Elsevier

Physiology & Behavior

Volume 106, Issue 1, 12 April 2012, Pages 29-39
Physiology & Behavior

Review
Adverse childhood experiences, allostasis, allostatic load, and age-related disease

https://doi.org/10.1016/j.physbeh.2011.08.019Get rights and content

Abstract

How do adverse childhood experiences get ‘under the skin’ and influence health outcomes through the life-course? Research reviewed here suggests that adverse childhood experiences are associated with changes in biological systems responsible for maintaining physiological stability through environmental changes, or allostasis. Children exposed to maltreatment showed smaller volume of the prefrontal cortex, greater activation of the HPA axis, and elevation in inflammation levels compared to non-maltreated children. Adults with a history of childhood maltreatment showed smaller volume of the prefrontal cortex and hippocampus, greater activation of the HPA axis, and elevation in inflammation levels compared to non-maltreated individuals. Despite the clear limitations in making longitudinal claims from cross-sectional studies, work so far suggests that adverse childhood experiences are associated with enduring changes in the nervous, endocrine, and immune systems. These changes are already observable in childhood years and remain apparent in adult life. Adverse childhood experiences induce significant biological changes in children (biological embedding), modifying the maturation and the operating balance of allostatic systems. Their chronic activation can lead to progressive wear and tear, or allostatic load and overload, and, thus, can exert long-term effects on biological aging and health.

Highlights

► We reviewed the physiological correlates of adverse childhood experiences. ► We examined the effects on the nervous, the endocrine, and the immune systems. ► These systems are abnormally active in maltreated children and adults. ► These effects may be adaptive in the short term but subsequently become detrimental. ► These effects may explain why maltreated individuals are at greater risk of disease.

Section snippets

Allostasis

Life is made possible by the relative stability of key physiological variables, such as body temperature, energy balance, and blood composition (homeostasis) [6]. This is testified by the narrow variations in these variables that are compatible with life. However, because animals are open biological systems constantly interacting with the environment, the stability of these key physiological variables is threatened by changing environmental conditions.

In order to maximize survival, biological

Allostatic load

Chronic or repeated exposure to psychosocial stressors has been linked to prolonged activation of the allostatic systems, with detrimental physiological consequences — allostatic load, and its more severe form, allostatic overload [5], [12].

In the nervous system, the chronic exposure to psychosocial stressors leads to structural and functional abnormalities in stress-sensitive regions, such as the prefrontal cortex, the amygdala and the hippocampus [2], [14]. In the prefrontal cortex, chronic

Age-related disease

Allostatic load or overload [5], the ‘wear and tear’ of the allostatic systems, is likely to mediate the effect of chronic stress on medical and psychiatric disorders related to aging.

First, individuals exposed to chronic stressors are at heightened risk of cardiovascular disease [33], [34], [35]. Stress-related amygdala hyper-reactivity, elevation in inflammation levels, and metabolic abnormalities may contribute to atherosclerosis progression promoting the development of cardiovascular

Child development

In addition to chronic or repeated stressors during life as a mature individual, stressors experienced in sensitive developmental windows may also have enduring influences on allostasis and allostatic load and overload. Adverse childhood experiences could induce significant biological changes in children (biological embedding), modify the maturation and responsiveness of allostatic systems and, thus, exert long-term effects on health.

The nervous, endocrine, and immune systems are not fully

Nervous system

We will consider here neurobiological and behavioral correlates of maltreatment in children [60], focusing on three key brain regions known to be highly sensitive to psychosocial stress; the prefrontal cortex, the amygdala, and the hippocampus [14].

Convergent findings suggest abnormalities in prefrontal cortex functioning in maltreated children. In a recent study, a non-clinical sample of substantiated cases of physical maltreatment, maltreated children showed smaller orbitofrontal cortex

Nervous system

Consistent with the evidence in children, adults with a history of childhood maltreatment also showed smaller prefrontal cortex volume. In a non-clinical sample, adults with a history of childhood harsh corporal punishment showed smaller volume in the left dorsolateral and the right medial prefrontal cortex [109]. In a different non-clinical sample, adults who experienced greater levels of childhood stress including maltreatment showed smaller volume in the anterior cingulate cortex [110].

Adverse childhood experiences and age-related disease

Adverse childhood experiences predict adult neurobiological, metabolic, and immune changes related to the development of age-related disease. For example, findings from the Dunedin study showed that childhood maltreatment, childhood socio-economic disadvantage, and childhood social isolation predicted elevated risk of depression, clustering of metabolic risk factors, and elevated inflammation levels in adult life [59]. The effects of adverse psychosocial experiences in childhood were

Conclusion and future directions

Adverse childhood experiences appeared to be associated with changes in the nervous, endocrine, and immune systems in children and adults (see Table 1). Previous research showed that experiences during child development (experience-dependent information) could influence maturational processes and, thus, exert long-term effects. For example, childhood social experiences influence adult social functioning [56], and childhood infection influence adult immune functioning [57]. Cross-effects between

Acknowledgments

Dr. Andrea Danese is supported by a Brain & Behavior Research Foundation/NARSAD Young Investigator Award. Dr. Bruce McEwen acknowledges the National Scientific Council on the Developing Child.

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