Adverse Childhood Experiences


Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur during childhood (0-17 years). Approximately 72 percent of children in the United States will have experienced at least one major stressful event—such as witnessing violence, experiencing emotional, physical or sexual abuse, or the loss of a loved one—before the age of 18. In 2019, the CDC found that at least five of the top 10 leading causes of death, including respiratory and heart disease, cancer, and suicide, are associated with ACEs. Multiracial children have a significantly higher cumulative ACE score (2.39) than all other races/ethnicities, and females are more at risk than males of experiencing an ACE.


There are three broad categorizations of ACEs: abuse, neglect, and household dysfunction. These often follow an intergenerational pattern; children who experience abuse, for example, may be more likely to commit violence or to be revictimized in the future. As decades of research depict, ACEs are associated with development of chronic diseases and behavioral challenges, changes to DNA expression, obesity, autoimmune disease, depression, and alcoholism. The greater the number of ACEs experienced, the greater the risk for negative health outcomes. 


ACEs threaten health by causing chronically high levels of toxic stress, a prolonged or excessive activation of the stress response system that can damage the body and brain, particularly in children. Multiple ACEs, particularly without support, can affect the nervous, endocrine and immune systems and worsen attention, behavior, decision-making and response to stress throughout a child’s lifetime. ACEs increase the risk of of injury, sexually transmitted infections, including HIV, mental health problems, maternal and child health problems, teen pregnancy, involvement in sex trafficking, unemployed and reduced earnings in adult life.


Domino effect of having an Adverse Childhood Experience (ACE) 


Experiencing adversity during childhood is highly personal and specific to every family’s socioeconomic, cultural, behavioral, and emotional conditions, but environmental risk factors like violence and crime, environmental hazards, and racism can also contribute to toxic stress. A large national study on ACEs found that ​​people with low-income and low educational attainment, people of color, and people who identified as gay, lesbian or bisexual had significantly higher chance of having experienced adversity in childhood.


Many schools lack health centers for primary care, and even fewer have mental health services or referral programs for substance abuse treatment or social services. Service providers often operate independently, causing fragmented care for students and families who need it the most. School-based integrated systems of care that involve parents and caregivers, particularly for uninsured families, can identify at-risk students and connect them to resources like community liaison, social services, and treatment options.


While not all ACEs are preventable, there are protective factors which can mitigate long-term negative impacts. These include strong family bonds, nurturing relationships, a sense of community, positive parenting skills, and integrating trauma-informed care in schools and child care centers to foster resilience. By reducing the daily stress and fulfilling basic needs with economic and social support, the physical effects of ACEs can be minimized.


Evidence shows that the following strategies are effective in preventing ACEs from happening in the first place: 


  • Strengthening economic supports for families

  • Promoting social norms that protect against violence and adversity

  • Ensuring a strong start for children and paving the way for them to reach their full potential

  • Teaching skills to help parents and youth handle stress, manage emotions, and tackle everyday challenges

  • Connecting youth to caring adults and activities

  • Intervening to lessen immediate and long-term harms


In practice, this could mean implementing paid family leave and Child Tax Credits, increased bystander training, childhood home visitation programs, more funding for afterschool programs, and family-centered treatment for substance abuse. Since January 2019, at least 26 states have enacted or adopted legislation to address childhood trauma, child adversity, toxic stress or ACEs specifically. New York, for example, passed a bill that requires ACEs training for all daycare providers, with a focus on understanding trauma and fostering resiliency. California implemented the first statewide effort to screen for childhood trauma through the ACEs Aware initiative, which develops, promotes, and sustains evidence-based methods to screen patients for ACEs and create treatment plans to help patients heal.


