What Are Adverse Childhood Experiences (ACEs)?

What Are Adverse Childhood Experiences?

Adverse childhood experiences (ACE’s) are traumatic experiences that impact a child’s ability to develop naturally, to feel safe and supported, and to have structure and consistency. These traumatic experiences tend to be adversities that the child experiences recurrently. For instance, they are frequently exposed to domestic violence, they have a caregiver that struggles with substance use disorder, and/or they are subjected to recurring forms of abuse.

The more adverse experiences someone goes through during their childhood, the more likely they are to be at an increased risk for physical and mental challenges throughout adulthood. Studies have shown that the higher a person scores on an ACE assessment, the more likely they are to experience homelessness, risk of sexually transmitted diseases, substance use, heart, liver or lung disease, and are more likely to attempt suicide throughout their lifespan.¹

Studying ACEs

The Center for Disease Control and Kaiser Permanente’s Adverse Childhood Experiences (ACEs) Study was conducted between 1995 and 1997 and explored adverse childhood experiences.² The ACE Study focused on three categories: abuse, household challenges and neglect. The study measured the total number of ACE’s experienced within the first 18 years of life and how they correlate with risk factors in adulthood.

The initial study was conducted on 9,508 participants and was supplemented by a secondary round that equated to 17,337 participants.² Each participant was given an assessment with different forms of child abuse and other related adverse experiences to assess the impact on public health throughout the stages of life.

What Are the Identified ACEs?

The three main categories of abuse, neglect, and household dysfunction were broken down into subtypes of each main traumatic experience, as seen below. In 2012, the Philadelphia Expanded ACE (PHL ACEs) was developed to incorporate more diversity into the original study. Due to Philidelphia harboring neighborhoods with some of the highest rates of child abuse, food insecurity, incarceration rates, community violence, and substance abuse, there was a clear need to explore how these stressors impacted quality of life into adulthood. This then prompted the expansion and exploration into additional adverse experiences that were not originally included.⁶ The PHL ACEs used its scale to assess a more diverse population that included Black, Latinx, and Asian ethnicities, amongst others.⁷ Unfortunately, the original study had a strong focus on middle to upper class white individuals with identified traumatic experiences that occurred solely in the home.⁸ Below are the added life stressors that were identified in the PHL ACEs.

The initial study identified 10 ACEs:

• Physical abuse
• Emotional Abuse
• Physical neglect
• Emotional neglect
• Growing up in a home with substance abuse
• Sexual trauma
• Exposure to mother being treated violently
• Parental divorce
• Parental incarceration
• Household member with mental illness

The Philadelphia Expanded ACE survey identified these additional ACEs:

• Experiencing bullying
• Having lived in foster care
• Witnessing violence
• Felt discrimination
• Adverse neighborhood experiences

How Prevalent Are ACEs?

You might be wondering why all of this is important and what this study tells us exactly. Well. of the 17,337 participants, 1 in 5 reported three or more ACE’s and two-thirds reported at least one.² Of the initial study group, the individuals that scored four or more on the ACE assessment scale were 4 to 12 times more likely to have health risks, struggles with alcoholism and substance use, experience depression and are more likely to attempt suicide. They are 2 to 4 times more likely to have an increased number of sexual partners and be at a higher risk for sexually transmitted infections.⁴ According to the CDC, 61% of adults have experienced a minimum of one ACE before the age of 18.⁵

Studies done with the PHL ACEs showed that 63.4% identified with at least one of the expanded ACEs and 49.3% experienced adversities from both the conventional and expanded studies.⁸ The importance of the PHL ACEs is that 13.9% of people were shown to only have experienced traumas associated with the expanded version and not the Conventional ACEs and would have gone unnoticed and unaddressed.⁸

ACEs & Toxic Stress

Stress is a common thing that people experience throughout their life and is even developmentally beneficial during childhood when it comes in sporadic short bursts. This, when coupled with supportive caregivers, allows our nervous system to learn to manage it and teaches us that it won’t last forever. When children are exposed to experiences that cause distress frequently, stress can turn harmful and shift into what is called toxic stress.

