Adverse Childhood Experiences

What are Adverse Childhood Experiences?

Adverse Childhood Experiences (ACEs) are traumatic events that occur in childhood (0-17 years old). ACEs are broken down into three categories:

  • Abuse
  • Neglect
  • Household Dysfunction

ACEs can be linked to long-term physical, mental, and behavioral health problems, impacting how the brain and body respond to stress in the affected individual.

It is important to note that an ACE score is NOT a diagnosis but a guide. If you are seeking diagnosis or medical/psychological intervention, please speak to a medical professional

Below are the ten categories of ACEs that are measured, followed by some examples of each:

Abuse ACEs

Physical Abuse

This involves non-accidental physical force that results in, or has the potential to result in, physical harm.

  • Being hit, kicked, or shoved hard enough to leave marks or cause injury
  • Being burned
  • Being shaken violently

Emotional Abuse

This refers to a pattern of behavior that harms a child’s sense of self-worth or emotional development.

  • Constant swearing or insulting
  • Being told you are “worthless” or “a mistake”
  • Frequent threats of physical harm or abandonment

Sexual Abuse

This includes any sexual contact or interaction between a child and an adult (or a much older child) for the sexual gratification of the perpetrator.

  • Fondling or touching
  • Forced sexual acts
  • Being coerced into looking at or participating in the production of pornographic material

Neglect ACEs

Physical Neglect

This is the failure of a caregiver to provide for a child’s basic physical needs.

  • Frequent hunger because there is no food in the house
  • Wearing dirty or torn clothes
  • Being left alone for long periods at an age where supervision is required

Emotional Neglect

This occurs when a caregiver fails to provide the necessary emotional support, affection, and attention.

  • Feeling that no one in the family is close to you or supports you
  • Caregivers who are “checked out” and never show affection or interest in your life

Household Dysfunction ACEs

Incarcerated Relative

Having a member of the household go to prison or jail during childhood.

  • A parent being sentenced to prison for a crime, leading to their absence and the associated social stigma or financial instability.

Divorce

The absence of a parent due to separation, divorce, or desertion of the primary relationship in the household.

  • Parents getting a legal divorce; parents separating and living in different homes
  • The permanent disappearance of a parent.

Witnessing Domestic Violence

Witnessing domestic violence directed toward a parent or parental figure.

  • Seeing or hearing a parent being pushed, slapped, or bitten
  • Witnessing a parent being threatened with a weapon or sustained physical battery

Substance Abuse

Living with anyone who is a problem drinker, alcoholic, or who uses street or prescription drugs illegally.

  • A parent frequently being intoxicated or high
  • Drug paraphernalia being left around the house
  • Family resources being spent on substances instead of necessities

Mental Illness

Living with a household member who suffers from a mental health condition.

  • A parent struggling with clinical depression or bipolar disorder
  • A household member attempting suicide
  • Living with a household member struggling with untreated mental health challenges due to untreated mental illness
ACE SCore Questionnaire
Understanding ACE Scores

Breaking Down Scores

For every type of trauma a person has experienced from ages 0-17, the person gets one point. Zero points mean a person has had no ACEs, while ten points mean a person has had every ACE.

  • lowest risk for chronic diseases and social challenges linked to toxic stress
  • slightly increased risk of developing habits like smoking, physical inactivity, or violence
  • 2x risk of heart disease and cancer
  • 4.6x risk of suffering from depression
  • increased likelihood of substance abuse as a form of “medication”
  • significantly increases the risk of mental health struggles, including suicidal ideation, making early intervention and support vital
  • the body’s stress response system may be stuck in ‘overdrive,’ making it harder to feel safe or calm
  • may have lifespan shortened by 20 years without intervention
    • While these statistics highlight the seriousness of toxic stress, they do not account for the power of resilience, therapy, and supportive relationships to change these outcomes

What are Positive Childhood Experiences?

Contrary to Adverse Childhood Experiences (ACEs), Positive Childhood Experiences (PCEs) are experiences that occur in childhood (0-17) that counterbalance Adverse Childhood Experiences, that show better lifelong and relational health. PCEs acts as the buffer between ACEs and lifelong health effects in adulthood.

The 7 PCEs

How often the individual has:

  1. felt able to talk to their family about their feelings
  2. felt their family stood by them during difficult times
  3. enjoyed participating in community traditions
  4. felt a sense of belonging in high school
  5. felt supported by friends
  6. had at least two non-parent adults who took genuine interest in them
  7. felt safe and protected by an adult in their home

ACEs: Data provided by the CDC-Kaiser Permanente Adverse Childhood Experiences Study. | PCEs: Based on the research of Dr. Christina Bethell and the HOPE (Healthy Outcomes from Positive Experiences) framework.