Adverse Childhood Experiences

Opening scenario
What are ACEs?
Beyond the ACE Score: Perspectives from the NCTSN on Child Trauma and Adversity Screening and Impact (11 page PDF)
How BHSD Students Fair - 2014-2023-2023
Childhood Abuse Leaves 'Devastating Impact' on Adults — Sicker, poorer, less educated, and likely to die sooner
Adverse Childhood Experiences and Suicide Attempts
What are ACEs?

Beyond the ACE Score: Perspectives from the NCTSN on Child Trauma and Adversity Screening and Impact (11 page PDF)
The National Child Traumatic Stress Network - External Resources
Complex Trauma: Facts for service providers working with homeless youth and young adults
Early Childhood Trauma (17 page PDF)
Impact of Complex Trauma (47 psge PDF)
Medical Events & Traumatic Stress in Children and Families

What’s Your ACE Score?

Take the ACE test
Take the Resilience test

Get your ACE Card for

In Spanish

Why do ACEs matter?
How are ACEs Relevant to Me?
Childhood Trauma And Its Lifelong Health Effects More Prevalent Among Minorities
Extending Mental Health Help to Vulnerable Kids
The Cost
Study Assesses Adverse Childhood Experiences and Strategies to Overcome Them
How can you prevent ACEs from damaging lives?
How Childhood Trauma and Dissociation Result in Horrible Adulthood Problems
Adverse Childhood Experiences and Suicide Attempts
7 Signs You Grew Up With Childhood Emotional Neglect
10 Traits of Toxic Parents Who Ruin Their Children’s Lives - video 10:21
Signs your child may be impacted from ACEs
Student Wellness Surveys - Oregon - Curry County - 2014 and 2016 with BHSD Extensions

Student Wellness Surveys - Oregon - 2014 - 2018

Adverse Childhood Experiences SAMHSA
Adverse childhood experiences, gender, and HIV risk behaviors: Results from a population-based sample
Adverse Childhood Experiences Study - Wikipedia
een Depression
ACEs and Child Trauma Leave Lasting Scars [INFOGRAPHIC] (21 page PDF)
Prevalence of Adverse Childhood Experiences (Adult Retrospective)
Resources to Strengthen Communities and Promote Systemic Change
rauma Informed


Opening Scenario
Your child witnesses violence at school, but hardly reacts at all. You might think that the incident was merely one of many insignificant moments to your child, but research shows that particular Adverse Childhood Event (ACE) may alter the way your child reacts to daily stressors. Even more startling: With multiple ACEs, your child’s brain development may be stunted leading to a lack of self-awareness and cognitive deficiencies. ACEs put children at high risk for serious mental, physical, emotional, and social health complications.

ACE expert Jane Ellen Stevens succinctly broke down the negative effects of ACEs on developing minds:

“They respond to the world as a place of constant danger. With their brains overloaded with stress hormones and unable to function appropriately, they can’t focus on learning. “They fall behind in school or fail to develop healthy relationships with peers or create problems with teachers and principals because they are unable to trust adults.”

What Are ACEs?

Adverse Childhood Experiences (ACEs) is a term used to describe neglect, abuse, violence and/or distressed family environments that children under the age of 18 years may experience. The cumulative effect of ACEs can be traumatic, especially if experienced repeatedly beginning at a young age. There is a strong association between the amount of ACEs an individual experienced during childhood and the increased risk for negative health behaviors (smoking, drug and alcohol abuse and risky sexual behaviors), chronic mental health concerns (depression and suicidal thoughts) and chronic diseases (heart disease, stroke, diabetes and cancer) later in life. The following table details the percentage of students who responded YES to the ACE questions. Click here for more informatoin about ACEs.

ACEs, or Adverse Childhood Experiences, are different for everyone, but in the broadest sense, they are negative moments or events that have the potential to leave lasting harmful effects on a child. ACEs come in many forms from: abuse, neglect, household dysfunction to witnessing violence. ACEs are important to identify due to their uncanny ability to mold and shape who our children grow up to be. When unchecked and unnoticed, ACEs can lead to a future of lifelong health concerns, risk aversion, passivity, and violence (both as a perpetrator and victim).  

Researchers have identified three categories of ACEs:

  • Abuse
  • Neglect
  • Household Dysfunction

Within these three categories are a plethora of experiences and events. To properly study how ACEs affect people as adults, researchers chose 10 types of childhood trauma and asked study participants to note whether or not they had experienced them as children.

64% had at least 1 ACE. 22% had 3 or more. 12.5% had 4 or more.

The ACE Test

In the first ACE study, Dr. Vincent Felitti and Dr. Robert Anda devised a test. There were 10 questions, each pertaining to a different type of ACE. For every question with a “Yes” (meaning they had an ACE) the test taker received a one point.

