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.

What are 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 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).

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.



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.

The 10 types of trauma on the ACE test are:

Household substance abuse | Parental separation/divorce | Family member with a mental illness | Violence between parents/abuse of mother | Incarcerated household member | Psychological/emotional abuse | Physical Abuse | Sexual Abuse | Neglect

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.



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.

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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 including, $83.5 billion in productivity losses and $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.

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Signs you or your child are 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


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. 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.”

Join the ACEs Connection Network

ACEs Response Toolkit

Resources from The National Child Traumatic Stress Network

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