Adverse Childhood Experiences

Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur during childhood (0-17 years). Approximately 72 percent of children in the United States will have experienced at least one major stressful event—such as witnessing violence, experiencing emotional, physical or sexual abuse, or the loss of a loved one—before the age of 18. In 2019, the CDC found that at least five of the top 10 leading causes of death, including respiratory and heart disease, cancer, and suicide, are associated with ACEs. Multiracial children have a significantly higher cumulative ACE score (2.39) than all other races/ethnicities, and females are more at risk than males of experiencing an ACE.

There are three broad categorizations of ACEs: abuse, neglect, and household dysfunction. These often follow an intergenerational pattern; children who experience abuse, for example, may be more likely to commit violence or to be revictimized in the future. As decades of research depict, ACEs are associated with development of chronic diseases and behavioral challenges, changes to DNA expression, obesity, autoimmune disease, depression, and alcoholism. The greater the number of ACEs experienced, the greater the risk for negative health outcomes.

ACEs threaten health by causing chronically high levels of toxic stress, a prolonged or excessive activation of the stress response system that can damage the body and brain, particularly in children. Multiple ACEs, particularly without support, can affect the nervous, endocrine and immune systems and worsen attention, behavior, decision-making and response to stress throughout a child’s lifetime. ACEs increase the risk of of injury, sexually transmitted infections, including HIV, mental health problems, maternal and child health problems, teen pregnancy, involvement in sex trafficking, unemployed and reduced earnings in adult life.

Domino effect of having an Adverse Childhood Experience (ACE)

Experiencing adversity during childhood is highly personal and specific to every family’s socioeconomic, cultural, behavioral, and emotional conditions, but environmental risk factors like violence and crime, environmental hazards, and racism can also contribute to toxic stress. A large national study on ACEs found that people with low-income and low educational attainment, people of color, and people who identified as gay, lesbian or bisexual had significantly higher chance of having experienced adversity in childhood.

Many schools lack health centers for primary care, and even fewer have mental health services or referral programs for substance abuse treatment or social services. Service providers often operate independently, causing fragmented care for students and families who need it the most. School-based integrated systems of care that involve parents and caregivers, particularly for uninsured families, can identify at-risk students and connect them to resources like community liaison, social services, and treatment options.

While not all ACEs are preventable, there are protective factors which can mitigate long-term negative impacts. These include strong family bonds, nurturing relationships, a sense of community, positive parenting skills, and integrating trauma-informed care in schools and child care centers to foster resilience. By reducing the daily stress and fulfilling basic needs with economic and social support, the physical effects of ACEs can be minimized.

Evidence shows that the following strategies are effective in preventing ACEs from happening in the first place:

Strengthening economic supports for families
Promoting social norms that protect against violence and adversity
Ensuring a strong start for children and paving the way for them to reach their full potential
Teaching skills to help parents and youth handle stress, manage emotions, and tackle everyday challenges
Connecting youth to caring adults and activities
Intervening to lessen immediate and long-term harms

In practice, this could mean implementing paid family leave and Child Tax Credits, increased bystander training, childhood home visitation programs, more funding for afterschool programs, and family-centered treatment for substance abuse. Since January 2019, at least 26 states have enacted or adopted legislation to address childhood trauma, child adversity, toxic stress or ACEs specifically. New York, for example, passed a bill that requires ACEs training for all daycare providers, with a focus on understanding trauma and fostering resiliency. California implemented the first statewide effort to screen for childhood trauma through the ACEs Aware initiative, which develops, promotes, and sustains evidence-based methods to screen patients for ACEs and create treatment plans to help patients heal.

There is a wide spectrum of approaches to preventing ACEs and mitigating their effects, including at the local level. Programs like Green Dot and Coaching Boys into Men are effective in reducing violence against partners, negative bystander behaviors like laughing at sexist jokes or encouraging abuse, and sexual violence perpetration and victimization. Home visitation models reduce child abuse and neglect and are effective in lowering children’s rates of substance use, teen pregnancy, and reliance on welfare. There are countless organizations and nonprofits preventing ACEs through mentoring and afterschool programs, like the Boys & Girls Club and YMCA, which can improve socioemotional learning, reduce absenteeism, improve school performance, and strengthen cultural identity and values and children’s ability to develop healthy relationships with peers and adults.

The economic and social costs of ACEs to families, communities, and society totals hundreds of billions of dollars each year, further reinforcing the need to treat childhood adversity like other public health issues. Investing in the nation’s youth by improving access to high-quality childcare, bolstering family socioeconomic safety nets, and emphasizing the need for mental health services and afterschool programs will help prevent ACEs and build healthier futures for all children.