Sample Question:

Before your 18th birthday, did a parent or other adult in the household often or very often swear at you, insult you, put you down, or humiliate you? Or did they act in a way that made you afraid you might be physically hurt?

The test only counted types of ACEs, not the number or separate incidents of the same type of ACE. So, if they experience physical abuse 25 times, and no other types of experiences, their score would be 1. The goal of the test was to see how ACEs correlated with the test takers’ health.


The results were shocking, and led to emotional moments between therapists and study participants.

What’s Your ACE Score?

There are 10 types of childhood trauma measured in the ACE Study. Five are personal — physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect. Five are related to other family members: a parent who’s an alcoholic, a mother who’s a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment. Each type of trauma counts as one. So a person who’s been physically abused, with one alcoholic parent, and a mother who was beaten up has an ACE score of three.

There are, of course, many other types of childhood trauma — watching a sibling being abused, losing a caregiver (grandmother, mother, grandfather, etc.), homelessness, surviving and recovering from a severe accident, witnessing a father being abused by a mother, witnessing a grandmother abusing a father, etc. The ACE Study included only those 10 childhood traumas because those were mentioned as most common by a group of about 300 Kaiser members; those traumas were also well studied individually in the research literature.

The most important thing to remember is that the ACE score is meant as a guideline: If you experienced other types of toxic stress over months or years, then those would likely increase your risk of health consequences.

What's your ACE Score? (prior to your 18th birthday)


If Yes enter 1

Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?

Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?

Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?

Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?

Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

Were your parents ever separated or divorced?

Was your mother or stepmother:

Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?

Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?

Was a household member depressed or mentally ill, or did a household member attempt suicide?

Did a household member go to prison?

Now add up your “Yes” answers: _ This is your ACE Scor

Source: Click here for a blank copy of this survey

Now that you’ve got your ACE score, what does it mean?

First….a tiny bit of background to help you figure this out…..(if you want the back story about the fascinating origins of the ACE Study, read The Adverse Childhood Experiences Study — the largest, most important public health study you never heard of — began in an obesity clinic.)

The CDC’s Adverse Childhood Experiences Study (ACE Study) uncovered a stunning link between childhood trauma and the chronic diseases people develop as adults, as well as social and emotional problems. This includes heart disease, lung cancer, diabetes and many autoimmune diseases, as well as depression, violence, being a victim of violence, and suicide.

The first research results were published in 1998, followed by 57 other publications through 2011. They showed that:

  • childhood trauma was very common, even in employed white middle-class, college-educated people with great health insurance;
  • there was a direct link between childhood trauma and adult onset of chronic disease, as well as depression, suicide, being violent and a victim of violence;
  • more types of trauma increased the risk of health, social and emotional problems.
  • people usually experience more than one type of trauma – rarely is it only sex abuse or only verbal abuse.

A whopping two thirds of the 17,000 people in the ACE Study had an ACE score of at least one — 87 percent of those had more than one. Eighteen states have done their own ACE surveys; their results are similar to the CDC’s ACE Study.

What’s Your ACE Score?
and, in the end, What’s Your Resilience Score?
# of ACEs
4 or more


The study’s researchers came up with an ACE score to explain a person’s risk for chronic disease. Think of it as a cholesterol score for childhood toxic stress. You get one point for each type of trauma. The higher your ACE score, the higher your risk of health and social problems. (Of course, other types of trauma exist that could contribute to an ACE score, so it is conceivable that people could have ACE scores higher than 10; however, the ACE Study measured only 10 types.)

As your ACE score increases, so does the risk of disease, social and emotional problems. With an ACE score of 4 or more, things start getting serious. The likelihood of chronic pulmonary lung disease increases 390 percent; hepatitis, 240 percent; depression 460 percent; suicide, 1,220 percent.

(By the way, lest you think that the ACE Study was yet another involving inner-city poor people of color, take note: The study’s participants were 17,000 mostly white, middle and upper-middle class college-educated San Diegans with good jobs and great health care – they all belonged to the Kaiser Permanente health maintenance organization.)

Adult Childhood Experiences are Common

The CDC gave a questionairre with these 10 types of childhood trauma and assigned a score of 1 for each trauma experienced.

  • Household substance abuse (27%)
  • Parental separation/divorce (23%)
  • Family member with a mental illmess (17%)
  • Violence between parents/abuse of mother (13%)
  • Incacerated household member (6%)
  • Psychological/emotional abuse (11%)
  • Physical abuse (28%)
  • Sexual abuse (21%)
  • Emotional neglect (15%)
  • Physical neglect (10%)

What’s Your Resilience Score?

