What Are ACE Scores and Why Do They Matter for Neurodivergent Adults?
As a therapist, I often work with individuals who have experienced various forms of trauma. One helpful tool to understand the long-term effects of early adversity is the Adverse Childhood Experiences (ACE) score. This score assesses the impact of negative experiences during childhood, helping predict how these experiences might influence a person's physical and mental health. ACE scores can be particularly relevant for autistic and ADHD adults, whose neurodevelopmental traits may interact uniquely with trauma.
What Are ACEs?
Adverse Childhood Experiences (ACEs) refer to potentially traumatic events before age 18. These include:
Abuse (physical, emotional, or sexual)
Neglect (physical or emotional)
Household dysfunction, such as exposure to substance abuse, domestic violence, mental illness, or parental incarceration
The original ACE study by the CDC and Kaiser Permanente found that the more ACEs a person experiences, the higher their risk of negative health outcomes later in life, such as mental health disorders, chronic diseases, and even early mortality (Felitti et al., 1998).
How ACE Scores Work
An ACE score is calculated by counting the number of categories of adverse experiences a person faced during childhood, with a range from 0 to 10. For example, a person who experienced emotional neglect and parental substance abuse would have an ACE score of 2. Higher scores are linked to more significant risks for long-term issues such as heart disease, depression, or substance use disorders (CDC, 2019).
Trauma and Neurodivergence: A Complex Intersection
For autistic and ADHD adults, the impact of ACEs can be particularly intense. Neurodivergent individuals are often more vulnerable to trauma because of factors such as social isolation, bullying, or misunderstanding from others. Autistic individuals, for example, may be more sensitive to changes in their environment or face challenges in social situations, heightening their risk of emotional trauma (Kerns et al., 2015). Similarly, ADHD individuals may experience criticism for their impulsive behavior or inattentiveness, increasing their exposure to emotionally painful experiences (Craig et al., 2016).
Unique Gendered Experiences
Gender presentation can further complicate the relationship between neurodivergence and ACEs. Girls and AFAB (assigned female at birth) individuals with ADHD and autism may be underdiagnosed, leading to feelings of being misunderstood or unsupported during formative years. Girls with ADHD are more likely to internalize symptoms, which can manifest as anxiety or depression, both of which are exacerbated by trauma. In contrast, boys or AMAB (assigned male at birth) individuals may face more externalizing symptoms, such as impulsive or disruptive behavior, increasing the likelihood of being labeled "troublemakers" and experiencing harsher discipline, which can be traumatic in itself (Hull et al., 2020).
The Impact of ACEs on Neurodivergent Adults
While ACE scores are predictive of health outcomes for the general population, neurodivergent adults face unique challenges. Trauma may amplify existing difficulties, especially around emotional regulation, executive functioning, and social communication. For example:
Heightened Anxiety and Hypervigilance: Many autistic individuals experience high levels of anxiety, which trauma can worsen. Hypervigilance, a common trauma response, is often intensified in autistic adults due to sensory sensitivities (Ozsivadjian et al., 2012).
Emotional Dysregulation: ADHD is associated with emotional dysregulation, and trauma can further complicate the ability to manage emotions. Individuals with both ADHD and high ACE scores may struggle with anger, frustration, and sadness, affecting personal and professional relationships (Craig et al., 2016).
Compounded Executive Functioning Challenges: Trauma can worsen executive dysfunction, such as difficulties with organization, time management, and decision-making, which are already present in autism and ADHD (Teicher & Samson, 2016).
Trauma-Informed Care for Autistic and ADHD Adults
For neurodivergent individuals, it’s essential that care providers understand the intersection between trauma and neurodevelopmental differences. Trauma-informed care helps clinicians tailor treatment to address both the impact of childhood adversity and the specific challenges associated with autism and ADHD. By fostering resilience and offering personalized strategies, therapy can support individuals in managing symptoms and improving their quality of life.
Conclusion
ACE scores provide valuable insights into the long-term effects of childhood trauma, especially for autistic and ADHD adults. Understanding this intersection helps clinicians offer effective, compassionate care that addresses both trauma and neurodevelopmental challenges.
Citations:
Felitti, V. J., et al. (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.
Centers for Disease Control and Prevention (CDC). (2019). Adverse Childhood Experiences (ACEs). Retrieved from https://www.cdc.gov/violenceprevention/aces/index.html
Kerns, C. M., et al. (2015). Anxiety in autism spectrum disorder: Clinical and research perspectives. Neuropsychiatry, 5(1), 147-155.
Craig, F., et al. (2016). A review of executive function deficits in autism spectrum disorder and ADHD. Neuropsychiatric Disease and Treatment, 12, 1191-1202.
Hull, L., Mandy, W., & Petrides, K. V. (2020). Behavioral and cognitive differences in autism spectrum condition as a function of sex and gender. Autism, 24(2), 347-359.
Ozsivadjian, A., Knott, F., & Magiati, I. (2012). Parent and child perspectives on the nature of anxiety in children and young people with autism spectrum disorders: A focus group study. Autism, 16(2), 107-121.
Teicher, M. H., & Samson, J. A. (2016). Annual research review: Enduring neurobiological effects of childhood abuse and neglect. Journal of Child Psychology and Psychiatry, 57(3), 241-266.