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HomeHealth TopicChildren's Health

What Are Adverse Childhood Experiences (ACEs)?

Jennie Bedsworth, LCSWMona Bapat, PhD, HSPP
Published on February 24, 2022

Key takeaways:

  • Adverse childhood experiences (ACEs) are difficult events people may experience during childhood.

  • ACEs may increase your risk of having certain health conditions or other problems later in life, such as heart disease or depression.

  • ACEs don’t mean you will definitely have trouble later in life, and counseling or therapy can help you cope with any impact ACEs may have on your life.

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There’s no such thing as a perfect childhood. All kids have difficult experiences growing up. However, some negative events are more impactful than others. And having traumatic experiences as a child may increase your chance of having certain problems as an adult

So what do we know about how adverse childhood experiences can affect your life into adulthood? Keep reading to learn more and check out some resources that may help.

Adverse childhood experiences (ACEs) 

An adverse childhood experience (or ACE) refers to at least one potentially traumatic event that happens before age 18. Examples include being abused, neglected, or witnessing violence at home.

The term ACE and a questionnaire to measure it were used in a 1998 study by the CDC and Kaiser Permanente. Researchers surveyed 17,000 adults about their life situations and health conditions, as well as their childhood experiences.

The study found that the more ACEs someone experienced, the more likely they were to have certain problems as adults. Some of these included: 

  • Depression

  • Suicide attempts

  • Alcohol or drug misuse

  • Heart disease

  • Cancer

  • Diabetes

  • Chronic obstructive pulmonary disease (COPD)

  • Stroke

There can be other associations between ACEs and later-life experiences. Those with higher ACE scores were more likely to face unemployment or not finish high school. They were also more likely to smoke.

Types of ACEs

The ACE survey includes three categories of negative childhood experiences. Each category is further broken down into specific events:

  1. Abuse:

    • Physical

    • Sexual

    • Emotional

  2. Problems at home:

    • Witnessing a parent or other adult being treated violently

    • Having someone at home with substance misuse problems

    • Living with someone who has a mental illness

    • Experiencing parent separation or divorce

    • Having a parent in jail

  3. Neglect:

    • Physical, like not having clean clothes or enough to eat

    • Emotional, such as not feeling loved

In total, all of the subcategories account for 10 potential ACEs. Each one that you check off counts as one ACE score. For example, if someone was emotionally neglected and had a parent with substance problems, their ACE score would be 2. 

Limitations of using ACE scores to measure health

The ACE score is often used to help explain someone’s health status in adulthood. But it does not guarantee health problems later in life. There are many other factors that contribute to your health. 

The ACE survey questions are also very general. They often don’t get to the heart of a situation or account for the severity of childhood trauma. 

For example, two people may report witnessing violence at home. Yet one person may have experienced this a few times, while another witnessed it all the time for more than 10 years. Or one incident of sexual abuse could lead to a low ACE score of 1. But this single traumatic event can lead to more problems than someone with a higher ACE score has. 

Understanding your ACE score can be helpful. But keep in mind that it doesn't replace a comprehensive mental health assessment or medical exam.

What are other possible consequences of childhood trauma?

Some people develop post-traumatic stress disorder (PTSD) following a trauma. They may develop PTSD as a child or later as an adult. If you have PTSD, you may have symptoms such as:

  • Having nightmares or flashbacks

  • Avoiding people, places, or memories that remind you of a traumatic event

  • Feeling irritable, on edge, or hyper aware of your surroundings

  • Isolating yourself from friends and family

  • Having trouble sleeping

Trauma can also lead to developmental and social problems. Children may have trouble trusting peers, authority figures, or adults in general. This could affect their grades, relationships, and ability to manage strong emotions. In some cases, trauma can lead to a child having thoughts of self-harm, which they may act on.

How can you deal with an ACE from your childhood?

Experiencing one or more ACEs may or may not impact you as an adult. One way to better understand an ACE’s impact is through professional counseling or therapy. 

Many therapists have specialized training and experience helping people with childhood trauma. A therapist can help you work through your thoughts and feelings about what happened. You can also learn to manage any health conditions and improve your coping skills. 

Here are some resources that might help:

Can you prevent ACEs?

In some cases, children can be protected from potentially traumatic experiences. The CDC encourages families and communities to prevent ACEs as much as possible. They recommend:

  • Educating families and communities about violence

  • Creating family-friendly workplaces

  • Helping families improve their financial situations

  • Providing high-quality childcare

  • Teaching families about healthy parenting and relationships

  • Offering mentoring and afterschool programs for kids

  • Providing social services for problems like substance misuse

These steps may not prevent all ACEs. However, a combination of prevention, education, and building resiliency can help. 

The bottom line

The majority of people in the ACEs study reported at least one potentially traumatic event from their childhood. In some cases, early trauma can have a big impact throughout your life. In other cases, it may have very little effect. If needed, counseling can help you understand what happened and how to cope with it as an adult. 

For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 1-800-273-8255.

References

Anda, R. F., et al. (2020). Inside the adverse childhood experience score: Strengths, limitations, and misapplications. American Journal of Preventive Medicine.

Centers for Disease Control and Prevention. (2019). Adverse childhood experiences (ACE).

View All References (10)

Centers for Disease Control and Prevention. (2021). About the CDC-Kaiser ACE study. 

Centers for Disease Control and Prevention. (2021). Post-traumatic stress disorder in children.

Centers for Disease Control and Prevention. (2021). Preventing adverse childhood experiences

Centers for Disease Control and Prevention. (2022). Promoting health for adults

Felitti, V. J., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine.

Kovács-Tóth, B., et al. (2021). Can the cumulative adverse childhood experiences (ACE) score actually identify the victims of intrafamilial childhood maltreatment? Findings from a study in the child welfare system. International Journal of Environmental Research and Public Health. 

National Alliance on Mental Illness. (n.d.). National alliance on mental illness (NAMI).

National Suicide Prevention Lifeline. (n.d.). National suicide prevention lifeline

Substance Abuse and Mental Health Services Administration. (n.d.). Behavioral health treatment services locator

The National Child Traumatic Stress Network. (n.d.). Effects.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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