This questionnaire was developed by the early childhood service providers, pediatricians, psychologists, and health advocates of Southern Kennebec Healthy Start, Augusta, Maine, in 2006, and updated in February 2013. Two psychologists in the group, Mark Rains and Kate McClinn, came up with the 14 statements with editing suggestions by the other members of the group. The scoring system was modeled after the ACE Study questions. The content of the questions was based on a number of research studies from the literature over the past 40 years including that of Emmy Werner and others. Its purpose is limited to parenting education. It was not developed for research.

RESILIENCE Questionnaire
Please check the most accurate answer under each statement


Definitely true
Probably true
Not sure
Probably Not True
Definitely Not True

1. I believe that my mother loved me when I was little.

2. I believe that my father loved me when I was little

3. When I was little, other people helped my mother and father take care of me and they seemed to love me.

4. I’ve heard that when I was an infant someone in my family enjoyed playing with me, and I enjoyed it, too.

5. When I was a child, there were relatives in my family who made me feel better if I was sad or worried.

6. When I was a child, neighbors or my friends’ parents seemed to like me.

7. When I was a child, teachers, coaches, youth leaders or ministers were there to help me.

8. Someone in my family cared about how I was doing in school

9. My family, neighbors and friends talked often about making our lives better.

10. We had rules in our house and were expected to keep them.

11. When I felt really bad, I could almost always find someone I trusted to talk to.

12. As a youth, people noticed that I was capable and could get things done.

13. I was independent and a go-getter.

14. I believed that life is what you make it.

How many of these 14 protective factors did I have as a child and youth? (How many of the 14 were checked “Definitely True” or “Probably True”?) _______

Of these circled, how many are still true for me? _______

Source: Click here for a blank copy of this survey.

Here are some specific graphic examples of how increasing ACE scores increase the risk of some diseases, social and emotional problems. All of these graphs come from “The relationship of adverse childhood experiences to adult health, well being, social function and health care”, a book chapter by Drs. Vincent Felitti and Robert Anda, co-founders of the ACE Study, in “The Hidden Epidemic: The Impact of Early Life Trauma on Health and Disease.”


ACE Test Results

When Dr. Anda got the first results back he was overcome with sadness. He said, “I saw how much people had suffered and I wept.”

The study largely focused on the consequences of several different types of trauma. The 1995 study found that over 66% of participants had at least 1 ACE. Startling enough on its own, but that was only the beginning:

  • 22% had an ACE score of 3 or more
  • 12.5% had an ACE score of 4 or more

When they dug into the scores, researchers discovered that over a quarter of participants had experienced physical abuse, household substance use, economic hardship, or a combination of the three.

  • 28% experienced physical abuse
  • 27% saw household substance abuse
  • 26% experienced economic hardship

The study showed that many had been neglected in their childhood and over 1/5 were sexually abused:

  • 21% experienced sexual abuse
  • 15% were emotionally neglected
  • 10% physically neglected

After discovering how prevalent these ACEs were in people’s lives, Anda and Felitti looked for correlations between ACEs and mental and physical health concerns. What they found, led to some shocking, but profound and beneficial trends. Most notably: An almost exact correlation between childhood trauma and mental illnesses, chronic diseases, incarceration, and employment status.

Why Do ACEs Matter?

When an adverse childhood experience occurs, the child’s brain is flooded with adrenaline in what is often called “Fight or Flight”. While this reaction helps the child react to any immediate dangers, it becomes toxic when turned on for too long.

When children are forced to constantly focus on surviving and avoiding harm, they are unable to focus on learning or developing skills to serve them in adulthood. Their ability to trust and relate to others never fully forms and they often experience depression, self-consciousness, and avoidance of challenges. This has a snowball effect where children may turn to self-medicating or other troublesome behaviors to deal with the pain.

  • When 4 or more ACEs occur, students are 32x more likely to have learning or behavior problems in school.

People who experience childhood trauma tend to respond to daily stresses with high anxiety, or try to avoid stressors at all costs. This may include high pressure situations like giving a presentation at work, or more minor situations, like making small talk at a school fundraising event.

Health Impact of Multiple ACEs

A single adverse childhood experience can harm a child’s future by increasing the risk of homelessness, exposure to violence, and work absenteeism. When multiple ACEs happen, the likelihood of mental, physical, and social concerns goes up exponentially.

Repeated abusive and traumatic situations often lead to Complex PTSD. This type of trauma happens before a child is allowed to fully develop cognitive maturity and an understanding of how to respond to stressful situations. A person suffering from Complex PTSD will have trouble regulating their stress hormones and responding to normal situations as if they were threatening situations. These reactions can lead to chronic health issues and dangerous behaviors to deal with stress.

