The documented health consequences span a wide range of chronic and life-threatening ailments in adulthood, such as heart disease, hypertension, chronic lung disease, skeletal fractures, liver disease, and premature mortality (Fox et al., 2015). Additionally, ACEs have been consistently associated with long-term difficulties in educational attainment and employment stability.

The original ACE score was developed by asking participants about their experiences of emotional, physical and sexual abuse; exposure to household violence; household substance use; household mental illness; and having an incarcerated family member (Fox et al., 2015). The framework later expanded to include physical and emotional neglect and parental separation or divorce (Fox et al., 2015).

Of the 17,000 participants, more than half reported experiencing at least one ACE, and one-quarter reported two or more (Felitti et al., 1998). Table 1 from Felitti et al.’s (1998) article presents the prevalence of each type of adverse experience by category, illustrating the widespread nature of childhood adversity.

One might argue that the original ACE data are dated and therefore less relevant to today’s experiences. However, subsequent research reveals that the problem has only intensified. The CDC reports that in America, one in five individuals has been sexually molested, one in four individuals severely beaten by a parent, and one in three relationships involves domestic violence (Van der Kolk, 2014). Children are also witnessing high levels of substance use. With approximately three million cases of child abuse and neglect reported annually, one million are classified as serious, warranting court intervention (Van der Kolk, 2014). Recent CDC data indicates that 60.9% of adults have experienced at least one ACE, while 15.6% report having experienced four or more (Jones et al., 2019).

NEUROBIOLOGICAL IMPACT OF TRAUMA

As van der Kolk (2014) explains, “Trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain and body. This imprint has ongoing consequences for how the human organism manages to survive in the present.” ACEs chronically activate the body’s stress response system, producing toxic stress, which disrupts biological pathways, including the limbic-hypothalamicpituitary-adrenal axis (regulates stress response), increased cortisol production (primary stress hormone), elevated catecholamine levels (fight or flight response), and proinflammatory cytokines (regulates inflammation and activates immune responses) (Jones et al., 2019). This dysregulation impairs attention and executive functioning, increases impulse behaviors, alters brain reward pathways, and undermines decision-making and stress regulation (Jones et al., 2019).

When the brain is impacted by adversity, these processes disruption can are create disrupted. This inappropriate associations among perceptual, contextual, and attributional information that become engrained due to traumatic experiences (Cross et al., 2017). It also diminishes the brain’s capacity to appropriately and effectively regulate recollections of these events, as well as interrupts the ability to moderate the fear responses tied to them (Cross et al., 2017). Fear, along with other emotions shaped by the stress response system, can produce debilitating symptoms for individuals. Under conditions of chronic exposure, fear repeatedly activates the hypothalamic-pituitary-adrenal (HPA) axis, a physiological stress response system. This causes irregular regulation of glucocorticoids (stress hormones) such as cortisol (Cross et al., 2017). Childhood adversity is associated with upregulation of this system, elevating the baseline level of cortisol. This resets the body's “normal” standard, impairs flexible responses, increases inflammation, and interferes with the body's ability to clear cortisol efficiently following emotionally triggering experiences.

Developmental psychology emphasizes the critical growth windows across different regions of the brain and recognizes that adversity causes significant disruptions in normative growth patterns. It weakens the strengthening of neural pathways between regions, compromising communication and impairing regulatory functions.

INTERGENERATIONAL TRAUMA, EPIGENETICS AND NEUROPLASTICITY

Intergenerational trauma occurs when elements of parental traumatic experiences are passed down to subsequent generations (Isobel et al., 2017). As children learn the behaviors and coping strategies of ancestors, these patterns are transmitted to their children. These experiences are not always recognized as traumatic within the home or broader culture. They can also affect gene expression, modifying which genes are turned on or off, a process central to epigenetic mechanisms (Lehrner & Yehuda, 2018).

Epigenetics is “the study of mechanisms that modify gene expression, thus shaping phenotypic outcome, but do not alter the underlying DNA sequence.” (Lehrner & Yehuda, 2018). Epigenetic modifications affect gene expression and influence how the brain adapts and rewires itself in response to these experiences– a concept central to neuroplasticity.

