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Exploring Adverse Childhood Experiences (ACEs)

Published on Feb. 02, 2022

It’s no secret that children are more likely to thrive in environments where they are supported, loved and feel safe. So what happens when children don’t have a positive environment to turn to? Over recent decades, we’ve learned adverse childhood experiences can have a much greater impact on children and adults than we previously understood.

What are adverse childhood experiences (ACEs)?

Adverse childhood events, or ACEs, are potentially traumatic experiences that occur in childhood that can have a long-lasting impact on future health and well-being. ACEs were first identified in the late 1990s through a joint study between the Centers for Disease Control and Prevention (CDC) and Dr. Vincent Felitti in San Diego. The study found that adults with risk factors for disease, disability, social dysfunction and early death were more likely to have experienced adversity in childhood. 

The study identified 10 ACEs, which fall into three general categories: abuse, neglect and household dysfunction such as being exposed to violence, mental illness, substance abuse, or divorce. The study also identified a dose-dependent relationship between ACEs and health risk: increased exposure to ACEs in childhood leads to a greater risk of negative health outcomes.

The Impact of ACEs: The initial ACEs study identified that at nearly 64% of adults experienced at least one ACE. And while some populations are more vulnerable to experiencing ACEs, socioeconomic status and educational level are not necessarily protective. Learn more >

How do ACEs affect kids as they grow?

Unfortunately, many children experience traumatic childhood events, though not all children will experience the stress in the same way. The presence of a stable, nurturing adult in a child’s life, even if not a parent, can help buffer the effects through the development of a healthy stress response. It is when children experience trauma repeatedly, without protective factors, that the stress becomes toxic.

Toxic stress during childhood is particularly impactful because it occurs during the critical time of brain development. Starting from infancy, children depend on the environment they grow up in to learn about the world and how to respond to its challenges. When children experience toxic stress, it is as if they are in a constant state of “fight or flight.” Imagine being stalked by a bear, never knowing at what moment or around what corner you will come face to face. These children – and their developing brains – are on heightened alert more often and for longer periods of time. In response, they develop unhealthy, or maladaptive, behaviors. Fighting back may be helpful when you encounter a bear, but it doesn’t serve you well in most routinely stressful situations. A child who experiences repeated trauma may develop behavioral issues that affect their ability to focus in school, interrupt sleep, or impair their ability to form relationships. They might lash out at others with their words or by hitting because they are confused and stressed but are unable to process these emotions. A child in a constant elevated state of stress who experiences even a small stressor will respond in a way that seems to others to be inappropriate or out of proportion.

But maladaptive behaviors aren’t the only consequence. Repeated activation of the stress response causes structural changes and functional changes in the brain. The brain’s chemistry changes, leading to increased levels of the stress hormone, cortisol, resulting in long-term inflammation and changes to the immune system.

According to the Center for Youth Wellness, a person with four or more ACEs is 21% as likely to live at or below 250% of the Federal Poverty Level (FPL), 27% as likely to have not graduated college, and 39% as likely to be unemployed. Read the full report here >>

What parents can do to mitigate the impact of ACEs

ACEs can have a lasting, negative impact on a child’s growth and development, but they can also be buffered and sometimes reversed. One of the first steps to limiting the effects is to identify them as early as possible and intervene. There are many things parents can do to be “ACEs aware”:

  • Do your best to create a safe, stable, supportive environment for your child. Let your child know you are available any time they need to talk about anything. Children who have strong support systems can develop resiliency skills to better process stressors.
  • Reach out to your child’s pediatrician. Let your child’s doctor know about any changes in behavior or family life. Let go of any shame you may have about your child’s behavior or what they have experienced. Try not to be defensive; remember that the doctor is there to help get you the resources and support you need.
  • Seek help for yourself. It is not uncommon for there to be generational trauma, or ongoing trauma due to systemic racism, poverty, or lack of educational and occupational opportunities. Seek out resources in your community that can provide support depending on your needs – food banks, adult literacy and educational programs, housing assistance organizations are just some of the great resources available to help alleviate challenges you may be facing as a family. If you’re struggling mentally or emotionally, don’t be afraid to talk to your doctor or a licensed mental health professional.

Whether you have experienced ACEs or not, we can all play a pivotal role in the life of a child by helping create and sustain safe communities, nurturing environments and stable relationships that promote resiliency and allow children to thrive.


About the Author

Dr. Carmela Sosa has practiced pediatrics in both the urban and rural health settings – always focused on children with special healthcare needs and pediatric mental health. She joined Valley Children’s Charlie Mitchell Children’s Center in April 2012 to provide complex primary care to children of the Valley. Her roles expanded in 2016 to include Associate Program Director of the Valley Children’s Pediatric Residency Program, and again in 2019 to Medical Director of Valley Children’s Primary Care and Medical Director of the Guilds Center for Community Health.