About Adverse Childhood Experiences (ACES)

Centers for Disease Control

What are adverse childhood experiences?

Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years). Examples include:

• Experiencing violence, abuse, or neglect.
• Witnessing violence in the home or community.
• Having a family member attempt or die by suicide.

Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding. Examples can include growing up in a household with:

• Substance use problems.
• Mental health problems.
• Instability due to parental separation.
• Instability due to household members being in jail or prison.

The examples above are not a complete list of adverse experiences. Many other traumatic experiences could impact health and well-being. This can include not having enough food to eat, experiencing homelessness, or unstable housing.

Quick facts and stats

ACEs are common. Three in four high school students reported experiencing one or more ACEs, and one in five experienced four or more ACEs. ACEs that were most common among high school students were emotional abuse, physical abuse, and living in a household affected by poor mental health or substance use.

Preventing ACEs could reduce many health conditions. For example, preventing ACEs could reduce suicide attempts among high school students by as much as 89%, prescription pain medication misuse by as much as 84%, and persistent feelings of sadness and hopelessness by as much as 66%.6 Additionally, preventing ACEs could also reduce many health conditions in adulthood, including chronic diseases and behavioral health conditions. Estimates show that preventing ACEs could reduce cases of heart disease by 22% and depression by 78% for adults.

Some people are at greater risk of experiencing one or more ACEs than others. While all children are at risk of ACEs, numerous studies show differences in such experiences. These differences are linked to the social and economic environments in which some families live. ACEs are highest among females, American Indian or Alaska Native and multicultural youth, and gay, lesbian, bisexual, or questioning youth.

ACEs are costly. ACEs-related health consequences cost an estimated $14.1 trillion dollars annually in the United States in direct medical spending and lost healthy-life years.

Outcomes

ACEs can have lasting effects on health and well-being in childhood and life opportunities (such as education and job potential) well into adulthood. These experiences can increase the risks of injury, sexually transmitted infections, and involvement in sex trafficking. They can also increase risks for maternal and child health problems including teen pregnancy, pregnancy complications, and fetal death. Also included are a range of chronic diseases and leading causes of death, such as cancer, diabetes, heart disease, and suicide.

ACEs and community factors such as living in under-resourced neighborhoods can cause toxic stress. Toxic stress (extended or prolonged stress) from ACEs can negatively affect children’s brain development, immune system, and stress-response systems. These changes can affect children’s attention, decision-making, and learning.

Children growing up with toxic stress may have difficulty forming healthy and stable relationships. They may also have unstable work histories as adults and struggle with finances, job stability, and depression throughout life. These effects can also be passed on to their own children. Some children may face further exposure to toxic stress from ongoing traumas. These ongoing traumas include the impacts of poverty resulting from limited educational and economic opportunities.

Prevention

Adverse childhood experiences can be prevented. Certain factors may increase or decrease the risk of experiencing adverse childhood experiences.

Preventing adverse childhood experiences requires understanding and addressing the factors that put people at risk for or protect them from violence.

Creating safe, stable, nurturing relationships and environments for all children prevents ACEs and helps all children reach their full potential. These relationships and environments are essential to creating positive childhood experiences. Everyone has a role to play in promoting positive childhood experiences and preventing the harmful effects of ACEs.

Parents and caregivers

• Talk to your child about their mental health and provide support for challenges they may be experiencing.
• Help your child learn to recognize and manage their emotions.
• Watch for signs of distress in your child like anger, withdrawal, changes in school performance, sleep or eating, and seek help when needed.
• Look for opportunities to praise your child, as it plays a vital role in their emotional development and self-esteem.
• Seek parenting skill training programs to help build stronger relationships with your children. Explore example program resources.

Raising children can be challenging—it's ok to ask for help. Reach out to babysitters, childcare providers, family members, or close friends. Discuss your concerns with your child's doctor. Also consider finding out if your community offers support groups or programs for parents and caregivers.

Everyone

Everyone can help prevent ACEs and promote positive childhood experiences by supporting children and families where they live and work.

Friends, family, and other trusted adults can consider volunteering as mentors at an afterschool program or offering to babysit.

Additionally, we can all support efforts to:

• Adopt policies that provide families assistance with childcare costs and healthy nutrition.
• Adopt policies that help parents balance work and family responsibilities like paid time off for caregiving and flexible work schedules.
• Promote non-violent attitudes, beliefs, and behaviors.
• Increase access to high-quality childcare and education.
• Provide access to free or low-cost, evidence-based parent training.

What communities can do

Community organizations, like faith-based and youth-serving groups, play a vital role in creating positive childhood experiences.

They can support early development by improving access to quality childcare, preschool programs, and in-home training for child health. Additionally, they can ensure childcare facilities at faith-based or youth-serving organizations are licensed and accredited.

These organizations can also promote healthy relationships by offering programs that teach youth skills to enhance healthy relationships.

Additionally, they can connect young people with positive role models and provide opportunities for skill-building through mentoring programs and after-school activities.

When ACEs do occur, community organizations can provide services like crisis intervention, therapy, and family-centered treatment to reduce harm and break the cycle of adversity.

Why prevention is important

Every child possesses incredible potential for health, well-being, and making a positive impact. When we prevent ACEs, we also prevent potential later involvement in violence, substance use, depression, and suicidal behavior. We also reduce the risk of other health challenges like cancer, diabetes, and heart disease.

All children deserve the best chance at lifelong health and well-being. Preventing, identifying, and responding to ACEs is the most powerful way to achieve this. Working together, we can help create neighborhoods, communities, and a world in which every child can thrive.

Key points

• Adverse childhood experiences can have long-term negative impacts on health, opportunity and well-being.
• Adverse childhood experiences are common and some groups experience them more than others.

Visit Children Home Society’s website for more information on ACEs and on ACEs trainings or learning sessions at https://chssd.org/prevention/aces.