What Are Adverse Childhood Experiences (ACEs)?

Adverse childhood experiences, or ACES, are negative or traumatic events and experiences that occur during childhood (0-17 years). Unfortunately, these events are common. In one study, 61% of surveyed adults reported experiencing at least one adverse childhood experience. These situations often have serious consequences for the health and wellness of children who experience them. 

ACES can be experienced at home or in their community. Examples of ACES include: 

• Experiencing violence, abuse, or neglect
• Witnessing violence inside or outside the home 
• Having a family member attempt suicide or die by suicide
• Growing up with household members who have substance use problems
• Growing up with household members who have mental health problems 
• Loss of access to a parent due to parental separation 
• Loss of access to a family member or household member due to that individual member being in jail or prison  

It's important to note that the above examples of ACES are not a comprehensive list. In addition to the above examples, many other types of adverse childhood events exist. 

Is your child at risk?  

Incidents relating to both the individual, family, and community can put children at risk for adverse childhood experiences. It is important to note that many of these risk factors are out of the control of children and/or their parents. The risk factors described below are not meant to place blame, but rather meant to allow us to learn how to better understand why adverse childhood experiences occur. 

Individual risk factors 

Individual risk factors, factors relating to the child’s behavior or experiences, include: 

• Youth who start dating or engage in sexual activity at an early age 
• Children who don’t feel close to their parents or caregivers 
• Children who feel they cannot share their feelings with their parents or guardians 
• Youth who have few or no friends 
• Youth who spend time with friends who engage in delinquent behavior. This type of behavior may include underage drinking, use of illegal drugs, breaking the law, or aggressive or violent behavior. 

‍

{{mid-page-cta="/dev-resources/staging"}}

‍

Family risk factors

Family risk factors, factors relating to a child’s parents, siblings, caregivers, or extended family, include: 

• Families with special needs children who face difficulties with childcare. Special needs children may include children with disabilities, mental illness, or chronic physical illness. 
• Families with caregivers who neglect their children 
• Families with caregivers who themselves were abused or neglected as children 
• Families that are low income
• Families with young caregivers 
• Families with single parents
• Adult caretakers with low levels of education 
• Families who are experiencing stress. Stress can be related to parenting, finances, and more. 
• Families where caretakers physically punish children. 
• Families where discipline is inconsistent 
• Families that are isolated and not connected to extended family, friends, neighbors, and more. 
• Families that fight often and often make negative or derogatory comments toward one another. 
• Families that normalize or justify violence or aggression. 

Community risk factors

Finally, community risk factors, factors relating to or describing a child’s community or living space, include: 

• Communities with high rates of violence and crime 
• Communities where families frequently do not have enough food
• Communities with poor opportunities for education 
• Communities with high rates of poverty 
• Communities with high unemployment rates and limited access to jobs 
• Communities where neighbors or community members do not know each other, look out for one another, or take care of each other 
• Communities with few activities for young people 
• Communities where residents are frequently coming and going 
• Communities where there is easy access to drugs and alcohol 

Adverse child experiences cause serious negative outcomes 

Children who have a history of adverse childhood experiences are more likely to have problems well into adulthood. 

Some outcomes that have been studied include: 

• Not finishing school
• Chronic health concerns
• “Toxic stress,” the body’s response to prolonged stress 
• Challenges with employment 
• Mental health issues
• Substance abuse 

The following three studies gives us more information about children and adolescents who experienced adverse childhood experiences: 

ACEs affect education and employment: A study titled, “Adverse childhood experiences and life opportunities: Shifting the narrative,” found that ACEs are associated with less adult education, employment, and income potential. By preventing early adversity, governments, communities, and families could play a positive role in  future generations.  

Multiple ACEs synergistically increase harm to health: A study titled, “The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis,” searched for all previous research studies examining adverse childhood experiences. 

They found that those who had experienced multiple ACEs were at a much higher risk of adverse outcomes such as drug use, violence against others and themselves, mental illness, problematic alcohol use, and strong sexual risk taking. 

They also found that those with multiple ACEs were at a slightly increased risk for smoking and heavy alcohol use, cancer, heart disease, respiratory disease, and poor self-rated health. This study shows that multiple ACEs can lead to a number of negative outcomes related to physical and mental health. 

The effects of ACE’s are long lasting: A study titled, “Time Does Not Heal All Wounds: Older Adults Who Experienced Childhood Adversities Have Higher Odds of Mood Anxiety and Personality Disorders,” studied 34,653 Americans aged 20 or older. Interviewers assessed participants' mood and anxiety over the course of the previous years. 

They found that older adults who experienced childhood adversity had higher odds of having mood, anxiety, and personality disorders. Those who sought treatment had reduced anxiety and mood disorders, demonstrating that the effect of ACEs can last a lifetime.  

‍

How can you protect your child from adverse childhood experiences? 

Above, we described certain qualities relating to the individual child as well as their family and community that increase the risk of adverse childhood experiences. 

In this section, we will discuss how individuals, families, and communities can work together to do the opposite - protect children against ACES. 

We recognize that not all of the protective factors below are possible for children or their parents to achieve. In addition, even in the healthiest of families and communities, adverse childhood experiences may still occur. We respect the unique circumstances each family faces. And in the section below this one, we will discuss how to care for children who have already experienced ACES. 