When we experience stress, our body releases the hormone, cortisol. This hormone triggers our autonomic nervous system which is responsible for our fight, flight, freeze or fawn responses. When this is constantly being activated by traumatic experiences, our body learns to constantly be in a state of hypervigilance in order to always be prepared for the inevitable threat. Toxic stress has the ability to alter the chemistry of the brain, modify gene functioning, and result in epigenetic alteration which in turn impacts a person’s mental and physical wellbeing.⁹

The behavioral consequences of experiencing ACEs and toxic stress include:

• An increased risk for depression
• An increased risk for anxiety disorders
• An increased risk of developing a substance use disorder
• An increased risk of smoking
• An increased risk of abusing alcohol
• Long-lasting consequences for cognitive functioning
• Long-lasting consequences for physical functioning

The physical consequences of experiencing ACEs and toxic stress include:⁹

• Autoimmune disease
• Heart disease
• Diabetes
• Depression
• Anxiety disorders
• Stroke
• Weakened immune system
• More frequent infections
• Chronic obstructive pulmonary disease
• Cancer

Risk Factors for ACEs

The home and community environment plays a major role in the likelihood of a child experiencing one or more adverse experiences. If the home environment is unsafe, inconsistent and lacks an emotionally and physically supportive caregiver, this increases the risk. Add in low socioeconomic status and overwhelmed and burnt out teachers, you’ve created the perfect storm for adverse childhood experiences. The family history is also an important factor because trauma and abuse gets passed down generation after generation until one person decides to end the cycle.

It is important to be aware of what causes ACEs so that caregivers and anyone else that plays a role in a child’s life can help promote change. The better we understand the cause, the better equipped we can be to provide the necessary support.

Risk factors for experiencing ACEs include:¹⁰

• Children that don’t feel close to their parents
• Single parents or young caregivers
• Growing up with high levels of family stress
• Being raised in a low-income household
• Living in a community with high rates of violence
• Caregivers with low levels of education
• Families that use corporal punishment
• Living in communities with high rates of crime
• Communities with high unemployment rates
• Communities with easy access to drugs and alcohol

Long-term Negative Effects of ACEs

One study showed that mothers that reported ACEs, specifically childhood physical abuse, were 1.5 times more likely to implement corporal punishment and infant spanking.³ This can imply that physical forms of abuse and punishment are passed down intergenerationally.

The risk factors that are correlated with ACEs are also some of the leading causes of death in adults which means that the adverse experiences that children are going through can increase their risk of early morbidity and mortality.³

The life stressors experienced as a child impact all aspects of their adult life. The more they impact the more likely they are to have increased mental and physical struggles as an adult. These struggles range from homelessness and an inability to maintain interpersonal relationships all the way to heart disease and cancer.

Preventing ACEs

These studies and all of the information that has come to light with them, give us insight into how we can prevent ACEs and toxic stress, because at the end of the day, they are preventable. Studies consistently show that if a child receives warmth, responsiveness and effective boundaries and structure, they demonstrate an increase in resiliency when faced with adversity. In addition, support received outside the home from a mentor can be a positive factor.¹¹

By instilling more protective factors throughout the childhood experience, the public would experience a better quality of life and would be more capable of handling stressors.

Key ways to prevent adverse childhood experiences include:

• Prioritizing youth services: providing safe structured places for children to build connections, be in a safe environment, and learn resilience tools.
• Expanding early childcare education options: allows children to begin to receive support at a younger age while also providing childcare to families that may otherwise not be able to afford it.
• Offering resources to parents: Resources to provide education on the ACEs and effective parenting skills. This can allow them to provide support to their children to help counteract ACEs that the children are exposed to outside of the household environment.
• Connect youth to caring adults and activities: provide resources for underprivileged children to have more access.
• Intervene to lessen immediate and long-term harms: educate teachers, doctors and other professionals on the warning signs that children are being exposed to adversity and provide them with the wherewithal to intervene and provide support.
• Access to behavioral and mental healthcare: make healthcare more accessible for children and families.

How to Help Children Experiencing ACEs

Resilience plays a major role in how children are not consumed by the often persistent challenges that life can throw at them. To be resilient is to continue to get back up and push through the hard times. Children’s resilience factors help to explain how some children that have experienced an immense amount of adversity are able to continue to move through life effectively.

Resilience is influenced by biological and developmental characteristics along with interpersonal factors based on their home and community environments.

