Children don’t always get the best start in life. Many experience adverse childhood experiences (ACEs).

The ACE concept has been around since the 1980s. Kaiser Permanente’s Vincent Felitti developed it after observing a connection between childhood trauma and obesity at his San Diego clinic in California. Since then, other mental health professionals have contributed significantly to research in this area. The ACE framework is now a canonical tool in psychological and clinical work.

This post will discuss the nature of adverse childhood experiences, how they relate to toxic stress, and what people can do to mitigate their effects later in life.

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What are adverse childhood experiences?

Adverse childhood experiences refer to a spectrum of adverse events researchers believe are detrimental to the developing child’s brain. These include:

  • Physical and emotional abuse
  • General neglect
  • Witnessing abuse

Physical abuse includes being kicked, punched, or spanked with implements. It could also involve sexual abuse by caregivers, family members, or strangers outside the home. Emotional abuse includes bullying, unfair treatment, or constantly being put down. Parents, caregivers, teachers, family friends, and strangers are all potential perpetrators. Neglect is also harmful to developing children and an ACE. Parents may fail to provide enough food, clean clothes, or emotional support. Kids may feel unloved by caregivers who don’t seem interested in them.

Witnessing violence is also an ACE. Children may see abuse in the home or community or experience a family member dying by suicide. Coming into contact with substance abuse and mental health problems or seeing the instability of the parental relationship also counts as an ACE.

ACEs can occur to anyone under the age of 18, according to the CDC. Definitions used to be narrow, but the National Scientific Council on the Developing Child expanded them considerably in the early 2000s, pointing out that children can have adverse experiences even without direct threats.

Poverty and endemic racism became additional factors bundled into “community” and “systemic” causes. The council argued children’s brains don’t distinguish between direct and indirect threats in their environment – they either see them or don’t.

How many people experience ACEs?

According to studies reported by the CDC, adverse childhood experiences affect most U.S. adults. Figures show 61 percent of people had at least one ACE before 18, while one in six said they had more than four ACEs, as measured by a standard profiling test.

How do ACEs relate to stress?

Psychologists believe ACEs in childhood cause adverse health outcomes later in life. Early negative experiences seem to reprogram the developing nervous system, making children more prone to disease as they age.

According to research, stress is a significant mediator of this effect. “Toxic stress,” or stress that doesn’t relate to dealing with an imminent life situation, over-activates the developing child’s nervous system. The fight-or-flight system becomes hyperactive and can’t switch off, even when no danger exists. This hyperactivity can then damage other body parts, including metabolism, the cardiovascular system, and the immune system. Obesity and chronic disease find it easier to get a foothold. Most children experience negative experiences as they grow up. However, trauma is short-lived. Caring adults are close by to provide reassurance, support, and affection.

That’s not the case for ACE children. These individuals don’t have the supportive relationships to take on life’s challenges healthily. Consequently, their stress response can become elevated, causing lasting damage to their health.

ACEs, for instance, can increase the risk of:

  • Sexually-transmitted infections
  • Pregnancy complications and fetal death
  • Cancer
  • Diabetes
  • Heart disease
  • Suicide
  • Involvement in sex trafficking
  • Injury

Some elevated risks relate directly to the effect of chronic, life-long stress on the human body. However, others related to dysfunctional behavior that is more likely to arise in response to an adverse experience. For instance, people with ACEs in their history may adopt unhealthy coping behaviors to reduce their stress. These might include over-eating, under-eating, engaging in sexually risky behavior, or using substances. It might also involve seeking closer relationships outside the family context, which may also be dysfunctional.

ACEs can also have adverse effects on a person’s social life. For instance, they may find it more challenging to form healthy, stable adult relationships. They may have trouble holding a job or dealing with emotionally challenging situations. ACEs can also reverberate down the generations. Adult parent with a history of ACEs may unconsciously or consciously communicate their stress to their children, who then have ACEs. Parents do not need to be abusive for this to happen.

How can society, schools, and families reduce ACEs?

Fortunately, there are several strategies society and individuals can adopt to reduce the incidence of ACE and limit dysfunction in the upcoming generation. These include:

  • Strengthening families by enhancing financial security and putting family-friendly policies in place at work
  • Intervening quickly to prevent long-term harm by treating problem behavior at the source and reducing substance use in families
  • Bringing young people into contact with adults who care about their well-being at clubs or through after-school programs
  • Teaching children skills to help them cope better with life’s adversities and challenges they may face in the future, such as dating safely
  • Educating parents on the psychological value of treating children with gentleness and kindness and eliminating the use of corporal punishment
  • Helping children get the best possible start in life with quality childcare and preschool enrichment programs that include family members

Simply raising awareness of ACEs can have profoundly beneficial effects on individuals and the community. For instance, discussing the issues teaches people the consequences of trauma on the developing mind and how they can prevent it. It also shifts the focus away from the individual and onto the community as a whole.

Stigma may also be reduced. Once the community understands why people become suicidal or depressed, it may be easier to accommodate these conditions.

How to reduce the effects of ACEs

Unfortunately, prevention cannot eliminate all ACEs. Therefore, society and medical professionals must implement strategies to manage them.

Talk therapy and counseling

Talk therapy is one of the most effective ways to deal with ACEs and help affected individuals lead happier, more functional lives. Sessions with trained therapists and psychologists make it easier for patients to understand what happened to them and how to process it. A better knowledge of ACE’s context and emotional landscape can bring relief and even liberation.


Screening is another excellent approach for dealing with ACEs. Many patients live in the shadow of adverse childhood experiences without recognizing them as the source of their mental and physical health issues. Screening is helpful because it gives an understanding of their state of mind and information they can share with mental health professionals.

According to the CDC, the more adverse childhood experiences a person has, the more likely they are to experience negative health effects. Therefore, screening could be a preventative measure, identifying individuals most likely to develop dangerous chronic diseases in the future.

Trauma-informed care

Trauma-informed care is another popular approach for managing the aftermath of ACEs. This approach affects how practitioners across medical fields interact with known ACE cases. Doctors, nurses, and mental health professionals use this approach to interact with patients more sensitively.

Trauma and ACEs closely relate to each other. Trauma is the response that occurs after a terrifying situation of significant adversity. It is like scar tissue in the developing brain, trying to protect the person underneath.

Trauma-informed care recognizes that trauma is at the heart of the patient’s dysfunctional behavior. Therefore, it avoids treating them as wilful, punishable actions.

Improve social context

Lastly, poverty, malnutrition, substance abuse, unemployment, and isolation can all exacerbate the effects of ACEs. Therefore, improving the social context may help.

Communities may wish to try the following:

  • Building more responsive relationships with vulnerable people
  • Teaching victims of ACE critical life skills that can improve their long-term wellbeing
  • Practicing stress control at the group level
  • Reducing the incidence of illegal and legal substance abuse in the community.


ACEs have a tremendous impact on society. Children who grow up in abusive or neglectful environments can go on to develop physical diseases, mental health problems, and social challenges.

The best approach is prevention. Communities that can stop ACEs from occurring are most likely to thrive. Failing that, other interventions include screening, providing support to vulnerable individuals, and offering comprehensive talk therapy support. Raising awareness of ACEs and including them in the cultural zeitgeist may also help. Once people understand the roots of dysfunction, they are more likely to address them.