A score of 2 or more on the ACE test, when correlated with test taker’s health records showed the following compared to someone with a score of 0:

  • 3x more likely to have attempted suicide
  • 4x more likely to consider themselves alcoholics
  • Nearly 3x more likely to have used illicit drugs

A score of 4 had even more dire and sobering correlations:

  • 12x more likely to have attempted suicide
  • Over 7x more likely to consider themselves an alcoholic
  • 390% higher risk of Chronic Obstructive Pulmonary Disease (COPD)
  • 10x more likely to use illicit drugs
  • Twice as likely to be addicted to nicotine
  • 460% more likely to suffer from depression

In a more recent study, they found that when people had a score of 6 or more, the consequences were fatal. A person with 6 or more ACEs dies, on average, 20 years earlier than someone with 0.

The effects of ACEs go far beyond health concerns.

Economic Impact of ACEs

With problems reconciling fears, stress, and ambition, people suffering from ACEs can fail to secure financial stability and steady employment. While certainly a major strain on their own lives, this lack of financial support also puts a strain on the American economy.

ACEs cost the economy $124 billion in over the lifetime of all those affected by ACEs.
$83.5 billion in productivity losses

$25 billion spent for health care to combat the effects of ACEs

Child maltreatment and domestic abuse combined cost the economy roughly $500 billion a year. Health is certainly the #1 concern in combating ACEs, but the benefits of uncovering and treating ACEs are indefinite.

Signs You or Your Child May Be Impacted by ACEs

Possibly just knowing what ACEs are will help you determine if you or someone you know is impacted by ACEs. But for those more underlying and not talked about experiences look for the following ACE effects.

Many suffering from Complex PTSD, ACEs, and child trauma feel physical effects that can disrupt daily life:

  • Suffering from numerous health problems
  • Alcohol and/or illicit drug abuse
  • Poor sleep habits
  • Dealing with never-ending money management issues

More often than not these are coupled with emotional and social deficiencies. These issues consistently get in the way of victims’ ambitions and goals and can put a strain on their relationships.

  • Unable to control emotions and moods
  • Depression and/or living in isolation
  • Constantly worrying about just surviving and not enjoying life
  • Problems controlling anger and aggression
  • Unmotivated unless presented with severe consequences
  • Believing that bad things happen to you on purpose
  • Viewing humans as threats, not friends

87% of people with ACEs in Anda’s test had multiple types of trauma. That means only 13% had an isolated type of ACE. It appears that when someone has an ACE, many more are soon to follow. With multiple types of trauma, come multiple types of negative effects.


Therapists stress that the view should not be “Why are you behaving like this?” but “What happened to you?” If you or someone you know struggles with any of the above-mentioned concerns, take a look at the ACE test. It could lead to a path of recovery or at least an understanding of what events impacted the person you are today.

How You Can Prevent ACEs from Damaging Lives

Sometimes ACEs are unavoidable. Children will undoubtedly find themselves in adverse situations where they need to use that “Fight or Flight” adrenaline rush. But when coupled with protective and positive childhood experiences, adverse events can actually help children develop resilience.

The first step is creating an open dialogue between children and caring adults. There needs to be a trust between you and the child. They need a safe and loving environment where they can rid themselves of stresses and just be a kid.

Positive Childhood Experiences

It is vital to give your children positive life experiences and work with them to develop healthy self-regulation. Some of these include:

  • Reading and talking with your child
  • Providing good nutrition and plentiful sleep
  • Giving them an understanding of what is in their control
  • Working with them towards goals
  • Developing effective problem solving skills with your child

Teaching Self-Control

As they are still developing self-regulation and responses to stress, show and explain to them proper coping and conflict resolution techniques:

  • Direct them away from yelling and violent behavior
  • Limit exposure to violence in media
  • Discuss collaboration and compromising
  • Empathizing with others

A study on ACEs and their connection to problems with self-control stated,

“Innovative policies that put self-control center stage might reduce a panoply of costs that now heavily burden citizens and governments.”

While there is no cure-all for deafening the impact of ACEs, providing children with positive childhood experiences can dramatically limit some potentially fatal ACE effects. Resilience to negative events and an understanding that there are positive things in life are vital to living a fruitful life.

For adults living with the effects of ACEs, you’re not alone. A benefit of the recent understanding of ACEs is that many people are finding the courage and strength to overcome roadblocks from their childhood trauma. The dialogue is open; please join in.


Join the ACEs Connection Network
ACEs Response Toolkit
Resources from The National Child Traumatic Stress Network

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Childhood Trauma And Its Lifelong Health Effects More Prevalent Among Minorities

When researchers first discovered a link in the late 1990s between childhood adversity and chronic health problems later in life, the real revelation was how common those experiences were across all socioeconomic groups.

