Winter 2026 Issue

Children and Families: Biological Effects of Child Maltreatment
By Frank W. Putnam, MD
Social Work Today
Vol. 26 No. 1 P. 30

The Female Growth and Development Study

More than any other profession, social work is recurrently involved in the numerous tasks and duties required to keep at-risk children safe and healthy. From assessment and investigation, to support and intervention, to advocacy and collaboration, social workers are essential to creating safe environments for children and supporting stressed and dysfunctional families in crisis. Social work is absolutely critical to the health and stability of our communities.

As director of a Child Advocacy Center, I worked side-by-side with county and hospital social workers for a dozen plus years. I saw that, in addition to these traditional roles, social workers and their agencies also served another important function in keeping a coherent history of the family over time. Often, it was this longer term and broader perspective documented by social services that informed our assessments and guided interventions in acute crises.

The growing recognition of the pervasive negative effects of childhood maltreatment and exposure to family violence has stimulated scientific interest in the factors associated with the perpetuation of the family cycle of violence. Increasingly, we are finding complex interactions among biological, behavioral, and environmental factors that perpetuate the transgenerational transmission of risk for child maltreatment and intimate partner violence from one generation to the next.

The Biological Impacts of Childhood Trauma
Until recently, our understanding about the contribution of biological factors to adulthood and next-generation outcomes was limited to vague speculations about “genetic predispositions.” We are now discovering that a range of specific changes in stress-sensitive bodily systems are caused by repeated exposure to early childhood maltreatment and, to a lesser extent, poverty and adversity. These biological changes play a role in increasing the likelihood of child maltreatment and family violence in the next generation.

Best-selling accounts like Bessel van der Kolk’s The Body Keeps the Score, have familiarized the public with the concept that traumatic experiences can become “embedded” within a person’s biology, and expressed in different ways across the lifespan.1 One of the most comprehensive scientific studies of this biological embedding process is the landmark Female Growth and Development Study (FGDS), initiated in 1987.2

The FGDS
As of this article, the FGDS has followed a cohort of approximately 100 child protective services-substantiated sexually abused girls and an equivalent number of statistically matched comparison girls, six to 15 years of age at enrollment, for almost 40 years. Drawing on the prospective, longitudinal data collected on the original girls, their mothers/caretakers, and later the original girls’ offspring (three generations in all) the FGDS has followed the psychological, biological, and social effects of child sexual abuse from childhood into middle age—and across generations.3

What the FGDS is finding has changed our understanding of how trauma biologically embeds itself and is manifest over the lifespan and across generations.2

The FGDS focuses on a number of biological systems known to be impacted by stress, including the hypothalamic-pituitary-adrenal (HPA) axis, which produces the stress hormones, cortisol and adrenaline, and the hypothalamic-pituitary-gonadal (HPG) axis, which produces sex hormones such as estrogen and testosterone and is responsible for puberty. The FGDS also tracked the rate and degree of physical and cognitive development from childhood into middle age.

Biological Systems Impacted by Childhood Sexual Abuse
The HPA axis is the major neuroendocrine system by which the brain (hypothalamuspituitary) activates and prepares the body (adrenal gland) to respond to stress, danger, and injury. Like other multiple-step biological systems, the HPA axis must mature over childhood. Starting during the first year of life, the HPA axis reaches a milestone stage (adrenarche) at around age six years. Girls, however, may be ahead of boys by as much as two years.

Achieving adrenarche signals the start of puberty. Puberty, the process by which a child’s body matures into an adult body capable of sexual reproduction, proceeds through a series of stages that can be measured by assessing the development of secondary sexual characteristics such as breasts in females and voice changes and facial hair in males.

The FGDS measured the age of onset and rate of pubertal change using a standard sexual maturation scale administered by a nurse. The sexually abused girls started and finished puberty significantly earlier than the comparison girls. They were about a year ahead in pubic hair stage and eight months ahead in breast development.4

Early puberty has its problems, especially for females. More than 50 years of child development research has established that in our society early maturing girls are at much higher risk for many adverse outcomes, including earlier teenage pregnancy and substance abuse as well as later life fertility problems and reproductive cancers. The teenage outcomes are thought to be due to precocious sexual development that attracts older predatory males, while the adulthood reproductive disorders are attributed to accelerated biological aging associated with traumatic childhood experiences.2

The FGDS longitudinal cortisol results were even more revealing. In childhood and early adolescence, the maltreated girls had significantly higher resting levels of cortisol and urinary adrenaline.5 An extensive body of evidence from research on clinical syndromes, such as Cushing’s disease, and overuse of cortisol-containing medications, together with scores of animal studies, finds that high blood levels of cortisol damage the brain.