Ways to build and strengthen a child’s resilience include:^{10, 11}

• Fostering positive friendships
• Encouraging maternal warmth and support
• Teaching children problem-solving skills
• Helping a child build positive relationships with supportive adults
• Supporting parents and families
• Encouraging involvement in community activities
• Teaching emotion regulation skills
• Having a sense of purpose through faith or culture

Coping With Adverse Childhood Experiences

It is very common for an individual to have experienced one or more adverse childhood experiences. It is also common, due to toxic stress, for the effects of those traumas to impact an individual into adulthood.

Due to this, it is important to know how to support yourself and work to manage the long term effects of childhood trauma. Below is a list of coping mechanisms that you can explore and identify ones that work best for you.

Techniques for coping with ACEs include:

• Seek connection: Reach out to friends and family that you can trust and rely on. Volunteer and join activities that align with your values to meet like minded people. This can create a comfortable community.
• Routine: Incorporate routines and structure into your day. This creates predictability and consistency in a world that oftentimes feels very unpredictable.
• Take the ACE questionnaire: gain insight and validation on the adversities that you have experienced and that may be contributing to any hardships you are currently going through.
• Try writing to heal: Journaling our thoughts and emotions can help us make sense of them.
• Practice mindfulness: Learning to practice mindfulness can help a person to be present in the moment, focusing on relaxing and regulating their body. This can help avoid getting trapped in the past and feeling overwhelmed by the memories of the past traumas.
• Support groups: Join support groups that are for people that have experienced similar adversities. Being able to talk about the experiences with others who truly understand can be very healing and validating.
• Therapy: Seek out professional support in the form of psychotherapy  to process through the past experiences and allow yourself to heal and find peace.

Treatment Options for Overcoming ACEs

All of this might be sounding pretty overwhelming, especially if you have experienced one or more of the risk factors or adverse experiences mentioned above. Fortunately, there is a light at the end of the tunnel and there is opportunity for healing. Seeking out professional support can allow you to process through the past and unpack all of the baggage your nervous system has been carrying around for all of these years.  Online therapy options are beneficial in that they allow you to find the option that works best for you based on your unique needs. When exploring an online therapist directory, look for a therapist that feels like they are talking to you in their bio, a therapist who has the techniques that fit your needs, and someone that sounds like would offer a safe, vulnerable space for you to engage in the deep therapeutic process necessary for healing and growth.

Therapy options for overcoming ACEs include:

• Trauma-Informed Therapy: Trauma-informed therapy is a set of guiding principles that is sensitive to the needs and emotional distress of someone that experienced trauma. A trauma informed clinician is looking through the lens of “what happened to you” as opposed to “what is wrong with you.”
• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): TF-CBT  helps children ages 3-18 challenge negative cognitions that are a result of the traumas and works to reframe them to more recovery focused thoughts of self and the world while building tolerance.
• Dialectical Behavior Therapy (DBT): DBT teaches emotion regulation and mindfulness skills to help the individual learn to manage distressing emotions. DBT works to promote insight into maladaptive behaviors to be replaced with more helpful behaviors.
• Eye Movement Desensitization and Reprocessing (EMDR): EMDR  is a psychotherapy that allows people to process through emotional distress that stems from having experienced trauma through a technique called Bilateral Stimulation.
• Acceptance and Commitment Therapy (ACT): ACT is a psychotherapy that focuses on accepting things how they are and working to take committed action to work around this based on values.
• Emotion-Focused Therapy (EFT): EFT promotes emotional awareness and focuses on emotions as guides to decision making. EFT also focuses on attachment and works to repair attachment wounds.

In My Experience

In my experience, no one makes it out of childhood unscathed by some distressing experience or another. The difference on how traumas impact us is based on the available support we have during those difficult times. If we have someone to go to, to validate our experience, to let us know that we are safe, our nervous system is able to return to its baseline without causing us any long term side effects. If we are experiencing traumas and our homelife is abusive or unsupportive, our nervous system has to compensate for this by constantly being on edge and ready to protect against any threat that comes our way.

This is why it is so important for us to be aware of the detrimental effects the ACEs have on us so that we can start taking action against them. If you could relate to any part of this article, look into getting support for yourself from a professional. You don’t have to go through life carrying around all of your childhood baggage forever.