But the first major study to focus on adverse childhood experiences (ACEs) was limited to a single healthcare system in San Diego. A study published Monday in JAMA Pediatrics — the largest nationally representative study to date on ACEs — confirms that these experiences are universal, yet highlights some disparities among socioeconomic groups. People with low-income and educational attainment, people of color and people who identified as gay, lesbian or bisexual had significantly higher chance of having experienced adversity in childhood.

The study finds three out of five adults across the U.S. had at least one adverse experience in their childhood, such as divorce, a parent's death, physical or emotional abuse, or a family member's incarceration or substance abuse problem. A quarter of adults have at least three such experiences in childhood, which – according to other research — increases their risk for most common chronic diseases, from heart disease and cancer to depression and substance abuse.

"This is the first study of this kind that allows us to talk about adverse childhood experience as a public health problem in the same way we talk about obesity or hypertension or any other highly prevalent population risk factor," says Adam Schickedanz, an assistant professor of pediatrics at the David Geffen School of Medicine at UCLA, who was not involved in the research. "Up until now, we haven't really had a study that takes a national look."

The study researchers, led by Centers for Disease Control and Prevention researcher Melissa T. Merrick, analyzed data from 214,157 adults in 23 states between 2011 and 2014. The participants answered 11 questions about whether they'd experienced what have now become well recognized as ACEs: parental separation or divorce, child abuse (physical, emotional and sexual), domestic violence and living with someone who has been incarcerated or has a mental illness or a substance use disorder.

Nearly 62 percent of respondents had at least one ACE and a quarter reported three or more. The remaining respondents had at least two ACEs, including 16 percent with four or more such experiences.

Those identifying as black or Latino and those with less than a high school education or an annual income below $15,000 were more likely to have more ACEs. But a relatively new finding was that multiracial and gay, lesbian and bisexual individuals carried the greatest burden.

Multiracial participants reported roughly 2.5 ACEs, and bisexual adults reported 3.1, both the highest scores reported. Women, younger adults, unemployed people and those unable to work also tended to have higher scores.

But Schickedanz cautions that, while the disparities are real, it's important to recognize how common these experiences are among all people, including white and middle class families.

"This [study] shows that ACEs affect people from all walks of life everywhere," he says.

The link between trauma and health

The original ACE study, published in 1998, analyzed data from more than 9,000 primarily middle class adults in the San Diego area, starting in 1995-1997. Its publication opened people's eyes to how common adverse experiences are even among children in seemingly more privileged homes. Nearly 40 percent of participants had at least a college degree, and 75 percent were white.

More than a quarter of those original participants reported physical abuse in childhood, and one in five reported sexual abuse. And the study identified the link between adverse childhood experiences and poor physical and mental health decades later.

Since that study, an increasing number of states have begun collecting data on ACEs with the Behavioral Risk Factor Surveillance System, the database used by the new study's researchers. All states use the system, and 32 states since 2009 have collected ACEs data.

The CDC tracks the many ACE-related studies published on a website section specifically about ACEs. Studies have linked a greater number of ACEs with greater risk of heart disease, cancer, bone fractures and chronic lung or liver diseases, diabetes and stroke. Those with the most ACEs, four to six or more, tend to have higher rates of mental illness.

Scientists have just begun understanding the social and biological mechanisms that might explain how highly stressful experiences in childhood could translate to greater risks for heart disease or diabetes. One way has to do with the stress response itself: the body produces and releases the hormones cortisol and adrenaline while increasing blood sugar and blood pressure — all of which help with the body's need for fight or flight.

But chronic stress means chronically high levels of these substances, which isn't healthy in the long term. Consistently high blood sugar, for example, increases the risk of diabetes, and high blood pressure is linked to heart disease.

Opportunities for intervention

This new study suggests a need to target prevention resources where they can help most, says Jack Shonkoff, a professor of child health and development at the Harvard T.H. Chan School of Public Health. This also requires identifying what makes some people more susceptible than others to the effects of adversity.

"Nobody is immune to adverse experiences in childhood but for some population groups, they're a larger burden of childhood adversity than others," he says. "We needto focus on targeting limited resources to the people at greatest risk and making sure those resources go into programs that reduce or mitigate adversity."

Doing that will require developing tools to screen for people's sensitivity to adversity, he says. He also notes that ACEs alone don't account for health disparities. Genetics play a key role in health outcomes as well, he explains.

"Environmental risk factors are only part of the story. You can't separate genetics from environment," Shonkoff says.

