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Adverse Childhood Experiences (ACEs) and Health: What We Know and How to Cope

The landmark Kaiser/CDC study carried out in the 1990s showed poor adult health outcomes in a dose-dependent response to adverse childhood experiences or ACEs. Five of the 10 adverse childhood events in the study were physical and emotional neglect, and physical, sexual and emotional abuse. The remaining five ACEs were related to household dysfunction – family experience of violence against mother, mental illness, incarceration, substance abuse or divorce. These childhood experiences negatively impact physical and mental health far into adulthood. In fact, the odds of attempting suicide are 30 times higher for adults who have experienced 4 or more ACEs compared to those who experienced zero ACEs.

How is it, then, that some children who experience numerous ACEs can still thrive as adults? While there is no single or straightforward answer, we do know certain factors can help buffer the effects of toxic stress in children. These known protective factors include:

  • Caregiver knowledge of child development – Understanding developmental stages helps caregivers reframe challenging behaviors, such as temper tantrums, placing them in the context of the child’s physical, emotional and social competencies.
  • Concrete supports for parents – Although abuse and neglect cross all socioeconomic and educational lines, the added stressors of things such as food or housing insecurity can lead to increased parental stress. Providing concrete supports can help mitigate these stressors.
  • Nurturing and attachment – Stable, nurturing relationships help children feel confident as they explore the world. They allow children to develop independence and self-esteem, having dependable, protective individuals they can step away from and return to – allowing them to bounce back from difficult situations.
  • Social and emotional competence of children – Building social and emotional competence in children helps them learn to regulate their behaviors and emotions, allowing them to build healthy relationships with others.
  • Social connections – Having and maintaining positive, supportive social connections is key to every family. These are people you can rely on and help build you up.
  • Caregiver resilience – Caregivers are faced with all types of stress, from typical life events to social and environmental conditions such as poverty and structural racism.

One way to give our children the best chance for a healthy adulthood is to prevent abuse and neglect, or at least lower the likelihood it will occur, and build resilience. To understand this better, we can refer to the social ecological model Dahlberg et al proposed to understand violence. 

Dahlberg et al social ecological model
Image source: CDC1

The social ecological model describes the complex interplay between multiple factors that can either increase risk of or protect individuals from violence, providing a framework and strategies for prevention. At the individual level, factors such as educational attainment, financial security, presence of substance use, and history of abuse can all influence the likelihood of someone being a perpetrator or victim of abuse.

Close social relationships make up the second level of the model. Examples of these include the family unit, intimate partners, and peers. Whether or not violence and victimization are encouraged or discouraged plays a role in risk.

Community makes up the third level and is influenced by the degree of connectedness. Those communities which have higher rates of isolation, lower levels of connectedness, and lower rates of social support are more likely to experience violence.

The fourth level looks at those societal factors which may influence the presence or absence of violence. These include things such as a societal acceptance of violence as a means of resolving conflict, and inequity in policies and practices that maintain or promote inequality and unequal treatment between groups in society.

It is important to approach prevention efforts from a more global perspective and is paramount to the long-term health of our children, families and communities. One of Valley Children’s efforts to address ACEs and help build resilience is made possible by California’s ACEs Aware Initiative’s PRACTICE grant. Valley Children’s has established a partnership in Merced County with ACE Overcomers, Central California Alliance for Health, First Five Merced, Merced County of Education’s ACEs INC, and the California Consortium for Prevention and Intervention. The goals of the work are to strengthen partnerships to screen and respond to ACEs, develop evidence-informed services and build a sustainable workforce to continue to screen, respond, and prevent toxic stress and adversity.

For more information and training on screening, treatment, and healing, visit


Dahlberg LL, Krug EG. Violence: a global public health problem. In: Krug E, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, eds. World Report on Violence and Health. Geneva, Switzerland: World Health Organization; 2002:1-21.