Adverse Childhood Experiences (ACEs)

What is an adverse childhood experience?

Adverse childhood experiences (ACEs) are negative experiences that happen between the ages of 1 and 17 years. These experiences are usually traumatic events. ACEs can affect a person’s health throughout their lifetime. They may lead to issues such as mental health conditions, chronic physical health conditions and/or substance use disorder. These conditions can be treated or managed throughout a person’s life.

A child’s brain is like a sponge. They learn from their experiences and absorb knowledge from the world around them. For example, they learn how to hold a spoon or ride a bicycle. If a negative experience happens, like falling off a bicycle, a child will learn from that experience. They may go slower or take safety precautions. Sometimes, negative experiences are out of a child’s control and they’re unable to slow down or protect themselves from mental or physical harm. The loss of a loved one, sexual abuse and physical abuse, among others, are adverse childhood experiences.

What is a traumatic event?

An event or experience that causes long-term (chronic) stress or extreme stress (toxic stress) is a traumatic event. These events affect a person both physically and emotionally. Common signs of a traumatic event include feeling:

• Terrified.
• Helpless.
• At risk of danger or in danger.
• Physically hurt.

An adult or child may feel trauma if they experience an event firsthand or see an event through media like television or the internet. Media can also trigger flashbacks to traumatic events that happened during childhood.

Different types of traumatic events include:

• Natural disasters.
• Domestic violence.
• Shootings.
• Bullying.
• A car accident.
• Sexual abuse.
• Living in an area undergoing war.
• Witnessing serious injuries or the death of another person.
• Loss of family member/parental divorce or separation.

These are only some examples of traumatic events, but there are many more. A traumatic event may occur once or it could happen several times during one’s childhood. Not every child reacts to the same event in the same way. For example, if two children both experience the same traumatic event, one child may develop long-term stress. The other child may not have any long-term impact to their health after experiencing the same event.

How common are adverse childhood experiences?

Adverse childhood experiences are common. A study of adults in the United States reported that 60% to 80% experienced at least one type of adverse childhood experience. Of the same test group, 1 in 6 said they experienced four or more ACEs between the ages of 1 and 17.

Who is at risk of having an adverse childhood experience?

Any child under the age of 18 can have an adverse childhood experience. ACEs are more common among:

• Girls or children assigned female at birth.
• Racial or ethnic groups classified as a minority.
• Children who experience socioeconomic challenges.
• Children of parents or caregivers who experience stress.
• Children who have family members or friends diagnosed with substance use disorder or a mental health condition.

What are the signs of an adverse childhood experience?

After an adverse childhood experience, a child may show signs of trauma that could include:

• Fear of other people.
• Difficulty sleeping or frequent nightmares.
• Bedwetting.
• Changes to their mood.
• Difficulty showing affection towards friends or family.
• Avoiding situations or events that relate to a traumatic experience.
• Difficulty learning in school.

These signs might not be immediately present after a traumatic event. They usually develop after the child has time to process the experience. In certain cases, a trigger, which is something that reminds a person of a specific event, can cause a child to react.

How does an adverse childhood experience affect an adult?

Adverse childhood experiences can impact adults years after the traumatic event happened. It can impact your health, quality of life and access to opportunities like your career and education.

Conditions that occur as a result of an adverse childhood experience could include:

• Anxiety.
• Depression.
• Post-traumatic stress disorder (PTSD).
• Phobias.
• Insomnia.
• Mood disorders.
• Substance use disorder.
• Eating disorders.

ACEs can lead to chronic conditions like cancer and heart disease. This happens because stress takes a toll on your body. It can affect the way your cells divide and replicate, which can lead to cancer. In addition, it can affect the way your heart functions by increasing your blood pressure.

ACEs can decrease a person’s overall life expectancy by nearly 20 years compared to a person who doesn’t have any ACEs.

Behavioral changes caused by ACEs in adults

Research suggests that adults who had adverse childhood experiences may be more likely to participate in high-risk behavior, including:

• Using tobacco products.
• Misusing prescription medications.
• Experimenting with drugs or highly addictive substances.
• Participating in high-risk sexual behaviors.
• Attempting suicide or self-harm.

If you or one of your loved ones are considering suicide, reach out to a healthcare provider or call the suicide prevention hotline at 988.

What does an adverse childhood experience do to your body?

Adverse childhood experiences cause extreme stress to a child’s body. When you’re stressed, your body releases hormones (like cortisol and adrenaline) to help you adapt to the situation. This is called the “fight-or-flight” response. The release of these hormones causes an increased heart rate, changes to your breathing, changes to your vision and more. This response is usually temporary.

Long-term stress causes your stress hormones to be in use constantly, which isn’t supposed to happen. This is known as toxic stress, which can target your brain and change how it grows and functions.

