The Hidden Impact of ACEs: How Adverse Childhood Experiences Shape Coping, Behavior, and Misdiagnosis
- Stephanie Underwood, RSW
- Sep 6
- 6 min read
Updated: Sep 7
The Hidden Impact of ACEs: How Adverse Childhood Experiences Shape Coping, Behavior, and Misdiagnosis
In recent years, mental health awareness has exploded. People openly discuss autism, ADHD, attachment styles and “emotional unavailability” online. Yet one concept still flies under the radar: Adverse Childhood Experiences (ACEs). These early traumas quietly shape adult coping, behavior, and even misdiagnoses. Without acknowledging ACEs, we risk mistaking survival strategies for immutable personality traits or neurodevelopmental conditions.
This article explores what ACEs are, how they influence adult behavior, why they are often misdiagnosed, and why they deserve more attention in conversations about healing.
What Are Adverse Childhood Events (ACEs)?
What Are Adverse Childhood Experiences (ACEs)?
ACEs are traumatic events that occur before age 18. They include abuse, neglect, and household dysfunction. The landmark CDC‑Kaiser study identified 10 core categories:
Physical abuse
Emotional abuse
Sexual abuse
Physical neglect
Emotional neglect
Witnessing domestic violence
Household substance abuse
Household mental illness
Parental separation or divorce
Incarcerated household member
These experiences activate chronic stress responses that can alter brain development and health throughout the lifespan.
These experiences can have lasting effects on brain development, stress response systems, relationships, and physical health.
Lesser-Known Examples of Adverse Childhood Events
While the “classic” ACE list is well-known, there are other chronic or subtle experiences that may not seem adverse at first glance but still impact development. These include:
Chronic emotional neglect: basic physical needs are met but emotional needs are ignored.
Parentification: being expected to care for siblings or manage household responsibilities far beyond your age.
Frequent relocations: repeated loss of stability, friendships, and community. Moving frequently where a child has to change schools frequently. The adverse event is the lack of safety and the fear of abandonment that often forms from having to make and lose new friends.
High parental criticism or perfectionism: constant pressure to achieve =children learn that their worth is tied to their performance. That they are only worthy when they achieve (school, work)
Enmeshment: a parent relying on a child for emotional support.
Unpredictable caregiving: caregivers swinging between warmth and withdrawal.
Lack of privacy or autonomy: no personal space or respect for boundaries.
Subtle favoritism: quiet but persistent unequal treatment among siblings.
How Adverse Childhood Events Show Up Later in Life
The impacts of chronic ACEs go far beyond emotional pain, they actively shape the way people think, feel, and behave. ACEs shape how people view themselves in relation to others. Over time, the nervous system adapts to survive in unsafe or unstable environments. The result? A set of coping mechanisms and behavioural reactions that may have been protective in childhood, but often cause problems in adulthood.
Examples of ACE-Related Coping Mechanisms and Reactions
Perfectionism: staying “good” to avoid criticism.
People-pleasing: keeping the peace at any cost.
Emotional numbness: shutting down to feel safe.
Hyper-independence: never relying on anyone.
Overcontrol: creating predictability in chaos.
Avoidance: steering clear of anything that could cause the person to experience emotional pain.
These behaviours aren’t random personality quirks, they’re survival strategies. And they can become so ingrained that people often don’t realize that these responses are linked with early childhood adversity.
ACEs and Misdiagnosis
One of the most concerning issues is that the impacts of ACEs are often mistaken for symptoms of other mental health conditions, especially neurodevelopmental conditions like autism and ADHD.
For example:
Social fatigue may be labeled as autism, when it’s actually hyper vigilance from growing up in an emotionally unpredictable home.
Excessively rigid routines may be seen as autistic traits, when they’re a trauma-based need for control, and much more common than many people realize.
Avoidance of eye contact may be rooted in shame from being criticized in early childhood or learned deference from unsafe caregiving.
Why this matters
Misdiagnosing trauma adaptations as neurodivergence can delay or prevent people from addressing the root cause of their struggles. That’s why diagnosis should only be made by qualified mental health professionals who can explore both developmental history and current functioning.