Neuroplasticity is the brain’s ability to change, adapt and reorganize itself throughout life. This pliability is particularly important for individuals who have experienced early trauma, which disrupts the growth and connectivity of critical brain regions. Brain structures are susceptible to change from experience, and synapses – the connections between neurons – are also highly affected by trauma. Synaptic plasticity, a key mechanism underlying learning and memory, can be impaired by adverse experiences (Kraus et al., 2017). When synaptic plasticity is disrupted, neural atrophy and cell death may occur, contributing to the pathophysiology of depression (Kraus et al., 2017).

One significant neurotransmitter that plays a central role in these processes is serotonin, referred to as the “happiness chemical.” Deficiencies in serotonin can hinder the development and maintenance of neuronal networks formed during critical development windows, leading to brain disorders (Kraus et al., 2017). In such cases, selective serotonin reuptake inhibitors (SSRIs) may be prescribed to enhance serotonin function and support neuroplasticity, helping the brain recover and reorganize (Kraus et al., 2017).

THE GAP BETWEEN RESEARCH AND PRACTICE

Trauma psychology exists in a silo, with information primarily in academia, journals and conferences, which impacts accessibility. Language barriers and technical terminology further widen this gap, increasing the time lag between discovery and implementation. As a result, evidence-based treatment models can take years to progress from trial to practice.

Paywalls, lack of open access, and geographic restrictions also limit accessibility. Along with the rigor of ethical and institutional protocols, and controlled design systems, participant recruitment, screening, data collection and analysis, and publication requirements extend the research timeline.

The consequences of this gap are significant. Trauma survivors may go years without updated interventions, leaving them vulnerable to maladaptive coping before effective strategies are widely disseminated. As the ACE study demonstrates, unaddressed adversity increases risks for chronic disease, mental health struggles, and premature mortality (Jones et al., 2020). These effects ripple across families and communities, perpetuating intergenerational cycles of trauma and driving substantial societal costs in education, employment and healthcare.

TRANSLATING TRAUMA RESEARCH INTO CLINICAL APPLICATION

Practitioners must understand trauma-related neuroscience to select the most effective treatment modalities for their clients. Some treatment modalities focus on grounding techniques, and emotional regulation, while creative arts therapies assist in accessing and expressing emotions and provide corrective brain patterns (Perryman et al., 2019). Body movement-based practices aid in releasing stored trauma. These artistic and somatic approaches, combined with CognitiveBehavioral Therapy (CBT) create neuroscience-informed interventions (Perryman et al., 2019).

Eye Movement Desensitization and Reprocessing (EMDR) employs guided eye movements to help clients reprocess traumatic memories and reduce overall distress. Somatic Experiencing focuses on the body’s physical responses to trauma, helping clients release stored tension and regulate the nervous system.

Ultimately, it is the clinician’s responsibility to recommend interventions based on their expertise and assessment of the client’s trauma history. In some cases, this may involve referring clients to additional services or other providers whose approaches are better suited to the client’s specific needs.

FUTURE DIRECTIONS AND CALL TO ACTION

No matter the stage – students, early career clinicians, researchers, or seasoned practitioners – we must band together to ensure that the science behind psychology is actively explored and translated into practice.

• Stay informed and share knowledge. Students and early career psychologists can attend webinars, read study summaries, and discuss findings in study groups. Clinicians can integrate research updates into case discussions, supervision, and team meetings.
• Translate and disseminate findings. Create accessible content that accurately conveys psychological science, avoiding misconceptions and “pop psychology.” Community presentations, workshops, and training sessions are all effective ways to spread knowledge.
• Participate in research. Reduce the time lag between discovery and application by volunteering as a research assistant, collecting data, providing literature reviews, or collaborating on practice-based research.
• Advocate for open access and policy change. Encourage journals, institutions, and funders to make research widely available, not just behind paywalls.
• Provide mentorship and collaboration. Clinicians can mentor students and early career psychologists through feedback, support, and research guidance. Establish interdisciplinary networks to connect students, researchers, practitioners, and community stakeholders.
• Apply research personally and provide feedback. Implement evidence-based approaches in daily work. Observe outcomes, reflect on effectiveness, and share findings. This cycle of application and feedback promotes ongoing growth and strengthens the bridge between science and practice.