To address the consequences of childhood adversity, it will be important to develop programs that help children learn healthy coping mechanisms and strengthen families and communities overall, says Andrew Garner, a clinical professor of pediatrics at Case Western Reserve University School of Medicine in Cleveland.

"Our objective is not to put kids in a bubble but teach kids how to deal with adversity in a healthy manner," Garner says. "If parents are in survival mode, their kids are in survival mode too, and they're not going to learn as well and learn coping mechanisms. Those poor coping mechanisms are what we think links adversity to poor health outcomes."

For example, youth who cope by using drugs, alcohol, sex or other risky behaviors are increasing their risk of substance abuse problems, teen pregnancy and sexually transmitted infections, all of which increase risk of other chronic diseases later on.

Garner and Schickedanz both pointed to increasing levels of social isolation documented by other researchers as a substantial likely contributor to the health outcomes linked to ACEs.

"If you look the very highest risk group, it's bisexuals, and we know they may feel isolated. The second highest is multiracial people who may not necessary feel they belong in any particular group," Garner says. "We know from biology that it's really bad to be socially isolated and we're seeing that disparities in adversity are mirrored in health outcomes later on."

But Garner emphasizes that an ACE score is "not destiny." In addition to social programs that address underlying income and racial disparities, it's vital to teach kids resilience.

"Resilience reflects using skills, and the beauty of that is that skills can be learned, taught, modeled, practiced and reinforced, and kids learn better when they're in relationships," he says. "We need to do better job of primary prevention by focusing on emotional learning and promoting safe, stable, nurturing relationships."

Adverse Childhood Experiences and Suicide Attempts

A new study found that adults who had experienced adverse childhood experiences (ACEs) were more likely to have attempted suicide in their lifetime than those who had not experienced ACEs. These findings remained even after accounting for mental and substance use disorders. Researchers used data from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to match people who had attempted suicide with those who had not, based on the presence or absence of nine mental and substance use disorders that are associated with suicide risk. This allowed the researchers to estimate the role that ACEs played in the risk of suicide attempts independent of mental and substance use disorders.

The ACEs included in the study were (1) psychological abuse; (2) physical abuse; (3) sexual abuse; (4) emotional neglect; (5) physical neglect; (6) witnessing violence against a mother or other adult female; (7) substance misuse by a parent or other household member; (8) mental illness, suicide attempt, or suicide death of a parent or other household member; (9) incarceration of a parent or other household member; and (10) parents’ separation or divorce.

Researchers found that:

  • Men who had experienced four or more ACEs and women who had experienced two or more ACEs had significantly increased risk of attempting suicide at least once, compared to members of each sex with no ACEs.
  • Men and women who reported having a parent or relative with mental illness were more likely to have attempted suicide than those who did not.
  • Men who had experienced childhood emotional neglect were more likely to have attempted suicide than those who had not.
  • Men and women who had experienced childhood sexual abuse were more likely to have attempted suicide multiple times compared to those who had not.

The age at which respondents experienced ACEs, and the duration and severity of ACEs, were not measured. For this reason, the researchers cautioned that these results could not prove that ACEs caused the increase in suicide attempts. However, the findings still highlight the need for early detection of ACEs and targeted interventions to prevent future suicide attempts.

Choi, N. G., Dinitto, D. M., Marti, C. N., & Segal, S. P. (2017). Adverse childhood experiences and suicide attempts among those with mental and substance use disorders. Child Abuse & Neglect, 69, 252–262.

Why do ACEs matter?

When an ACE occurs, the child's brain is flooded with adrenaline in what is often called "Fight or Flight". While this reaction helps thr child react to any immediate dangers, it bcomes toxic when turned on for too long.

  • 32x more likiely to have learning or behavior problems in school with 4 or more ACEs
  • This stunted growth can lead to a snowball effect of poor decision making and an inability to process fear appropriately.
  • Brain development is paused to deal with threAts to safety.
  • Respond to daily stresses with hugher anxiety and view them as dangerous

Impact of ACEs

An ACE score of 2: 

  • 3x more likely to attempt suicide
  • 4x more likely to consider themselves an alcoholic
  • Nearly 3x more likely to use illicit drugs

An ACE score of 4:

  • 2x more likely to use tobacco
  • 4x higher risk for Chronic Obstructive Pulmonsry Disease (COPD)
  • 5x more likely to suffer from depression
  • 7x more likely to consider themselves an alcoholic
  • 10x more likely to use illicit drugs
  • 12x more likely to attempt suicide

An ACE score of 6:

  • Died 20 yeears earlier than those without ACEs

The Cost

ACEs cost the econhomy $124 billion over the lifetime of all those affected by ACEs: $83.5 billion in productivity losses and $25 billion spent on health care to combat the effects of ACEs (Editor's note: This probably doesn't include the cost to provide public safety caused by fACE affected peoolle and possibly homelessness, domestic vgiolence, etc.)

