Understanding Adverse Childhood Experiences (ACEs): A Guide for Everyone
by Ria Ravi
Childhood experiences shape who we become as adults. While positive experiences help us grow and thrive, negative ones can have lasting impacts on our health and well-being. These negative experiences are called Adverse Childhood Experiences, or ACEs. ACEs include various forms of trauma such as physical and emotional abuse, neglect, household dysfunction, and sexual exploitation or trafficking. Let's delve into what ACEs are, their various components, their effects, the efforts being made to further understand them, and what we are currently doing to address them.
What are ACEs?
Adverse Childhood Experiences are potentially traumatic events that occur before age 18. They can include various forms of abuse, neglect, and household challenges (Felitti et al., 1998; Hughes et al., 2017). The original ACE study, conducted by CDC-Kaiser Permanente, identified three main groups of ACEs and 10 categories total:
Abuse:
Psychological abuse
Physical abuse
Sexual abuse
Household Dysfunction:
Mother treated violently
Substance use
Mentall illness
Parental separation or divorce
Incarcerated household member
Neglect
Emotional neglect
Physical neglect
It's important to note that other traumatic experiences, such as racism, bullying, or community violence, can also be considered ACEs.
How Common are ACEs?
ACEs are surprisingly common. A study titled “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study” found that adverse childhood experiences (ACEs) were surprisingly common, with over half (52%) of respondents reporting at least one category of ACE and 6.2% reporting four or more categories. The research examined seven types of ACEs, including various forms of abuse and household dysfunction, with substance abuse in the household being the most prevalent at 25.6%. These findings align with national surveys like the CDC's Behavioral Risk Factor Surveillance System survey and the CDC-Kaiser ACE study, suggesting that ACEs are relatively common in the general population, though the authors note that actual prevalence may be even higher due to potential underreporting (Felitti et al., 1998).
The Impact of ACEs
ACEs can have a profound impact on physical, mental, and behavioral health throughout life. The more ACEs a person experiences, the higher their risk for negative outcomes (Felitti et al., 1998). This is known as a "dose-response" relationship.
Physical Health: ACEs have been linked to chronic health conditions like heart disease, cancer, and diabetes.
Mental Health: People with ACEs are at higher risk for depression, anxiety, and post-traumatic stress disorder (PTSD).
Behavioral Health: ACEs can lead to increased risk-taking behaviors, such as substance abuse, smoking, and unsafe sexual practices.
Adverse childhood experiences (ACEs) cause intergenerational trauma, especially in minoritized groups living in low-income urban areas. Research states that parental post-traumatic stress disorder (PTSD) symptoms resulting from childhood adversity may increase the risk of parent-child relationship difficulties, negative parenting practices, and ACEs in children. Social determinants of health (SDoH), like poverty and living in high-stress urban areas, make this trauma worse. These findings emphasize the need for solutions that address both personal and community issues to break the cycle of intergenerational trauma (Leslie et al., 2023; Narayan et al., 2021).
Physiological Responses to ACEs & Effect on Development
Adverse childhood experiences (ACEs) can cause extreme stress, triggering the body's "fight-or-flight" response, which releases hormones like cortisol and adrenaline. When this stress becomes chronic, it leads to toxic stress, which disrupts brain development and function. ACEs particularly affect the hippocampus, prefrontal cortex, and amygdala, areas responsible for memory, logical thinking, and emotional processing. This prolonged stress can hinder a child's development, requiring ongoing support from healthcare providers, family, and the community. However, with appropriate treatment and mental healthcare, the negative effects of ACEs can be mitigated (Cleveland Clinic, 2023; McEwen & Gianaros, 2010).
Sexual Exploitation as an ACE
Sexual exploitation is considered an Adverse Childhood Experience (ACE) with significant long-term impacts on a child's development and well-being. It falls under the category of sexual abuse and includes commercial sexual exploitation of children, such as child sex trafficking and pornography. The prevalence is alarming, as the Office of Juvenile Justice and Delinquency Prevention reports that one in six endangered runaways in 2020 likely victims of child sex trafficking. This trauma can disrupt emotional and psychological development, as discussed, leading to lasting consequences like depression, anxiety, and substance abuse in adulthood. As we’ve established, ACEs especially like sexual exploitation can be intergenerational, with parents who experienced ACEs potentially passing the trauma to their children. However, recovery is possible through support services, therapy, and resilience-building interventions. Prevention efforts include law enforcement initiatives, support services, and educational programs, which we will further discuss (Office of Juvenile Justice and Delinquency Prevention, n.d.).
