What you need to know about Adverse Childhood Experiences (ACEs)

What are Adverse Childhood Experiences?

Adverse Childhood Experiences, or ACEs, are traumatic events that occur between the ages of 0-17 years old. These experiences undermine safety, stability, or bonding for children (Centers for Disease Control and Prevention, 2020a). There is a total of 10 ACEs that can be broken up into three categories: abuse, neglect, and household challenges. The categories under abuse are emotional abuse, physical abuse, and sexual abuse. The categories under neglect are emotional neglect and physical neglect. The categories under household challenges are intimate partner violence (IPV), substance abuse in the household, mental illness in the household, parental separation or divorce, and incarcerated household member. (Centers for Disease Control and Prevention, 2020c). This is the current official list of ACEs, but the field is developing and beginning to recognize a few others that could be added later on such as how poverty and racism impact childhood development.

How common are ACEs?

ACEs are very common, and many people have experienced one or more. According to the CDC, 61% of adults have experienced at least 1 ACE, and approximately 17% reported experiencing 4 or more ACEs (Centers for Disease Control and Prevention, 2020a). There are some populations more likely to experience ACEs due to social and economic conditions in which people work, live, learn and play. For example, females and racial/ethnic minority groups can be at a greater risk for experiencing four or more ACEs (Centers for Disease Control and Prevention, 2019b) as well as differences based on poverty levels and parental education (Child Trends, 2019). The number of ACEs someone has experienced can be added up to create an ACE score. 


What is the ACE study? 

The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study was an investigation of child abuse and neglect that has informed a lot of what we now know and understand about the impact and reality of ACEs (Centers for Disease Control and Prevention, 2020b). It was originally conducted from 1995 to 1997, with a sample total of 17,000 people. In addition to finding how common ACEs are, the study concluded that as a person’s ACE score increases, so does increased risk of negative health outcomes. Today the ACE study continues. Through the Behavioral Risk Factor Surveillance System Survey, the CDC is able to track information about ACEs according to each state which is enhancing our knowledge surrounding ACEs. 

What are the outcomes of exposure to ACEs?

There are a range of negative consequences that can occur due to ACEs that impact health, wellbeing, and opportunity (Centers for Disease Control and Prevention, 2020a). Some of the lasting impacts of ACEs include (Centers for Disease Control and Prevention, 2020b): 

  • Risky health behaviors (such as alcohol abuse, drug abuse, unsafe sexual practices, and smoking)

  • Health conditions (such as autoimmune disease, cancer, COPD, diabetes, frequent headaches, health-related quality of life, HIV, ischemic heart disease, liver disease, myocardial infarction, obesity, STDs, and stroke)

  • Mental health challenges (such as autobiographical memory disturbances, depression, hallucinations, suicidality, work absenteeism, and PTSD)

  • Reproductive health challenges (such as fetal death, teen pregnancy, unintended pregnancy, and pregnancy complication)

  • Violence perpetration and victimization (such as IPV, sexual violence, youth violence, and self-harming behaviors)

  • Reduced life potential and opportunities (such as high school non-completion, unemployment, poverty, and work absenteeism)

  • Early death (premature death; study 2009 found 6+ ACEs die nearly 20 years earlier than 0 ACEs) 

What are the implications of preventing ACEs?

Preventing ACEs would have a wide range of implications for preventing other negative health outcomes. It is estimated that up to “1.9 million cases of heart disease and 21 million cases of depression could have been potentially avoided by preventing ACEs” (Centers for Disease Control and Prevention, 2020a). In regard to preventing depression, this approach could reduce depression in adults by as much as 44% (Centers for Disease Control and Prevention, 2019b). 

Additionally, the CDC has found preventing ACEs will help children and adults thrive by (Centers for Disease Control and Prevention, 2019b):

  • lowering the risk for conditions like depression, asthma, cancer, and diabetes in adulthood

  • reducing risky behaviors like smoking and heavy drinking

  • improving education and job potential

  • stopping ACEs from being passed from one generation to the next 

How do we prevent ACEs?

ACEs can be prevented by creating safe environments and nurturing relationships for children and families from an early age (Centers for Disease Control and Prevention, 2020a). There are a range of approaches that utilize policy, interventions, and support for children in order to prevent ACEs. Some of the specific strategies recommended by the CDC that can be used to prevent ACEs include: strengthen economic support for families, promote social norms that protect against violence and adversity, ensure a strong start for children, teach skills, connect youth to caring adults and activities, connect youth to caring adults and activities, and intervene to lessen immediate and long-term harms (Centers for Disease Control and Prevention, 2019a).

There needs to be a shift in focus of how we think about ACEs. Rather than focusing on an individual responsibility, there should be a community focus that brings community solutions (Centers for Disease Control and Prevention, 2019a). By utilizing the social ecological model and focusing on all levels, this change in approach will be useful in preventing ACEs and reducing the impact and negative health outcomes that occur due to ACEs.

 

Download the Adverse Childhood Experiences (ACEs) Resource Guide

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Sean’s Legacy gratefully acknowledges Lucy Dollinger, CHES for the assistance in the preparation of this report.

Sources: 

Centers for Disease Control and Prevention. (2020a). Preventing adverse childhood experiences. Retrieved from https://www.cdc.gov/violenceprevention/acestudy/fastfact.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Fchildabuseandneglect%2Faces%2Ffastfact.html

Centers for Disease Control and Prevention. (2020b). About the CDC-Kaiser ACE study. Retrieved from  https://www.cdc.gov/violenceprevention/aces/about.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Facestudy%2Fabout.html 

Centers for Disease Control and Prevention. (2020c). Behavioral risk factor surveillance system ACE data. Retrieved from https://www.cdc.gov/violenceprevention/acestudy/ace-brfss.html 

Centers for Disease Control and Prevention. (2019a). Preventing adverse childhood experiences (ACEs): Leveraging the best available evidence. Retrieved from https://www.cdc.gov/violenceprevention/pdf/preventingACES.pdf 


Centers for Disease Control and Prevention. (2019a). Adverse childhood experiences (ACEs): Preventing early trauma to improve adult health. Retrieved from https://www.cdc.gov/vitalsigns/aces/pdf/vs-1105-aces-H.pdf 

Child Trends. (2019). Adverse experiences. Retrieved from https://www.childtrends.org/indicators/adverse-experiences