Childhood is a powerful time of growth and development. Experiences from our youth - both the beautiful and challenging - shape the adults we become. While we wish only the best for children, smaller obstacles can promote resilience and strength. Much more challenging experiences, however, can have health impacts and long-term effects for children. Often called “ACEs,” or Adverse Childhood Experiences, these events are quite common and impact many adults today in the form of health complications and toxic stress. It is important for the health and wellbeing of society to address ACEs, both their sources in order to decrease the frequency of ACEs and their outcomes in order to support people in coping with their ACEs.
What are ACEs?
ACEs stands for Adverse Childhood Experiences. ACEs are certain experiences that significantly disrupt a child’s wellbeing and development. The term was coined by researchers Vincent Felitti, Robert Anda, and their colleagues in their landmark study conducted from 1995 to 1997. This study gave surveys to collect a person’s “ACE score,” or the total number of ACEs they had experienced growing up. The study found that the higher number of ACEs reported, the worse their physical and mental health outcomes.
This original study asked about seven categories of adversities, which since then, have been slightly adjusted or added to. A commonly used list of ACEs, used by the CDC-Kaiser Permanente ACE Study and encompassing all of the original ACEs, uses the following ten categories:
Abuse: emotional abuse, physical abuse, sexual abuse
Household challenges: incarcerated household member, parental separation or divorce, mental illness in the household, substance abuse in the household, witnessing violence in the household
Neglect: emotional neglect, physical neglect
Additional adversities include: bullying, community violence, natural disasters, refugee or wartime experiences, witnessing or experiencing acts of terrorism
What is the difference between ACEs and trauma?
It is important to note the difference between ACEs and trauma. ACEs encompass various types of adversity, or experiences in a child’s life. These experiences can fit into these clear ACE categories, but each individual child’s response to an adversity may vary. Trauma is just one potential response to adversity; it is when a child perceives this adversity as extremely harmful or threatening.
For example, two children may experience the same adversity, but one may recover relatively quickly, while the other may feel deep and lasting trauma. For example, let’s say that both Mateo and Penelope lived in a house in which a parent struggled with mental illness. Mateo could feel very much affected by this and develop lasting trauma, manifested in separation anxiety and a lack of trust in others. Penelope, on the other hand, could experience this adversity differently and with less perceived trauma; she could go on to still form secure attachments and trusting relationships, regardless of her ACE. This difference in response is normal, as every child has such different individual, family, and environmental factors that influence their responses to adversity. This idea is similarly shown in Post Traumatic Stress Disorder (PTSD). While a group of people may experience the same life-threatening event, not every person will necessarily develop PTSD, as they all have many different life factors that will affect their perception of the experience and their journey after the experience. The same goes for children experiencing ACEs; some may experience trauma from an ACE and others may not. It is important to note, though, that certain adversities (such as a sudden loss in the family or physical abuse) are much more likely to cause trauma in children, while others (such as parental separation or divorce) may have a much wider range of responses from children.
Trauma can have a serious impact on a child’s development, so parents and educators should know the signs of a child experiencing trauma, which vary greatly depending on a child’s age, support systems, and history. The Center for Early Childhood Mental Health Institute has an extensive list of possible signs including the following: eating or sleeping disturbances, separation anxiety, language delay, aggressive or sexualized behavior, and general fearfulness. These symptoms could all of course be unrelated to trauma, so one should always look at a child’s behavior with the larger context of a child’s life.
How common are ACEs?
According to the Center for Disease Control and Prevention (CDC), ACEs are very common. The CDC reports that around 61% of adults have experienced at least one ACE, and nearly one in six adults have experienced four or more ACEs. The CDC additionally reports that racial minority groups and women are at a greater risk of experiencing ACEs. Below is a screenshot from the CDC-Kaiser findings, but you can see even more visuals of the breakdown here.
What are the effects of ACEs?
Adverse Childhood Experiences have lasting effects on health and opportunities. ACEs are linked to many health outcomes including heart disease, cancer, obesity, stroke, and mental illness. Many of the conditions associated with ACEs (frequent moves, food insecurity, under-resourced neighborhoods) can cause extended or prolonged stress, often called Toxic Stress. Children developing under Toxic Stress may have difficulties forming healthy relationships and will likely experience negative health outcomes. Toxic Stress can remain until adulthood and even be passed on to children. Many children experience Toxic Stress from both ongoing and historical trauma, which is how systemic racism or poverty can affect health and opportunities for generations.
How can we reduce the effects of ACEs?
The CDC recommends six main strategies for reducing the effects of ACEs.
Strengthen economic supports to families
Promote social norms that protect against violence and adversity (like “public education campaigns” or “legislative approaches to reduce corporal punishment”)
Ensure a strong start for children (like quality childcare and preschool)
Teach skills
Connecting youth to caring adults and activities
Intervene to lessen immediate and long-term harms
And along with all these strategies for reducing ACE effects, the CDC does clarify that the best strategy is to reduce the sources of ACEs. We can volunteer our time and resources to protect our network from trauma, and we can work on a larger scale to support programs and organizations that work to meet the needs of all families and children, particularly those that are at higher risk of ACEs in our society.
How does Social Emotional Learning alleviate the effects of ACEs?
As a part of the “Teach skills” strategy, the CDC specifically recommends social emotional learning (SEL), along with healthy relationship programs and parenting skills. We know that ACEs often have lasting impacts that affect relationships and emotions. Children exposed to adversity or experiencing trauma may have learned to perceive certain situations as dangerous, and rightfully respond to triggers with fear or anger without understanding why. Children may internalize troubling feelings, making healthy emotion management challenging. Teaching SEL skills can help children cope with their experiences and overcome potential negative effects of ACEs. By creating safe spaces to learn about feelings and communication, adults can support children’s development after experiencing an ACE.
We at Better Kids truly believe in our SEL program for children, knowing that it can have profound impacts on early childhood classrooms and in the homes of families. By incorporating SEL-focused instruction and practices, adults can create safe spaces for children to learn about feelings and communication, which is helpful for all children, but especially for those who have experienced trauma. Additionally, our resources for guardians work to support positive childhood development; they support parents with topics like grieving, anxiety, mindfulness and patience (just to name a few). Programs that help children understand their feelings and communicate healthily with others can work to alleviate the effects of ACEs.
As we have learned, Adverse Childhood Experiences are very common. While ACEs are linked to negative health or opportunity outcomes, it is important to remember that ACEs do not equate with “broken.” Based on statistics alone, it is likely that most of our readers have experienced at least one ACE, if not more. No matter the number of ACEs, no one is broken because of them; we can heal and learn to cope with the potentially lifelong effects of ACEs. That being said, we can each do our part to support organizations and policies that will reduce the number of ACEs that today’s children face, so that fewer adults will have to experience these adversities.
To end this post, we would like to remind our readers to care for yourself and your loved ones. Be gentle with yourself in your healing.
If you would like to learn more, consider reading the following books on childhood adversities and trauma:
Fostering Resilient Learners: Strategies for Creating a Trauma-Sensitive Classroom, by Kristin Souers and Peter A. Hall
Relationship, Responsibility, and Regulation: Trauma-Invested Practices for Fostering Resilient Learners, by Kristin Souers and Peter A. Hall
Building Trauma-Sensitive Schools, by Jen Alexander
The Boy Who Was Raised As a Dog, by Bruce Perry
Distressed or Deliberately Defiant, by Judith Howard
What happened to you? Conversations on Trauma, Resilience, and Healing by Oprah Winfrey and Bruce Perry
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, by Bessel van der Kolk
A prior version of this article was originally published on August 17, 2020.