We all experience a decline in resting cortisol levels (called the “cortisol attenuation curve”) with age, typically starting in late adolescence or early adulthood. The sexually abused girls’ cortisol decline started earlier and was faster than the comparison girls, so that by young adulthood, they had significantly lower resting levels of cortisol.6 This trajectory was associated with a dramatic increase in the abused girls’ size (body mass index), such that by age 18 years, the average sexually abused girl in the FGDS was physically larger than 75% of US females of the same age.6,7

Accelerated Biological Aging
This same cortisol attenuation curve is associated with epigenetic changes to a person’s DNA by methylation. Methylation is a process in which certain molecules (called methyl groups) attach to specific points (known as CpG sites) on DNA. The rate of methylation can be measured and compared with the amount of methylation that occurs with normal chronological aging. If an individual has higher numbers of methylated sites than the average for individuals of the same chronological (birth) age, they are said to have an accelerated biological age. If they have fewer methylation sites, they have a younger biological age. Two FGDS studies using epigenetic DNA-methylation biomarkers found higher rates of accelerated biological aging.8,9

In addition to finding an earlier and faster transition through puberty and an earlier decline in resting cortisol, the FGDS found an earlier decline in cognitive functions, increased rate of BMI accumulation, and higher rates of autoimmune dysfunction, as well as a corresponding greater utilization of medical services.

In aggregate, these data confirm that one of the overall principles emerging from research on the biological effects of childhood maltreatment is that trauma triggers accelerated biological aging in several organs and bodily systems, such as the HPA and HPG axes, the immune system, and cognitive development and decline. Independent research with other samples has found similar trauma- and stress-related epigenetic accelerated biological aging effects.10

Accelerated biological aging is associated with an earlier onset of serious chronic illnesses, such as heart disease and cancer, traditionally correlated with increased chronological aging. By predisposing childhood trauma victims to earlier onsets of these chronic illnesses, accelerated biological aging is hypothesized to lead to an earlier death. Indeed, individuals with high childhood trauma scores on measures such as the Adverse Childhood Experience (ACE) checklist have significantly shortened average lifespans—by as much as 20 years. They are two and a half times more likely to die before age 66 than individuals with low ACE scores.11

Implications of Research on Childhood Trauma
Just as we’ve garnered deeper understanding of troubled families through long-term involvement of social services than we would from scattered impressions gathered in a moment of crisis, prospective, longitudinal research reveals the lifelong, complex impact on bodily systems wrought by childhood trauma and medical, mental, and social decline starting at younger ages.

The ability to quantify biological age acceleration using epigenetic DNA-methylation biomarkers promises to greatly improve our capacity to objectively identify highly traumatized individuals for earlier and specialized interventions. Given that methylation may be reversible in some cases, these biomarkers may also provide objective measures of therapeutic effects.

Today, another generation of scientists is analyzing the FGDS datasets and producing landmark research, including studies of posttraumatic stress symptom trajectories and biobehavioral interactions among hormones and personality factors increasing risk for family violence.

— Frank W. Putnam, MD, is cofounder of the Female Growth & Development Study and the author of Old Before Their Time: A Scientific Life Investigating How Child Maltreatment Harms Children and the Adults They Become (Routledge, December 2025), available through Amazon.

References
1. Van der Kolk B. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking; 2014.

2. Putnam FW. Old Before Their Time: A Scientific Life Investigating How Maltreatment Harms Children and the Adults They Become. Routledge; 2025.

3. Trickett PK, Noll JG, Putnam FW. The impact of sexual abuse on female development: lessons from a multigenerational, longitudinal research study. Dev Psychopathol. 2011;23(2):453-476.

4. Noll JG, Trickett PK, Long JD, et al. Childhood sexual abuse and early timing of puberty. J Adolesc Health. 2017;60(1):65-71.

5. DeBellis MD, Chrousos GP, Dorn LD, et al. Hypothalamic-pituitary-adrenal axis dysregulation in sexually abused girls. J Clin Endocrinol Metab. 1994;78(2):249-255.

6. Li JC, Hall MA, Shalev I, et al. Hypothalamic-pituitary-adrenal axis attenuation and obesity risk in sexually abused females. Psychoneuroendocrinology. 2021;129:105254.

7. Noll JG, Zeller MH, Trickett PK, Putnam FW. Inordinate obesity risk for female victims of childhood sexual abuse: a prospective study. Pediatrics. 2007;120(1):e61-e67.

8. Felt JM, Yusupov N, Harrington KD, et al. Epigenetic age acceleration as a biomarker for impaired cognitive abilities in adulthood following early life adversity and psychiatric disorders. Neurobiol Stress. 2023;27:100577.

9. Shenk CE, Felt JM, Ram N, et al. Cortisol trajectories measured prospectively across thirty years of female development following exposure to childhood sexual abuse: moderation by epigenetic age acceleration at midlife. Psychoneuroendocrinology. 2022;136:105606.

10. Palma-Gudiel H, Fañanás L, Horvath S, Zannas AS. Psychosocial stress and epigenetic aging. Int Rev Neurobiol. 2020;150:107-128.

11. Brown DW, Anda RF, Tiemeier H, et al. Adverse childhood experiences and the risk of premature mortality. Am J Prev Med. 2009;37(5):389-396.