At least 1 in 7 children have experienced child abuse or neglect in the past year in the United States, and this number is likely an underestimate because many cases go unreported.

Experts say trauma prevention and intervention strategies should focus on the family as a whole.

Shavonne Moore-Lobban, PhD, a licensed psychologist who specializes in assessing and treating trauma, said that the impact of childhood trauma is long-lasting.

“When people experience trauma, it begins to form a part of their understanding of how they operate with others and how they operate within the world," Moore-Lobban told Verywell.

Moore-Lobban said the repercussions of childhood trauma can manifest in various ways for adults, such as feeling unsafe in the world, having low self-esteem, and struggling with intimacy. Processing these difficult feelings can help adults create healthy environments for their families and loved ones, she added.

“There are ways in which our own trauma continues, even in our parenting,” Moore-Lobban said. “Generational trauma is generational because it’s passed down, and part of prevention is beginning to figure out how to break that cycle.”

According to the Centers for Disease Prevention and Control (CDC), 61% of adults had at least one ACE, and 16% had four or more types of ACEs.

Childhood trauma can create long-lasting stress on brain development by overworking the Hypothalamic Pituitary Adrenal (HPA) axis, a complex system that regulates hormones and stress responses.

Constant stress in children can disrupt the HPA axis, resulting in physical and mental complications. In the long run, living with traumatic childhood experiences can harm how the body responds to stress. ACEs are also linked to chronic health problems, mental illness, and substance misuse in adulthood. Compounded adverse experiences over time further increase these health risks.

“It’s heartbreaking to think about adults who have gone through ACEs, who maybe did not have the support or interventions or access to resources that they should have had,” said Sonali Rajan, EdD, an associate professor of health education at Teachers College, Columbia University. “In order to have healthy, happy, developmentally supported children, we need healthy adults.”

Not all childhood trauma comes from home life. Gun violence is a public health crisis in the U.S. that affects millions of children. Children of color, especially Black children, have higher exposure to neighborhood firearm violence than White children, and the COVID-19 pandemic has only exacerbated these racial disparities.

According to the activist group Everytown for Gun Safety, the U.S. gun homicide rate is 26 times higher than that of other developed countries. Each year, approximately 3 million children bear witness to gun violence in the U.S., and 18,000 of them are shot and killed or wounded by firearms.

Despite its devastating impact, witnessing or living close to gun violence is not screened for as a standalone ACE. Rajan is part of a research group advocating for gun violence to be looked at as a stand-alone ACE to better support people who have witnessed and suffered from its impact.

“If we start to recognize exposure to gun violence during childhood as an ACE, then we can start to allocate resources to both preventing this kind of ACE,” Rajan said. “But also, importantly, we can allocate resources to support children in the aftermath of exposure to this kind of violence.”

The ACEs Aware initiative, which advocates for ACEs screening, is currently funded by grants from several healthcare organizations, including the American Academy of Pediatrics.

Similar to healing from trauma in a household, both prevention and intervention to experiences with gun violence require a multifaceted approach, she added. Resources need to be offered on personal and community levels—both to children and their caregivers.

How Can Families Prevent and Address ACEs?

Communities that are already vulnerable or underserved are more likely to have child maltreatment, according to Moore-Lobban.

Mental health professionals should be equipped to provide culturally-competent care that addresses diverse identities and experiences, she added.

Studies note that interventions may be costly and they could widen existing inequities in trauma-based care. And over-screening for ACEs could place blame on parents or exacerbate harmful cultural stereotypes if it is not conducted in a culturally-sensitive manner.

“We sometimes create systems where we shame and blame people for getting help,” Moore-Lobban said.

To change this narrative, people in power need to reimagine care “in ways that allow us to come in and support instead of coming in and taking children away,” she added.

Effective ACEs screening should be brief and inform care solutions, such as identifying community and family support, connecting families to resources like financial assistance or housing if needed, and reporting abuse to keep a child safe.

According to the CDC, ACEs prevention could reduce up to 21 million cases of depression and 1.9 million cases of heart disease.

Providing intervention and support as soon as possible could be critical due to the impact of trauma on the developing brain, Rajan said.

“The earlier we intervene and provide support—really comprehensive, thoughtful, needed support—for children in the aftermath of these kinds of experiences… we can do all we can to ensure that they live a long, and healthy, and well-supported life as every child deserves,” Rajan said.