adverse childhood experiences
Last updatedWhat to know
Adverse childhood experiences are incidents of abuse, neglect, and dysfunction in the home that occur under the age of 18. These experiences, known as ACEs, can be traumatic and have lasting effects into adulthood. Most adults have had at least one, and nearly a quarter have had three or more. Childhood stressors can increase the risk of physical and mental health problems later in life.
The term originated from a CDC-Kaiser Permanente study conducted from 1995 to 1997 looking at the impact of these negative and unsafe childhood experiences in over 17,000 adults. Participants were asked specifically about 10 different types of ACEs: physical, emotional, or sexual abuse; physical and social neglect; and mental illness, domestic abuse, divorce, incarceration, and substance abuse in the household. An ACE score is the tally of these types of experiences. Nearly two-thirds of study participants reported at least one ACE, and more than one in five reported three or more ACEs. The study found the higher the ACE score, the higher the likelihood of negative outcomes in adulthood, including poor performance in school, unemployment, and incarceration.
Research also correlates ACEs with future health complications including STIs, heart disease, asthma, chronic lung disease, cancer, and liver disease. A CDC study in 2019 showed that at least five of the top 10 leading causes of death are associated with ACEs. ACEs can also lead to depression, substance abuse, PTSD, anxiety, and suicide.
The CDC also notes “some children may face further exposure to toxic stress from historical and ongoing traumas due to systemic racism or the impacts of poverty resulting from limited educational and economic opportunities.” Later studies expanded beyond household adversities to look at the impacts of systemic and environmental factors on childhood trauma, such as bullying, community violence, racism and poverty. These experiences can also lead to trauma and chronic stress that have lasting physical and mental health effects.
Having one or more ACE doesn’t necessarily predict negative health or societal consequences for any given individual. Interventions early on such as counseling, trauma therapy, or support from other adults and caretakers can lead to positive experiences and prevention and recovery from adverse experiences. As the ACE framework has become more widespread, critiques have emerged, including concerns about privacy and the misuse of ACE data to blame families or predict individual outcomes in ways that foreclose hope. Careful coverage will consider the strengths and limitations of ACE framework and take into account both individual/family-level solutions as well as institutional and policy changes that can help address the factors that contribute to the prevalence of ACEs.
Additional resources
- Adverse Childhood Experiences Resources (Centers for Disease Control and Prevention)
- Findings from the Philadelphia Urban ACE Survey (Robert Wood Johnson Foundation)
- Adverse Childhood Experiences: Expanding the Concept of Adversity (National Institutes of Health)
- National Conference of State Legislatures: Adverse Childhood Experiences
- ACEs and Toxic Stress: Frequently Asked Questions (Harvard University)
- The Deepest Well: Healing the Long-Term Effects of Childhood Adversity (National Institutes of Health)
Summary
Adverse childhood experiences are incidents of abuse, neglect, and dysfunction in the home that occur under the age of 18. They can have lasting effects on mental, emotional, and physical health. Interventions early on such as counseling, trauma therapy or support from other adults and caretakers can lead to positive experiences and prevention and recovery from adverse experiences. Careful coverage will consider strengths and limitations of the ACEs framework and take into account both individual/family-level solutions as well as institutional and policy changes that can help address the factors that contribute to the prevalence of ACEs.