiences (BCEs) scale Child Abuse Negl. doi: 10.1016/j.chiabu.2017.09.022.
Nelson C.A., Sullivan E.F., Valdes V. (2025) Early adversity alters brain architecture and increases susceptibility to mental health disorders. Nat Rev Neurosci. Oct;26(10):642-656. doi: 10.1038/s41583-025-00948-9. Epub 2025 Jul 24
