Certain things in life can be hard for adoptees. Regardless of the reason for the adoption, many adoptees feel abandoned as a result of their adoption experience, which may lead to a lack of trust or difficulty in relationships, among other things. But not everything that’s hard in an adoptee’s life is necessarily related to his or her adoption experience.

In fact, in my own life, I would attribute many more of my own difficulties in adulthood to the sexual abuse I endured while I was growing up. One might argue, perhaps, that the sense of abandonment and lack of trust that may have been present in my life because of my adoption experience led to a vulnerability that resulted in the abuse. But even if that’s so, I can assure you that the abuse in and of itself has been extremely difficult and painful, and its impact persists in my life, although I can say that I feel like I am able to manage it fairly well for the most part.

Regardless, there are many experiences that occur in childhood that lead to difficulties in adulthood. It is widely understood that unresolved issues from childhood cause these difficulties to persist. One well-known study, the Adverse Childhood Experiences (ACE) study, consisted of a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente’s Health Appraisal Clinic in San Diego. As part of the collaboration, more than 17,000 Health Maintenance Organization (HMO) members undergoing a comprehensive physical examination chose to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction in ten categories.

During the initial phase, each respondent was assigned an ACE score, and the medical status of the baseline participants has been tracked over time. The ACE score was used to assess the total amount of stress during childhood and has demonstrated that as the ACE number increases, the risk of significant health problems—such as depression, suicide attempts, illicit drug use, alcoholism and alcohol abuse, among other things—increased in a strong and graded fashion.

So what is an ACE? There is a series of ten questions that are asked as part of the study that, when answered yes, constitutes an ACE if it occurred before the respondent’s eighteenth birthday. One question reads, “Was a biological parent ever lost to you through divorce, abandonment, or another reason?” That question, of course, gets to the issue of adoption. But there are nine other questions that are designed to measure traumatic experiences during childhood, including ones related to sexual abuse, physical abuse, dysfunctional household circumstances, and others.

The bottom line is, sadly, that there are many experiences that occur in childhood that have a long-term impact on a person’s life. And while adoption is one, it’s not the only one. Unfortunately, the difficulties that carry on through a lifetime for many adoptees are not the only difficulties in their lives. Many adoptees suffer from multiple adverse childhood experiences, and the important question is not necessarily to determine what the cause or causes are, but to figure out how those difficulties can be addressed positively in adulthood.