There is a wide spectrum of approaches to preventing ACEs and mitigating their effects, including at the local level. Programs like Green Dot and Coaching Boys into Men are effective in reducing violence against partners, negative bystander behaviors like laughing at sexist jokes or encouraging abuse, and sexual violence perpetration and victimization. Home visitation models reduce child abuse and neglect and are effective in lowering children’s rates of substance use, teen pregnancy, and reliance on welfare. There are countless organizations and nonprofits preventing ACEs through mentoring and afterschool programs, like the Boys & Girls Club and YMCA, which can improve socioemotional learning, reduce absenteeism, improve school performance, and strengthen cultural identity and values and children’s ability to develop healthy relationships with peers and adults.


The economic and social costs of ACEs to families, communities, and society totals hundreds of billions of dollars each year, further reinforcing the need to treat childhood adversity like other public health issues. Investing in the nation’s youth by improving access to high-quality childcare, bolstering family socioeconomic safety nets, and emphasizing the need for mental health services and afterschool programs will help prevent ACEs and build healthier futures for all children.


Resources & Tools


Illustration of six people standing side-by-side, each with a different color shirt (red, orange, yellow, green, blue, purple) and their pronouns written across their chest.
Beyond Inclusion: Pronoun Use for Health and Well-Being
Story - Original
Brought to you by Community Commons
Graphic depicting key elements of the Health Impact Assessment Report entitled Grade Retention:  A Case Study in Cincinnati Public Schools which includes icons related to the following: education; children and youth; Urban; Quantitative research; lifelong learning
Grade Retention: A Case Study in Cincinnati Public Schools
Resource - Assessment
Brought to you by Health Impact Project
Published on 03/01/2013
Screen capture of BRFSS image: Behavioral Risk Factor Surveillance System ACE Data
Behavioral Risk Factor Surveillance System ACE Data
Resource - Data Bank/repository
PDF Cover: Adverse Childhood Experiences: The Protective and Therapeutic Potential of Nature
Adverse Childhood Experiences: The Protective and Therapeutic Potential of Nature
Resource - Journal Article
Brought to you by Frontiers
Screen capture of article photo: PACEs Connection Resource Center
PACEs Connection Resource Center
Resource - Guide/handbook
PDF Cover: Conversation Guide: Social, Emotional, and Spiritual Renewal for Youth
Conversation Guide: Social, Emotional, and Spiritual Renewal for Youth
Resource - Guide/handbook
Brought to you by Living Room Conversations
youth skateboarding Photo by Daria Tumanova on Unsplash
Bright Spot: Seeking Safety for Adolescents
Resource - Model Policy
Brought to you by 100MHL
Graphic depicting key elements of the Health Impact Assessment Report entitled Muskegon County Jail which includes icons related to the following: Incarceration; ; ; ; basic needs for health and safety
Muskegon County Jail
Resource - Assessment
Brought to you by Health Impact Project
Published on 01/11/2019
Graphic depicting key elements of the Health Impact Assessment Report entitled The Long Road Home: Decreasing Barriers to Public Housing for People With Criminal Records which includes icons related to the following: housing; justice-involved populations; Urban; Qualitative research; humane housing
The Long Road Home: Decreasing Barriers to Public Housing for People With Criminal Records
Resource - Assessment
Brought to you by Health Impact Project
Published on 04/30/2016
Screen capture of Lifelong Health
Lifelong Health
Resource - Website/webpage
Brought to you by Harvard University
Graphic depicting key elements of the Health Impact Assessment Report entitled Eugene-Springfield Consolidated Plan and the Impact of Housing on Children�s Health which includes icons related to the following: affordable housing; children and youth; Urban; Qualitative research; humane housing
Eugene-Springfield Consolidated Plan and the Impact of Housing on Children's Health
Resource - Assessment
Brought to you by Health Impact Project
Published on 07/31/2014
Graphic depicting key elements of the Health Impact Assessment Report entitled Restorative Justice in San Diego which includes icons related to the following: Incarceration; justice-involved populations; Urban; Primary research; basic needs for health and safety