ACEs Coping Mechanisms vs. How They’re Often Misdiagnosed
ACEs-Related Coping Mechanism / Behavior | Why It Develops (Trauma Lens) | Common Misdiagnoses / Mistaken Conditions | |
Perfectionism | Trying to avoid criticism or rejection by achieving flawlessly. | Obsessive-Compulsive Personality Disorder (OCPD), Anxiety Disorders. | |
People-Pleasing (Fawning Response) | Keeping peace in unstable environments by putting others first. People-Pleasing is a nervous system response. | Dependent Personality Disorder, Social Anxiety Disorder. | |
Emotional Numbness | Shutting down feelings to survive emotional pain or chaos. Struggling to identify and label our different emotional states. | Depression, Schizoid Personality Disorder, alexithymia. | |
Hyper-Independence | Avoiding reliance on others due to past experiences with betrayal or abandonment. A child who is emotionally neglected more often than not, may develop an Avoidant Attachment style as a result which may lead to hyper independence. | Avoidant Personality Disorder, Autism Spectrum Disorder (due to social withdrawal) | |
Overcontrol / Rigid Routines | Creating predictability when life felt chaotic or unsafe. | Autism Spectrum Disorder, Obsessive-Compulsive Disorder (OCD), Anxiety Disorder. | |
Avoidance | Steering clear of triggering people, places, or situations. Avoidance is a coping mechanism to avoid having to experience emotional pain. | Avoidant Personality Disorder, PTSD. | |
Difficulty with Eye Contact | Learned deference, shame, or safety behavior in unsafe caregiving, impacts of growing up in certain cultures. | Autism Spectrum Disorder, Social Anxiety Disorder. | |
Social Fatigue | Emotional exhaustion from hyper vigilance in social settings stemming from the fear of abandonment, fear of rejection). | Autism Spectrum Disorder, Chronic Fatigue Syndrome, Social Anxiety, Depression. | |
Direct or Blunt Communication | Lack of exposure to safe, low-stakes social environments. | Autism Spectrum Disorder, Personality Disorders. |
*The Information is educational, not diagnostic. Overlapping traits don’t equal identical causes. For assessment and diagnosis, consult a licensed mental health professional.
The Prevalence of ACEs
ACEs are far from rare. In fact, they are the norm.
CDC–Kaiser Study (U.S.): ~64% of adults reported at least one ACE; 12.5% reported four or more.
Global meta-analysis (2023): Across over 500,000 adults, prevalence of at least one ACE averaged around 61%, with regional ranges between 55% and 89%.
WHO international surveys: Consistently show more than half of adults worldwide report at least one ACE.
Why ACEs Deserve More Attention
ACEs force us to look at the root causes of suffering, not just the surface-level symptoms. Talking about ACEs means confronting systemic issues, family dynamics, and intergenerational trauma. Without this conversation, we risk mistaking survival adaptations for immutable traits, and leaving people stuck with coping mechanisms that no longer serve them.
Frequently Asked Questions (FAQs)
What are ACEs?
ACEs are traumatic events before age 18—such as abuse, neglect or household dysfunction—that can affect brain development and later health.
How common are ACEs?
Studies show that 60–70% of adults worldwide report at least one ACE. In the U.S., about 64% have at least one and 12.5% have four or more.
Can ACEs cause mental health problems later in life?
Yes. ACEs increase the risk for depression, anxiety, PTSD, chronic illness and other issues due to long‑term stress on the body.
How do I know if my coping behaviors are trauma‑related or a disorder?
Many ACE‑related strategies mimic symptoms of conditions like autism or ADHD. A trauma‑informed assessment from a qualified clinician can help determine whether behaviors stem from childhood trauma or a neurodevelopmental disorder.
Can people heal from the effects of ACEs?
Absolutely. Healing involves acknowledging trauma, developing self‑compassion, building safe relationships, and often working with professionals who understand ACEs. Many people find recovery through therapy, support groups, mindfulness, and somatic practices.
Where to Learn More About ACEs
If you want to go deeper into the science and implications of ACEs, here are some credible starting points:
CDC-Kaiser ACE Study – Original landmark research. https://www.cdc.gov/violenceprevention/aces/about.html
CDC ACEs Overview – What ACEs are, their health effects, and prevention strategies
Meta-analysis on ACE prevalence – Global prevalence and impact
Research on ACEs and multimorbidity – How ACEs link to multiple chronic illnesses
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03505-w
References
Centers for Disease Control and Prevention. (2023). About the CDC-Kaiser ACE study. U.S. Department of Health & Human Services. https://www.cdc.gov/violenceprevention/aces/about.html
Centers for Disease Control and Prevention. (2022). Preventing adverse childhood experiences. U.S. Department of Health & Human Services. https://www.cdc.gov/vitalsigns/aces/index.html
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. The Lancet Public Health, 2(8), e356–e366. https://doi.org/10.1016/S2468-2667(17)30118-4
Petruccelli, K., Davis, J., & Berman, T. (2019). Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis. Child Abuse & Neglect, 97, 104127. https://doi.org/10.1016/j.chiabu.2019.104127
Yang, H., & Ma, J. (2024). Associations between adverse childhood experiences and adult multimorbidity: A systematic review and meta-analysis. BMC Medicine, 22(1), 134. https://doi.org/10.1186/s12916-024-03505-w
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