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Adverse Childhood Experiences (ACES)



The Adverse Childhood Experiences Study (ACE study) confirmed the linkage between exposure to adversity in childhood and the risk of chronic disease and poor health outcomes as an adult.


Dr. Vincent Felitti, from Kaiser Permanente's Health Appraisal Clinic in San Diego and Dr. Robert Anda, from the Centers for Disease Control and Prevention  (CDC) were the principle investigators in the study.


More than 17,000 Health Maintenance Organization (HMO) members were included in the study (CDC)

Most of the study participants were well educated, middle class, and white and consisted of a near equal percent of   men and women. 

Each participant underwent a thorough physical exam and gave a detailed history of any exposure in childhood to stressful or traumatic experiences (adverse childhood experiences- see list below).

The ACE Study specifically looked at ten categories of abuse, neglect, and family dysfunction.

Each category is worth one point. Exposure to any of the ACEs before the age of 18, regardless of how often it occurred, or how long it lasted, counts as one point resulting in a total of ten points possible. This point total is the ACE score.  For example: An individual has a childhood history of witnessed domestic violence in the home, was often physically abused by a parent, and had a parent who was mentally ill and suffered a substance abuse problem. Their ACE score would be four.

The evaluation is ongoing as ACE study participants continue to be followed today.




Categories of ACEs




Family Dysfunction


Living with:

Mentally ill, depressed, or suicidal family member


A family member with a substance abuse problem



Loss of a parent due to death, divorce, or abandonment


Incarceration of a family member



Abuse & Neglect









What the Study Uncovered


Adversity in childhood is a leading determinant of adult disease and disability.


Adversities experienced in childhood are at the root of the ten most common causes of death


Adversity experienced in childhood is expensive and results in millions of dollars each year in health care and other related costs.



l These adverse experiences lead to chronic health problems, poor   

    outcomes and even early death as an adult!

    The more ACEs a child experienced, the greater the risk for lifetime health  

    problems, poor outcomes, and even early death!

    Scientists refer to this as the ACE Dose Response.


l ACEs are very common and often co-occur!

    Almost two-thirds of the study participants reported having experienced at  

    least one ACE, and more than one of five reported experiencing three or

    more ACEs.


l The ACE scores, combined with the overall health of the participants,    

    confirmed a link between adverse experiences in childhood and

    numerous illnesses that are prevalent in adults!




Health Conditions linked to ACEs


·         Alcoholism

·         Smoking

·         Drug use/abuse

·         Depression

·         Mental Illness

·         Poor School Performance

·         Compulsivity/Hyperactivity

·         Chronic Obstructive Pulmonary Disease (COPD)

·         Heart disease

·         Liver Disease

·         Skeletal Fractures

·         HIV/AIDS

·         Adolescent Pregnancy

·         Sexually Transmitted Infections (STI)

·         Suicide

·         Intimate Partner Violence

·         Cancer

·         Diabetes

·         Asthma

·         Multiple Sexual Partners


All of these Conditions can Negatively Impact overall lifetime Earnings, affecting a person’s Economic Stability and Quality of Life.




Probability of Outcomes

Given 100 American Adults

33 with 0 ACEs


51 with 1-3 ACEs

16 with 4-8 ACEs

1 in 16 smokes

1 in 9 smokes

1 in 6 smokes

1 in 69 are alcoholic

1 in 9 are alcoholic

1 in 6 are alcoholic

1 in 48 uses IV drugs

1 in 43 uses IV drugs

1 in 30 uses IV drugs

1 in 14 has heart disease

1 in 7 has heart disease

1 in 6 has heart disease

1 in 96 attempts suicide

1 in 10 attempts suicide

1 in 5 attempts suicide

Chart from ACEs Iowa 360






There’s an App for That!




ACE icon



Take the ACE quiz on the ACE Quiz App. Available for free on iTunes, Google Play, and Amazon.


Download the ACE Quiz App for iTunes


Download the ACE Quiz App For Android


Download the ACE Quiz App for Kindle Fire




ACES Alter Development!

How Brains Are Built:

The Core Story of Brain Development


The Alberta Family Wellness Initiative.



Exposure to traumatic experiences effect the way a child’s brain develops.


It is well known that the first three years of a child’s life are a time of tremendous brain growth and activity. It is during this time that the foundation of the brain is being laid. 

Just like the foundation for a house or a building must be sturdy to support the walls and the roof, the foundation of the brain must be strong to support all future learning and development.  We are born with the necessary genes for our brain to grow and develop, but how it grows and develops is based on the experiences we have.