Signs your child may be impacted from ACEs

  • Anger management problems
  • Manipulations
  • Lack of motivation

When developmental trauma is present:

  • View humans as threats, not friends
  • Believe bad things happen on purpose
  • Avoid risks at all costs

How can you prevent ACEs from damaging lives?

Give your children positive life experiences and work with them to develop healthy self-regulation.

Undersanding of what is in their control
Working towards goals
Cresting effective problem solving skills
Empathizing with others

Read and talk with your teen
Create a community of loving people for your child to interact with
Provide good nutrition and the right amount of sleep
Listen to your child's needs
Discuss collaboration and compromising
Direct themaway from yelling and aggressive behavior
Avoid exposure to violence in media, community and at home.


Resources to Strengthen Communities and Promote Systemic Change

Community Development

The resources in this section focus on the development of community-wide systems to prevent and mitigate the impact of adverse childhood experiences and toxic stress.


This section includes resources which could be used by individuals, groups or entire communities to inform political leaders, legislators, and the legislative process around issues related to adverse childhood experiences (ACEs) and toxic stress.


This section includes links to professional and social networks with a focus on the topics of adverse childhood experiences (ACEs), toxic stress, resiliency, and other related components of this work.

Cultural Awareness

This section includes resources that acknowledge cultural groups and highlight the need for cultural sensitivity when working with diverse groups or communities on topics related to adverse childhood experiences (ACEs) and toxic stress.

Social Determinants of Health

The links in this section describe the influence of social factors such as poverty, race and socioeconomics, on health equity and lifelong health outcomes.

Trauma Informed Care

The links in this section describe the framework of Trauma Informed Care, which calls for a cultural shift that can be applied in any setting. Trauma Informed Care is not a specific intervention or a clinical response. Rather, it highlights the need for a broader understanding of the impact trauma has on everyone.

Trauma-Informed Interventions

This section includes links to examples of specific interventions created through a trauma-informed lens.


How are ACEs Relevant to Me?

ACEs are relevant to individuals, family and community members, and people in a variety of different occupations and roles.

People Who Have Experienced ACEs

People who have experienced ACEs should be aware of their effects so they can seek appropriate health care when needed. They can also get professional and social support to improve their lives and avoid allowing ACEs to impact their children, families, and futures. Some ACE survivors find they understand themselves better after learning about ACEs and considering their own experiences.

Healthcare Providers

Healthcare providers of all types including traditional practitioners, physicians, nurse practitioners, midwives, nurses, and others-should understand ACEs and their impacts on physical and mental health. This information can help them understand and help their patients efficiently and make appropriate referrals and screenings.

Social Workers and Community Health Workers

Social workers and community health workers can use ACE knowledge to better help their clients, screening for ACEs when appropriate and providing support and referrals. ACEs can also help explain ongoing client challenges, trauma, behavioral challenges, and repeating cycles of violence.

Teachers and Others Working with Children

Teachers and others who work with children are sometimes the first and only individuals outside of a family to recognize when children are currently experiencing ACEs. They can provide initial support and referrals to help the children and their families. Understanding ACEs can also help teachers and others better understand their children's challenges, behaviors, and needs.

Family and Community Members

People who have family members, friends, community members, or coworkers who have experienced ACEs can offer support and help address needs. Sometimes, they can be the first to identify that someone is having problems or needs help. Understanding ACEs can also help people become more patient, offer support and assistance, and prevent further damage.

Tribal Leaders

Tribal leaders should know about ACEs to help understand and support their communities and include ACEs in decision making.

Policy Makers

Policy makers and related experts should understand ACEs to allocate funding to address these needs.

Law Enforcement

Law enforcement staff and others in related roles can use ACE knowledge to efficiently serve their communities. Understanding challenges can help them recognize and address special needs and prioritize support to physical and mental health care services and rehabilitation.


Everyone should know about ACEs! Their impact on individuals and on our communities is important.

Childhood Abuse Leaves 'Devastating Impact' on Adults — Sicker, poorer, less educated, and likely to die sooner

Abuse in childhood can set up a row of falling dominoes that increases the risks of mental and physical health issues, legal troubles, and even early death, according to two large longitudinal studies.

A study on long-term health outcomes found that children abused before age 5 are two to three times more likely to experience negative health outcomes as young adults, particularly when the abuser is a loved and trusted person, said Jennifer Lansford, PhD, of Duke University in Durham, North Carolina, and colleagues.

