Quick look
What if two people with the same childhood trauma score have very different stories and outcomes? New Iowa State research suggests that understanding the specific kinds of adversity people experience, and not just how much, could help transform how schools, clinicians and correctional systems provide support.
AMES, Iowa – For years, childhood trauma has often been measured with a simple score.
The widely used Adverse Childhood Experiences, or ACEs, system assigns points for experiences such as abuse, neglect, parental divorce, substance abuse in the home and other adversities before age 18. In general, the higher the score, the greater the risk for future health and behavioral problems.
But new research from Iowa State University professors Carl F. Weems and Amie Zarling suggests that score may not tell the whole story.
In a study published in the Journal of Psychopathology and Behavioral Assessment, Weems and Zarling surveyed 552 adults on probation or parole in Iowa and found that the specific types of adversity people experience in childhood may be just as impactful as the total number of hardships they face.
“The question isn’t simply how much adversity someone experienced growing up, but what kind, what they remember and report, and which patterns they experienced,” said Weems, professor of human development and family studies at Iowa State.
Weems said different experiences can shape people’s lives in different ways and may require more individualized responses from the systems designed to help them, adding that “how people respond, report and remember this past is also shaped by what and how you ask them.”
Looking beyond the ACE score
The ACEs framework emerged from landmark research in the 1990s and includes 10 categories of adversity, ranging from physical abuse and neglect to parental separation, household substance abuse and mental illness.
The framework’s appeal, Weems and Zarling said, has traditionally been its simplicity. When using ACEs, each adverse childhood experience counts as one point, creating a total score linked to increased risks for depression, addiction and chronic disease in adulthood.
But that simplicity may also be a limitation, the researchers said.
In their new study, Weems and Zarling instead drew from an expanded traumatic events and adverse childhood experiences framework – also known as TRACEs – that was previously developed by Weems to help incorporate broader trauma, risk and protective factors into childhood adversity models.
In doing so, Weems and Zarling said they hoped to capture a fuller, more nuanced picture of TRACEs by expanding their analysis to include other traumatic events such as bullying, living in an unsafe neighborhood, disasters, accidents and foster care placement.
“Our goal was to integrate emerging neuroscience on memory of TRACEs and advanced statistical modeling to move beyond counting childhood hardships and better understand the distinct ways different types of adversity affect people later in life,” said Zarling, professor and chair of Iowa State’s department of human development and family studies.
“While two people may have the same ACE score, they may have arrived at that score through very different experiences,” said Zarling, who noted researchers have increasingly questioned whether different experiences should be lumped together into a single score.
“A child exposed to chronic emotional neglect may face different challenges than a child who witnessed domestic violence or grew up with a parent struggling with addiction,” she said. “And while all three experiences contribute to an ACE score, our research suggests they do not necessarily affect people in the same way.”
When focusing on a total score based only on the traditional ACEs, “we lose information that may be important for understanding risk, resilience and what kinds of support are most likely to help,” Weems added.
Childhood adversity was nearly universal
Of the 552 Iowa adults on probation or parole surveyed by Weems and Zarling, more than 95% reported at least one childhood adversity, and the average participant reported 4.6 traditional ACEs along with nearly 10 additional traumatic experiences.
Only 4.7% reported no traditional ACEs at all.
As they analyzed the reported experiences, Weems and Zarling identified 11 distinct categories of adversity: physical and emotional abuse; domestic violence; sexual abuse; household mental illness; household drug and alcohol abuse; physical neglect; parental separation and divorce; emotional neglect; disasters, war and accidents; lack of community safety; and an incarcerated household member.
Importantly, the researchers found that models examining specific types of trauma – for example, factor-based models that identify specific categories of trauma and “formative” models that treat adversity as being built from different experiences rather than reflected by them – consistently did a better job explaining adult outcomes than a simple ACEs total.
“Traditional ACEs sum scores performed the worst,” Weems said. “We found that knowing a person’s specific trauma profile provides more useful information than simply knowing the total number of adverse experiences they endured in childhood.”
Connections to adult behavior
The study also examined traits linked to successful rehabilitation, including psychological flexibility, or the ability to adapt to challenges while staying focused on long-term goals.
Across nearly every category of adversity, higher levels of childhood trauma were associated with lower psychological flexibility, and higher levels of coercive control, a pattern of using pressure, threats or other negative behaviors to influence others.
Weems and Zarling also noted differences between men and women.
Women reported significantly higher levels of sexual abuse, emotional neglect, parental separation, household mental illness and household substance abuse, while men were more likely to report experiences involving disasters, war or serious accidents.
“These differences mirror prior research showing that women in the justice system often have particularly extensive histories of interpersonal trauma,” Zarling said. “They suggest trauma-informed interventions may need to account for those differences rather than treating all childhood adversity as interchangeable.”
Weems and Zarling said one of the study’s more surprising findings involved men convicted of violent crimes.
Among male participants, those with violent offenses reported substantially higher levels of sexual abuse, emotional neglect and exposure to disasters, war and accidents than men whose offenses were limited to substance-related crimes.
“This adds nuance to common assumptions about violence and trauma,” said Weems, who noted the study’s use of a multi-item assessment may have helped identify this unexpected finding.
“Rather than being linked only to physical abuse or family violence, serious offending among some men may also be associated with less-visible experiences such as childhood sexual victimization and emotional deprivation,” he said.
Why it matters
The researchers said their findings have implications beyond the criminal justice system.
For clinicians, a more detailed understanding of childhood adversity could improve treatment planning. For schools and social service agencies, it could help identify children facing specific challenges. And for correctional systems, it could lead to rehabilitation programs tailored to different trauma histories.
“For years, ACEs screening has helped organizations recognize that childhood experiences matter,” said Zarling, who emphasized that the study’s findings don’t mean the original ACEs framework is wrong. “Many of the strongest factors we identified correspond closely to the traditional ACEs categories, but richer assessments could help provide a more complete picture of a person’s history.
“Our findings suggest the next stage of this work may be understanding which experiences matter most, how they interact, what patterns reveal about future needs and how to deploy the more nuanced assessment of TRACEs we used in the study,” she said.
Overall, Weems and Zarling said the study’s broader takeaway is a straightforward one: childhood trauma is rarely a single event and cannot always be captured by a single score.
“Sometimes, what you remember happening, or what you’re willing to report happening, depends on what and how you’re asked,” they said.