Restorative Justice in San Diego
Resource - Assessment
Brought to you by Health Impact Project
Published on 09/30/2016
Graphic depicting key elements of the Health Impact Assessment Report entitled Boston Living Wage Ordinance which includes icons related to the following: meaningful work and wealth; people living in poverty; Urban; Mixed methods; meaningful work and wealth
Boston Living Wage Ordinance
Resource - Assessment
Brought to you by Health Impact Project
Published on 05/02/2016
Cover page of Strategy Report for the Task Force on Trauma-Informed Care 2020
Strategy Report for the Task Force on Trauma-Informed Care 2020
Resource - Report
Brought to you by OCCY
Cover page of The Long Road Home: Decreasing Barriers to Public Housing for People With Criminal Records
The Long Road Home: Decreasing Barriers to Public Housing for People With Criminal Records
Resource - Assessment
Brought to you by Ella Baker Center for Human Rights
Graphic depicting key elements of the Health Impact Assessment Report entitled Marijuana Policies Related to Child Abuse and Neglect in the State of Colorado which includes icons related to the following: substance use; children and youth; Primary research; basic needs for health and safety
Marijuana Policies Related to Child Abuse and Neglect in the State of Colorado
Resource - Assessment
Brought to you by Health Impact Project
Published on 10/31/2016
Graphic depicting key elements of the Health Impact Assessment Report entitled Family Responsibility Statements in Judicial Decisions which includes icons related to the following: Incarceration; justice-involved populations; Urban; Focus groups; basic needs for health and safety
Family Responsibility Statements in Judicial Decisions
Resource - Assessment
Brought to you by Health Impact Project
Cover page of Pathways to High-Quality Jobs for Young Adults report
Pathways to High-Quality Jobs for Young Adults
Resource - Report
Brought to you by Brookings
Children playing tug-of-war
Bright Spot: Project STRIVE
Resource - Model Policy
Brought to you by 100MHL
Graphic depicting key elements of the Health Impact Assessment Report entitled Massachusetts Proposed Expungement Bill which includes icons related to the following: adverse childhood experiences; justice-involved populations; Survey; basic needs for health and safety
Massachusetts Proposed Expungement Bill
Resource - Assessment
Brought to you by Health Impact Project
Published on 06/30/2016
Graphic depicting key elements of the Health Impact Assessment Report entitled California Proposition 47: The Safe Neighborhoods and Schools Act which includes icons related to the following: neighborhood safety; justice-involved populations; Focus groups; basic needs for health and safety
California Proposition 47: The Safe Neighborhoods and Schools Act
Resource - Assessment
Brought to you by Health Impact Project
Published on 09/03/2014
PDF Cover: Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences,  Toxic Stress, and Health
Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health
Resource - Report
Brought to you by Office of the Surgeon General of the United States
Graphic depicting key elements of the Health Impact Assessment Report entitled Colorado Statewide Regulatory Structure for Retail Marijuana which includes icons related to the following: substance use; children and youth; Suburban; Primary research; basic needs for health and safety
Colorado Statewide Regulatory Structure for Retail Marijuana
Resource - Assessment
Brought to you by Health Impact Project
Screen capture of Strengthening Families Program website
Strengthening Families Program
Resource - Website/webpage
Graphic depicting key elements of the Health Impact Assessment Report entitled Southeast Kansas Casino which includes icons related to the following: meaningful work and wealth; Rural; Primary research; meaningful work and wealth
Southeast Kansas Casino
Resource - Assessment
Brought to you by Health Impact Project
Graphic depicting key elements of the Health Impact Assessment Report entitled Massachusetts Community Investment Tax Credit Grant Program which includes icons related to the following: complete communities; people living in poverty; Mixed methods;
Massachusetts Community Investment Tax Credit Grant Program
Resource - Assessment
Brought to you by Health Impact Project
Published on 08/31/2014
