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Preventing Adverse Childhood Experiences


What are adverse childhood experiences?

Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years). For example:

  • experiencing violence, abuse, or neglect

  • witnessing violence in the home or community

  • having a family member attempt or die by suicide

Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding, such as growing up in a household with:

  • substance use problems

  • mental health problems

  • instability due to parental separation or household members being in jail or prison

ACEs are linked to chronic health problems, mental illness, and substance use problems in adulthood. ACEs can also negatively impact education, job opportunities, and earning potential. However, ACEs can be prevented.

Please note the examples above are not meant to be a complete list of adverse experiences. There are many other traumatic experiences that could impact health and well-being.

As many of us know, these are not the only kind of adversities we may face as children. Other common childhood adversities beyond the ten ACEs in the original study include:

  • Discrimination based on race, ethnicity, gender identity or sexual orientation, religion, learning differences, or disabilities

  • Poverty

  • Racism, systemic and institutional

  • Other violence, like getting bullied, experiencing violence yourself, or seeing others get hurt in your neighborhood, community or school

  • Intergenerational and cultural trauma, like the displacement and genocide of indigenous people, slavery, and the Holocaust

  • Separation from a parent or caregiver because of immigration or foster care

  • Other big changes in life, like migration or immigration, being a refugee or seeking asylum, moving to a new area where you don’t know anyone, or separation from someone important to you

  • Bereavement and survivorship, like having a relative or caregiver die, or surviving an illness, injury or accident, or natural disaster

  • Adult responsibilities as a child, like caring for someone who’s sick or disabled, or being the one responsible for getting food on the table at a young age

ACEs are common. About 61% of adults surveyed across 25 states reported that they had experienced at least one type of ACE, and nearly 1 in 6 reported they had experienced four or more types of ACEs.

Preventing ACES could potentially reduce a large number of health conditions.

For example, up to 1.9 million cases of heart disease and 21 million cases of depression could have been potentially avoided by preventing ACEs.

Some children are at greater risk than others.

Women and several racial/ethnic minority groups were at greater risk for having experienced 4 or more types of ACEs.

ACEs are costly.

The economic and social costs to families, communities, and society totals hundreds of billions of dollars each year. What are the consequences? ACEs can have lasting, negative effects on health, well-being, as well as life opportunities such as education and job potential. These experiences can increase the risks of injury, sexually transmitted infections, maternal and child health problems (including teen pregnancy, pregnancy complications, and fetal death), involvement in sex trafficking, and a wide range of chronic diseases and leading causes of death such as cancer, diabetes, heart disease, and suicide.

ACEs and associated social determinants of health, such as living in under-resourced or racially segregated neighborhoods, frequently moving, and experiencing food insecurity, can cause toxic stress (extended or prolonged stress). Toxic stress from ACEs can change brain development and affect such things as attention, decision-making, learning, and response to stress.

Children growing up with toxic stress may have difficulty forming healthy and stable relationships. They may also have unstable work histories as adults and struggle with finances, jobs, and depression throughout life. These effects can also be passed on to their own children. Some children may face further exposure to toxic stress from historical and ongoing traumas due to systemic racism or the impacts of poverty resulting from limited educational and economic opportunities.

How can we prevent adverse childhood experiences?

ACEs are preventable. There are a number of factors that may increase or decrease the risk of perpetrating and/or experiencing violence. To prevent ACEs, we must understand and address the factors that put people at risk for or protect them from violence.

Creating and sustaining safe, stable, nurturing relationships and environments for all children and families can prevent ACEs and help all children reach their full potential.

Preventing ACEs

Strengthen economic supports to families

  • Strengthening household financial security

  • Family-friendly work policies

Promote social norms that protect against violence and adversity

  • Public education campaigns

  • Legislative approaches to reduce corporal punishment

  • Bystander approaches

  • Men and boys as allies in prevention

Ensure a strong start for children

  • Early childhood home visitation

  • High-quality child care

  • Preschool enrichment with family engagement

Teach skills

  • Social-emotional learning

  • Safe dating and healthy relationship skill programs

  • Parenting skills and family relationship approaches

Connect youth to caring adults and activities

  • Mentoring programs

  • After-school programs

Intervene to lessen immediate and long-term harms

  • Enhanced primary care

  • Victim-centered services

  • Treatment to lessen the harms of ACEs

  • Treatment to prevent problem behavior and future involvement in violence

  • Family-centered treatment for substance use disorders

Raising awareness of ACEs can help:

  • Change how people think about the causes of ACEs and who could help prevent them.

  • Shift the focus from individual responsibility to community solutions.

  • Reduce stigma around seeking help with parenting challenges or for substance misuse, depression, or suicidal thoughts.

  • Promote safe, stable, nurturing relationships and environments where children live, learn, and play.

Let’s help all children reach their full potential and create neighborhoods, communities, and a world in which every child can thrive.

Note: The original 10 ACEs were identified in the CDC and Kaiser Permanente Study of 1997.


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