The second study found that adults maltreated as children were up to five times more likely to die by age 33. These deaths were largely due to self-harming behaviors such as poisonings, alcohol and/or other substances, and suicide, said Leonie Segal, PhD, of the University of South Australia in Adelaide, and colleagues.

The studies were simultaneously published in Pediatrics.

"These results demand our attention," Segal said. "We must ask, what are we doing or failing to do in supporting children exposed to child abuse or profound neglect and their distressed families? How can we do better, from early childhood, to stop this progression to an untimely death?"

"This speaks to the importance of early intervention by pediatricians, teachers, adults, and society in general, talking about nonviolent forms of discipline and providing support for parents," especially during the COVID-19 pandemic, when families are under enormous logistical and financial stress, noted Lansford in an interview with MedPage Today.

"This is one reason why calls to Child Protective Services [CPS] and domestic violence hotlines have increased so much," she added. "Family violence is also associated with more stressful life experiences. The need for social safety nets to both prevent and treat violence against children is crucial."

Lansford and co-authors examined early adulthood outcomes of 1,048 participants followed from kindergarten to adulthood in two multisite studies. In an interview during kindergarten, the children's caretakers were asked about responses to the child's problem behaviors. The participants were interviewed annually until age 20, and sporadically thereafter.

Of the combined cohort, the mean age was about 6 years at study entry; 33% were Black and 66% were white. About a third lived in single-parent homes; 18% of the mothers hadn't completed high school at the time of enrollment. Participants were about 25 years old at their last assessment.

Outcome measures included any physical signs of abuse, as well as family financial issues, legal issues, or conflict within the family; a move or major home remodeling; separation or divorce; and parent-child separation.

Of the cohort, 93 had been abused or suffered a major stressor from ages 1 to 5 years. However, Lansford noted that abusive caretakers don't always admit the problem, so these numbers are probably an underestimation.

The researchers found that more young adults with early abuse or severe stressors had received special education services (RR 3.2) and repeated a grade (RR 2.14). Just 13.6% had a 4-year college degree compared with about 30% of those who did not experience abuse, but this was not a statistically significant difference after controlling for numerous confounding factors.

Additionally, they had double the odds of receiving any kind of public assistance (19.5% vs 9.8%) and significantly worse physical health (self-report index 0.74 vs 0.81). Risky sexual behavior wasn't significantly different.

They also had numerically more convictions for drug use (19.6% vs 10.3%), public or private order offenses (33.3% vs 23%), and violent crime (26.7% vs 16%), and more than twice the chance of being convicted in the last 12 months (18% vs 7%).

The mechanisms behind these increased risks aren't entirely clear, Lansford said. "There is evidence that physical abuse changes brain structure at this critical time of maturation. It surely causes relationship issues and disrupts a child's ability to trust and feel secure. Children become hypersensitive to hostile cues and more likely to interpret ambiguous information as hostile. In the long term, this change can make them hypervigilant and more aggressive."

Other researchers have been looking at markers of cellular aging in abused children. Among the findings: maltreatment and other adverse childhood experiences sufficiently predicted shortened telomere length and DNA methylation.

The study by Segal and team comprised all people born in South Australia from 1986-2003 and included in linked databases (N=331,254). Contact with CPS was considered a proxy for childhood exposure to violence. The number of deaths by age 33 was the main outcome measure. The study adjusted for child and maternal characteristics.

In all, 20% of the cohort had some CPS contact by age 16; only 2% had been placed in out-of-home care (OOHC).

Those with CPS contact were more than twice as likely to die by age 33 (HR 2.09). Those placed in OOHC were 4.67 times more likely to die, although placement before age 3 somewhat mitigated this risk (HR 1.75).

Several causes of death were significantly higher in the CPS-exposed group compared with the control group. These included deaths from poisonings, alcohol and/or other substances, and mental health problems (RR 4.8), as well as suicide (RR 2.8). Natural deaths were also significantly higher (RR 1.99).

By age 33, overall mortality in the CPS-exposed group was 30.9 per 1,000 compared with 5.1 per 1,000 in in the non-exposed group. Individuals with confirmed maltreatment exposure in childhood had considerably higher mortality (13.7 per 1,000).

"The strength of association was highest in categories indicating more serious maltreatment exposure, supporting the relationship as causal, when taken together with well-described mechanisms linking [child maltreatment] to disturbed emotional and behavioral responses, a high sense of shame and low impulse control, risk factors for substance use, and suicide," the authors wrote.

"Child maltreatment exerts a devastating impact in terms of increased risk of death. I think these findings are especially pertinent now, given the considerable increased stresses on families associated with the COVID-19 pandemic, which will undoubtedly increase the exposure of children to serious child abuse and neglect. We need to act now to avoid these potential disastrous consequences in adolescence and adulthood," said Segal.