Minority Populations and ACEs
According to a study by Mersky et al., ACEs are generally more prevalent among racial/ethnic minority groups compared to non-Hispanic Whites, with Non-Hispanic Blacks and Hispanics reporting higher average ACE scores. However, among those living in poverty, poor Whites report more ACEs than poor Blacks and Hispanics. The study underscores the importance of considering intersectionality—how race/ethnicity, gender, and economic status interact—in understanding ACE disparities. While most variance in ACE scores is explained by additive main effects, accounting for these intersections offers a different perspective on inequality in ACE exposure, highlighting that ACE distribution among minority communities is influenced by various socioeconomic factors (Mersky et al., 2021).
Prevention, Mitigation & Protective Factors
Preventing ACEs and mitigating their effects is possible by fostering protective factors and creating supportive environments. Healthcare providers often recommend regular psychotherapy, managing underlying health conditions, and sometimes using medications. At home, prevention includes using kind language, non-violent discipline, teaching conflict resolution, and setting positive examples. Community resources such as supportive education programs, support groups, crisis intervention services, mentorship programs, and joining sports teams or clubs can help children build confidence and learn new skills. A meta-analysis of 118 studies identified four key protective factors—self-regulation, family support, school support, and peer support—that significantly bolster resilience in children exposed to violence. These findings highlight the importance of nurturing, safe environments and the need for caregivers to seek necessary support, often with help from friends, family, and the community (Bethell, 2019; Yule et al., 2019).
Current Research and Trauma-Informed Care
A paper written to discuss ways to implement trauma-informed care in order to build childhood resilience to trauma shares the sheer importance of ACEs research and trauma-informed care in understanding the long-term health effects of childhood trauma. It highlights a shift from viewing behaviors as character flaws to recognizing the impact of early trauma. However, it notes an overemphasis on negative events, often neglecting positive factors. The paper suggests a balanced approach that highlights people's strengths and skills, uses neuroscience in criminal justice and social services, and focuses on practical actions. It advocates for research that assesses protective factors without causing re-traumatization and promotes skills to build self-regulation and resilience in both clients and service providers (Leitch, 2017).
Conclusion
Understanding ACEs is crucial for creating healthier, more resilient communities. By recognizing the impact of childhood experiences, we can work together to prevent ACEs, support those affected by them, and break the cycle of intergenerational trauma. It's never too late to seek help and start healing.
References:
Bethell, C., Jones, J., Gombojav, N., Linkenbach, J., & Sege, R. (2019). Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels. JAMA pediatrics, 173(11), e193007.
Cleveland Clinic. (2023). Adverse Childhood Experiences (ACEs) & Childhood Trauma. https://my.clevelandclinic.org/health/symptoms/24875-adverse-childhood-experiences-ace
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.
Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., Jones, L., & Dunne, M. P. (2017). The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. The Lancet. Public health, 2(8), e356–e366. https://doi.org/10.1016/S2468-2667(17)30118-4
Leitch, L. (2017). Action steps using ACEs and trauma-informed care: a resilience model. Health Justice, 5, 5.
Leslie, C. E., Walsh, C. S., & Sullivan, T. N. (2023). Implications of intergenerational trauma: Associations between caregiver ACEs and child internalizing symptoms in an urban African American sample. Psychological Trauma: Theory, Research, Practice, and Policy, 15(5), 877–887.
McEwen, B. S., & Gianaros, P. J. (2010). Central role of the brain in stress and adaptation: links to socioeconomic status, health, and disease. Annals of the New York Academy of Sciences, 1186, 190–222. https://doi.org/10.1111/j.1749-6632.2009.05331.x
Mersky, J. P., Choi, C., Lee, C. P., & Janczewski, C. E. (2021). Disparities in adverse childhood experiences by race/ethnicity, gender, and economic status: Intersectional analysis of a nationally representative sample. Child Abuse & Neglect, 117, 104-197.
Narayan, A. J., Lieberman, A. F., & Masten, A. S. (2021). Intergenerational transmission and prevention of adverse childhood experiences (ACEs). Clinical psychology review, 85, 101997.
Office of Juvenile Justice and Delinquency Prevention. (n.d.). Sexual Exploitation of Children. https://ojjdp.ojp.gov/programs/sexual-exploitation-children
Yule, K., Houston, J., & Grych, J. (2019). Resilience in Children Exposed to Violence: A Meta-analysis of Protective Factors Across Ecological Contexts. Clinical child and family psychology review, 22(3), 406–431. https://doi.org/10.1007/s10567-019-00293-1