How do adverse childhood experiences affect development?

Adverse childhood experiences can impact how a person develops. Children are born eager to learn from the environment around them. This desire helps them become independent and reach childhood milestones set for their age. All of their childhood experiences, both positive and negative, influence how a child grows and develops.

A child’s brain is very sensitive. Its development is similar to growing a seed. The seed (brain) looks for certain things in its environment to help it grow, like sunlight, water and soil. When a seed has its basic needs met, it turns into a flower. If there’s not enough sunlight (experience trauma) and your seed doesn’t get the nutrition it needs, it may grow. But it needs a little support from the flowers around it to stand tall.

ACEs are often out of a child’s control and negative experiences cloud their brain. A child who has ACEs may need support throughout their life from healthcare providers, friends, family and their community to help them bloom.

While traumatic events can cause harm to a person at any age, trauma to a child is more severe, as their brain is still growing. Specifically, ACEs target a child’s memory (hippocampus) and areas of the brain that help them think logically (prefrontal cortex) and process emotions (amygdala). Severe or long-term stress places these parts of a child’s brain into survival mode for too long. This can weaken those parts of their brain and influence the way they react to certain situations as they grow into an adult.

While these changes to their brain can affect a child’s overall development, they’re not always permanent. Treatment and mental healthcare for a child or an adult who experienced ACEs are available to refocus how their brain processes trauma and stress.

What are the most common causes of adverse childhood experiences?

A traumatic event that happens during childhood causes adverse childhood experiences. There are many causes of ACE, including:

• Violence.
• Abuse (physical, emotional or sexual).
• Neglect.
• Loss of a friend or family member.
• Missing parental figures or divorce.

There are also social determinants of health, which are factors within your environment that can influence you. Some of these determinants can have a negative impact on a child’s life and cause an adverse childhood experience, including:

• A disrupted living situation.
• Lack of access to healthcare.
• Financial challenges.
• Being unhoused or moving frequently.
• Discrimination.

How are adverse childhood experiences treated?

A healthcare provider may recommend the following treatment for adverse childhood experiences:

• Regularly seeing a mental health therapist for psychotherapy (talk therapy).
• Managing or treating any underlying health conditions, often with medications.

Medical treatments for adverse childhood experiences vary based on the cause. Long-term, chronic medical conditions like heart disease and mental health conditions like anxiety and depression will need lifelong treatment and management.

Within your community, resources you and your child can participate in include:

• Enrolling your child in supportive education programs in school.
• Joining a support group for grief, substance use disorder, etc.
• Receiving crisis intervention services to support your medical, legal or housing needs.
• Participating in mentorship programs where children can learn from others in their community.
• Joining sports teams or clubs to help your child make new friends, build confidence and learn new skills.

At home, you can try to prevent adverse childhood experiences by:

• Using kind language to speak to your children.
• Using a non-violent approach to disciplining your children.
• Teaching your child how to handle conflict safely.
• Being a role model and setting a positive example for your child to aspire to be.

How can adverse childhood experiences be prevented?

While some adverse childhood experiences can be prevented, there’s no prevention method for all types of childhood trauma. The best prevention method is to raise awareness within a person’s home and community of how adverse childhood experiences (ACEs) can affect a person as they grow.

You can reduce your risk of exposing your child to trauma by:

• Providing a nurturing and safe environment for your child.
• Creating a bond or building a relationship with your child.
• Making sure your child’s physical and emotional needs are met.
• Getting the care and support you need as a caregiver.

These risk prevention methods can be difficult to achieve on your own. You may need support from your friends, family and community to help your child grow in a safe environment. It’s OK to ask for help when you need it.

Where should I go if I need help with adverse childhood experiences?

If adverse childhood experiences are affecting you or your child’s ability to grow and thrive, visit a healthcare provider. They may give you resources to meet with:

• A mental health therapist.
• A medical specialist to treat any underlying health conditions.
• Law enforcement if you’re in danger.
• Support groups in your community.

If you or a loved one are considering self-harm or suicide, call 988, or visit the emergency room. The number 988 is a suicide prevention hotline to help you if you’re struggling with your mental health. But you don’t need to be in a crisis to call 988 or reach out to a healthcare provider. Help is available to you when you need it. All you need to do is ask.

A note from Cleveland Clinic

A child is constantly learning from the world around them. Some children have a difficult time growing and learning when they’re faced with trauma. Adverse childhood experiences (ACEs) are common. While some cases are preventable, that’s not true for all ACEs. Children can grow into well-adapted adults with help from a healthcare provider and/or a mental health professional. Treatment may be lifelong to help a child or adult overcome ACEs. It’s important to remember that you’re never alone when it comes to taking care of yourself and your mental health.