First page of Climate Change is a Threat Multiplier for Violence Against Children. article
Climate Change is a Threat Multiplier for Violence Against Children
Resource - Journal Article
Brought to you by Elsevier, Inc.
Adverse Childhood Life Opportunities Cover
Adverse Childhood Experiences and Life Opportunities: Shifting the Narrative
Resource - Journal Article
Brought to you by CDC
Graphic depicting key elements of the Health Impact Assessment Report entitled Full-Day Kindergarten which includes icons related to the following: education; children and youth; Mixed methods; lifelong learning
Full-Day Kindergarten
Resource - Assessment
Brought to you by Health Impact Project
Published on 05/31/2015
Graphic depicting key elements of the Health Impact Assessment Report entitled Revitalization in Historic Natchez, Mississippi which includes icons related to the following: belonging and civic muscle; black, indigenous, and people of color; Mixed methods; belonging and civic muscle
Revitalization in Historic Natchez, Mississippi
Resource - Assessment
Brought to you by Health Impact Project
Screen capture of Neighborhood Adversity, Child Health, and the Role for Community Development
Neighborhood Adversity, Child Health, and the Role for Community Development
Resource - Journal Article
Brought to you by American Academy of Pediatrics
Screen shot of top of webpage: Firearms and Suicide Prevention
Firearms and Suicide Prevention
Resource - Website/webpage
Screen capture of adult hands holding child's hands holding a plant
The National Child Trauma Stress Network
Resource - Website/webpage
Screen capture of Behavioral Risk Factor Surveillance System webpage
Behavioral Risk Factor Surveillance System
Resource - Website/webpage
Brought to you by CDC
Graphic depicting key elements of the Health Impact Assessment Report entitled Hartford Neighborhood Revitalization and Sustainability Plan which includes icons related to the following: neighborhood safety; urban communities; Urban; Primary research; basic needs for health and safety
Hartford Neighborhood Revitalization and Sustainability Plan
Resource - Assessment
Brought to you by Health Impact Project
Screenshot of The Impact of Childhood Adversity on Health and COVID-19
The Impact of Childhood Adversity on Health and COVID-19
Resource - Blog
Brought to you by ACPM
Screen capture of Why Strong Afterschool Programs Matter article
Why Strong Afterschool Programs Matter
Resource - Blog
Brought to you by WaPo
Post Traumatic Stress Disorder in Young Men of Color
Story - Written
Brought to you by Community Commons
Photo of a mother holding two young children
For The Babies Of The Opioid Crisis, The Best Care May Be Mom’s Recovery
Story - Original
Brought to you by Community Commons
Published on 05/15/2018
Screen capture of article photo: The Silence: The Legacy of Childhood Trauma
The Silence: The Legacy of Childhood Trauma
Story - Written
Brought to you by TNY
Creating Safer Communities: Lessons on Violence Prevention
Story - Written
Brought to you by Community Commons
Photo of person with dark skin, a blue shirt, and jeans using an at-home blood pressure monitor
Hypertension, Race, and Ethnicity: Decreasing the Disparities
Story - Original
Brought to you by Community Commons
Photo of a dirty, worn stuffed animal, likely Winnie the Pooh
Adverse Childhood Experiences – Trauma in Children Across the Nation
Story - Original
Brought to you by Community Commons
Published on 12/19/2017
Photo of an unhappy young boy looking at a laptop. On the right, emojis and random text are floating in the air.
Youth, Young Adults, and Digital Abuse
Story - Original
Brought to you by Community Commons

Data & Metrics


Collage of images of LGBTQ+ people with transparent overlays in progress pride flag colors. At the top, bold white text on a charcoal background reads
LGBTQ+ Health Equity Library
Library
Published on 03/01/2022
Collage of images of Black, Indigenous, and People of Color with teal, olive green, golden yellow, and burnt orange transparent overlays. Bold white text on charcoal background at the top reads
BIPOC Health Equity Library
Library
Published on 09/27/2022
Banner graphic reads
Accessibility and Disability Equity Library
Library
Published on 09/01/2022

 Related Topics


Card image
Substance Use

Card image
LGBTQ+ Youth

Card image
Children and Youth

Card image
Eating Disorders

Card image
Early Childhood Education

Card image
Youth Mental Health

Card image
Mental and Behavioral Health