Adverse Childhood Experiences, Cognitive Functioning, Depression, and Anxiety in Adulthood

Background: Evidence suggests that adverse childhood experiences (ACEs) predict cognitive dysfunction, possibly through direct (e.g., brain structure/function changes) and indirect (e.g., increased psychopathology risk) pathways. However, extant studies have focused on young and older adults, with limited understanding of how ACEs affect cognitive health in midadulthood. Objective: This study compared psychiatric and cognitive differences between adults at high- and low-risk of adverse health outcomes based on the ACE risk classification scheme. Participants and Setting: Adult patients (N = 211; 46.9% female; Mage = 44.1, SD = 17.1; Meducation = 13.8, SD = 3.0) consecutively referred for outpatient neuropsychological evaluation within a large, Midwestern academic medical center. Method: Patients were divided into high and low ACE groups based on the number of ACEs endorsed. Subsequently, a series of one-way analyses of variances were conducted to compare high versus low ACE groups on the Test of Premorbid Functioning, Wechsler Adult Intelligence Scale-Fourth Edition Digit Span Test, Trail Making Test-Parts A and B, Rey Auditory Verbal Learning Test, Beck Depression Inventory-II, and Beck Anxiety Inventory scores. Results: Significant group differences were detected for anxiety and depression with the high ACE group endorsing significantly greater depression and anxiety symptoms relative to the low ACE group. High and low ACE groups did not significantly differ on any cognitive measures. Conclusions: Results indicate that an individual's psychological health, but not cognitive functioning, is impacted by the level of ACE exposure. Study findings highlight the importance of including ACE measures in neuropsychological evaluations, as it will aid in case conceptualization and tailoring treatment recommendations. Clinical Impact Statement This study suggests that an individual's psychological health, but not neurocognitive testing, is impacted by the level of adverse childhood event exposure. Specifically, individuals at high risk of adverse health outcomes based on the adverse childhood experiences risk classification scheme endorsed greater symptoms of depression and anxiety compared to those at low risk. Study findings highlight the importance of including adverse childhood event measures in psychodiagnostic and neuropsychological evaluations, as it will aid in case conceptualization and tailoring treatment recommendations.