Adverse childhood experiences (ACEs) are traumatic events that occur during childhood. ACEs can have a significant impact on a person’s physical, emotional, and mental health throughout their life.
Although ACEs increase a person’s risk of certain health conditions and behaviors in adulthood, they do not guarantee them. With support, children who face adverse events can learn to manage their experiences and lead meaningful lives.
In this article, we discuss ACEs in more detail, including the potential outcomes for people who experience them and methods of prevention.
An ACE is a negative or potentially traumatic event that occurs before a person reaches 18 years of age. ACEs can damage a child’s sense of safety, stability, or bonding.
Examples may include:
- abuse, which can be emotional, physical, or sexual
- neglect, either physical or emotional
- domestic violence
- substance misuse by a member of the household
- divorce or separation of parents or caregivers
- mental illness of a member of the household
- having a member of the household go to prison
Associated risk factors include:
- living in under-resourced or racially segregated neighborhoods
- frequently moving to new homes or areas
- food insecurity
Adverse experiences at a young age can be problematic because children are especially vulnerable to the effects of trauma. Their brains are still developing, which means that childhood trauma can disrupt normal brain development.
The prolonged stress from ACEs can affect:
- decision making
- stress management
Research has linked ACES to various health consequences, such as:
- physical health issues
- psychological conditions
- risky behaviors
- developmental disruption
- increased use of healthcare services
They can also have other implications for the individual, such as problems with education, work, and relationships. The more ACEs a child experiences, the higher their risk of negative outcomes.
On a societal level, ACEs cost hundreds of billions of dollars each year in economic and social costs.
Potential consequences of ACEs may include:
Physical health problems
ACEs increase the risk of physical health problems, such as:
- heart disease
- maternal and child health problems
- sexually transmitted infections (STIs)
Mental health issues
Children who experience ACEs may go on to develop mental health issues, such as:
- post-traumatic stress disorder (PTSD)
- substance use disorder
- suicidal behaviors or death by suicide
- addictive behaviors, including food addiction
The Centers for Disease Control and Prevention (CDC) estimate that the prevention of ACEs could have reduced the number of cases of depression by up to 21 million.
Those who have had ACEs may be more likely to experience several other challenges in their lives. These may include:
- issues relating to education and job opportunities
- being a perpetrator of violence or being subject to it
- teen pregnancy
- involvement in sex trafficking
ACEs carry huge economic and social costs for communities and the wider society, including in terms of healthcare and incarceration costs.
Experiencing childhood abuse and other ACEs leads to higher rates of offending overall, and of violent offending and property offending, specifically.
Additionally, people who experience ACEs are at higher risk of outcomes that may contribute to ACEs for the future generation, such as mental illness, substance misuse, and violence. In this way, the effects of ACEs can be intergenerational.
It is possible to prevent many ACEs. Addressing social inequalities may help, as people in areas of higher deprivation are more likely than other people to experience ACEs. However, ACEs occur in all areas of society.
The CDC’s strategy for preventing ACEs involves:
- strengthening economic supports to families
- promoting social norms that protect against violence and adversity
- ensuring a strong start in life for children
- teaching skills to parents, caregivers, children, and families
- connecting youths to caring adults and activities
- intervening to lessen both immediate and long-term harm
One 2017 article describes a health outcome from positive experiences (HOPE) framework to prevent toxic stress. The authors explain that positive childhood experiences fall into four broad categories:
- being in nurturing, supportive relationships
- living, developing, playing, and learning in safe, stable, protective, and equitable environments
- having opportunities for constructive social engagement and developing a sense of connectedness
- learning social and emotional competencies
Individuals who suspect child abuse or believe that a child may be at risk should contact the appropriate state authority, such as child protective services, immediately.
The main test for ACEs is the ACE Study’s questionnaire, which comprises 10 questions.
The questions correspond to 10 types of childhood trauma. Exposure to any type of ACE counts as 1 point, regardless of the number of incidences or the severity of the experience. A person simply totals the points to get the final ACE score.
It is important to note that the conditions that the questionnaire includes represent only a selection of potentially traumatic childhood experiences. People who have experienced other forms of toxic stress may still be at higher risk of adverse health outcomes.
Therefore, a person’s score on the questionnaire is only a guideline.
The original study of ACEs — the CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study — ran from 1995 to 1997.
It involved thousands of participants across 25 states who completed surveys, making it one of the largest studies of this nature. According to the CDC, approximately 61% of the respondents reported at least one ACE. Almost 1 in 6 reported four or more ACEs.
The study findings suggest that:
- ACEs are common across all populations.
- Some populations are more vulnerable to ACEs because of their social and economic status.
- Women and people belonging to certain ethnic groups are at greater risk of 4 or more types of ACEs.
- There is a dose-response relationship between ACEs and negative health and well-being outcomes. The more ACEs, the more substantial the risk of negative outcomes.
Many states in the United States collect information about ACEs through the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a random telephone survey that collects data regarding adults’ health conditions and risk factors.
The findings from this research are similar to those of the original ACE Study. Since this original study, much of the related research has focused on how ACEs affect people’s health and well-being in adulthood.
Individuals who have had ACEs may wish to seek help from a therapist. Therapy can help people deal with their past while also learning to manage the effects that persist in the present.
A doctor may prescribe medication to help people manage symptoms associated with ACEs, such as depression or anxiety.
ACEs are common and affect people from all populations. They can negatively affect a person’s physical and mental health, relationships, and overall well-being.
Individuals who have experienced one or more ACEs may wish to see a therapist for treatment. With help and support, a person can learn to address childhood traumas and move forward with their life.