Individual protective factors

Individual protective factors describe factors that make a child less likely to experience adverse experiences. This includes: 

• Children who have positive friendships or positive relationships with children in their age group 
• Children who do well in school 
• Children who have adult figures in their lives that can serve as mentors or role models. These figures do not need to be biological parents. 

Family protective factors

Family protective factors are qualities relating to a family that make children feel safe and supported. This includes: 

• Families that create stable and nurturing relationships with their children 
• Families that underscore the importance of school for children. 
• Families in which caregivers have college degrees or higher 
• Families in which caregivers are stably employed
• Families in which caregivers meet the child’s basic needs for foot, shelter, and healthcare 
• Families with a strong support network of neighbors, family members, faith-based community members, or more. 
• Families in which caregivers engage in parental monitoring and supervision. Families in which parents consistently enforce fair rules. 
• Families in which adults are able to work through conflicts in a peaceful way without verbal arguments or physical violence. 
• Families in which caregivers help children work through problems or experience failure. 
• Families that spend time together in a fun way. 

Community protective factors

Community protective factors are factors relating to a community that protect children from adverse childhood experiences. This includes: 

• Communities where families have access to medical care and mental health care 
• Communities with access to safe and stable housing
• Communities where families can get financial help or support if needed
• Communities where families have access to safe childcare and quality preschools 
• Communities where children have access to safe and engaging after-school programs and activities
• Communities where job opportunities are family-friendly 
• Communities where community members feel they are in partnership with local businesses, health care clinics, the government, and more. Communities where community members feel their voices are heard on a larger scale. 
• Communities where residents feel connected to one another 
• Communities that do not support or condone violence 

Taking Community Action to Reduce Risk

The above factors are numerous and may be overwhelming. Taking action to make your family or community more protected may involve one step at a time. This can include informally mentoring at-risk children, enrolling in a career workshop, finding local free after school programs for children, searching online for community-based programming, or partaking in parenting class.   

No one should feel that they have to take action alone. In 2020, the Centers for Disease Control and Prevention announced funding for a project to help learn more about and prevent adverse childhood experiences. 

Examples of states that are taking advantage of this funding to build new and creative community-based safety initiatives include: 

Georgia Department of Health: The department first learned more about ACES by adding questions about ACES to surveys administered to Georgia public high school students.  

After gathering information, the Georgia Department of Health of Health instituted two new ACES prevention strategies: 

• Increased access to early childhood home visitation programs. This program assists new parents in getting the resources and ongoing support they need. 
• A public education campaign for the 1-800-CHILDREN Helpline. This helpline connects parents, caregivers, and professionals with the assistance needed to help their children thrive. This helpline is available to anyone in Georgia. 

Minnesota Public Health Institute: The state’s health institute first gathered information by providing surveys to Minnesota students in grades 5,8,9, and 11. They also gathered data from multiple other sources including Child Protective Services, the Minnesota Department of Education, and the Minnesota Department of Human Services. 

After gathering data, they developed the following two initiatives: 

• A partnership with the Minnesota Indian Women’s Sexual Assault Coalition. This partnership was developed as an intervention to teach Indigenous boys and young men nonviolent conflict resolution skills and de-escalation skills in order to reduce violence. 
• Increased access to home visitation and high-quality childcare for incarcerated families. In addition, training for Department of Corrections staff was completed about ACES, ACES prevention, and best practices to support incarcerated parents. 

Other states with similar initiatives include New Jersey, Connecticut, Massachusetts, and Michigan.  

Early Intervention May Help Prevent Negative Outcomes 

Researchers who study the long-term impacts of ACEs state that early intervention matters. 

In one study, 138 participants were included, some of whom had experienced adverse childhood experiences such as caregiver substance abuse, caregiver mental illness, household domestic violence, criminal household members, parent marital discord, and more from ages 0-2. Researchers found that the individuals who experienced a greater number of ACEs from ages 0-2 had poorer health in adulthood. 

To help combat this worrisome prediction, researchers of this study as well as other studies suggest gathering information about ACEs through surveys administered at schools, pediatric visits, and other community locations. These tools can help stop abuse or other traumatic experiences. Furthermore, the authors also underscored the importance of early intervention programs and family-based services, like the ones listed above, as ways to reduce further adversity for children who have experienced common ACEs. 

My child has faced an Adverse Childhood Experience. How can they get help? 

Before all else, it is most important to make sure a child is safe. In suspected cases of abuse or neglect that is endangering a child, please contact Child Protective Services (CPS). Child Protective Services is a branch of each state’s social services department that completes assessments and interventions in cases of suspected child abuse or neglect. Definitive proof of abuse or severe neglect is not required to make a CPS claim.  

If safety is currently guaranteed, mental health support, in addition to working toward some of the protective factors listed above, can help your child process the experiences they faced. 

‍

‍

‍

Family support at Charlie Health

Charlie Health specialists trained in managing the effects of childhood trauma can help children and adolescents deal with any given traumatic experience individually in one-on-one therapy sessions. 

Additionally, our Intensive Outpatient Program is designed for adolescents in need of more than once-weekly therapy and allows clients to receive 9-11 hours of care each week from home. 

Finally, family therapy sessions may be helpful in this case as a cohesive and supportive family unit is a protective factor against experiencing further harm from adverse childhood experiences. Family therapy sessions allow families to work together to process a wide range of challenges such as loss of a loved one, substance use disorders, inter-family conflict, and more. Get started today.

‍