Experiences are the Building Blocks that form the Physical and Chemical structures of the Developing Brain. 

When someone experiences stress his/her body responds by increasing the blood pressure, the heart and breathing rate, and flooding the body with stress hormones, like cortisol and adrenalin. This is the body’s way of getting ready to “deal” with the stress.  Under typical circumstances the stress response system is a good thing and provides the body with the energy to either run away or stay and fight (the fight or flight response). When the stress is gone, the body “turns off” the stress response system and returns to baseline.

When there is constant or ongoing exposure to stress, the system stays “turned on.” Cortisol and adrenalin continue to be released throughout the body resulting in high levels of these hormones. For a short term in small quantities cortisol is very helpful, but too much of it and it quickly becomes toxic and has a negative effect on many parts of the body.

Exposure to high levels of cortisol for a child can be especially damaging as they are growing and developing and more susceptible to the toxic effects of cortisol.

When a child in a safe, stable, nurturing environment is exposed to stress, with the comfort of his caregivers he is able to cope with the stress and “turn off” his stress response system. The cortisol levels decline and his body physiologically returns to baseline. This whole process helps the child learn how to handle the stressors of everyday life, like taking a test, or going to a new school and is a part of healthy development. 


What Happens when a child is in a chaotic, neglectful or abusive environment and doesn’t have a loving caregiver to respond to his needs?





Toxic Stress Derails Healthy Development




His stress response system stays “turned on.” Cortisol is continuously released, flooding the body and the developing brain in too much cortisol. This toxic chemical environment alters the way the brain develops. Its physical structures and functions will predictably develop in a different way than that of a brain of a child in a safe and supportive environment. This change in development increases the risk for developmental delays, future learning difficulties, chronic health conditions later in life and even early death.




This video series developed by the Center on the Developing Child at Harvard and the National Scientific Council on the Developing Child explain how the early experiences both positive and negative, impact a child’s development.


The Science of Neglect



Experience Builds Brain Architecture


Serve and Return


ACEs Impact on Lifelong Health!






 A young child that is exposed to ongoing adversity has a higher risk of disrupted development.

Social, emotional and cognitive adaptations are made, greatly increasing the risk of unhealthy behaviors, leading to a higher risk of chronic disease, disability, social problems, and ultimately end in an early death.




This chart shows the increase in risk when the ACE score goes from 0 to an ACE score of 4.


For example: a person with an ACE score of 4 has a 1,525% increase in the likelihood that they will attempt suicide when compared to someone with an ACE score of 0.



ACEs Iowa 360


The Amazing Brain

books are great

resources that can be

 downloaded at no cost.



The Amazing Brain: Trauma and the Potential for Healing




Partnering with Parents: Apps for Raising Happy, Healthy Children





The Amazing Teen Brain: What Parents Need to Know





The Amazing Brain and Discipline





The Amazing Brain: What Every Parent and                             Caregiver Needs to Know











Baby Brain Map is an interactive brain map from Zero To Three that allows you to explore how your baby’s brain develops from pregnancy through the age of three.





What does this mean for Washington State Residents?

ACEs Are Common!

62% of Washingtonians have at least one ACE!



The Behavioral Risk Factor Surveillance System (BRFSS) is a survey used by the CDC to determine the prevalence of health behavior and other determinants of health in the United States. In 2009 the CDC incorporated ACE questions (ACE Module) into the WA state BRFSS.  The ACE Study and the ACE Study Module in the Washington BRFSS provides information


Categories of ACEs


Total % of Population

ACE Score









6 or more




Anda, Family Policy Council




on a broad range of childhood adversities and their relationship to numerous health and social problems throughout the lifespan.                                                            





ACEs In The Classroom





The Healthy Youth Survey is given to 6th, 8th, 10th, and 12th grade students to provide important information about youth in WA State. 


Two ACE questions are asked:

1. Have you ever been physically abused?

2. Have you witnessed adult to adult violence (more than once)?


 Research tells us these two ACEs are strongly linked to  

 the likelihood of experiencing numerous other ACEs

 (Family Policy Council)


What the survey shows for high school students in the 10th and 12th grades in WA State:


42% experience physical abuse and/or witness adult violence (estimated to have an ACE score greater than 3)

29% experience physical abuse or witness adult violence (estimated to have an ACE score greater than 5)

13% experience both physical abuse and witness adult violence


ACE Score

# Of Students/30

% of classroom
















4 or 5



6 or more






Family Policy Council


Washington State School Classroom


What this means for school, behavior, and physical health problems




Students with higher ACE scores have difficulty controlling their emotions which leads to difficulty at school, both in the classroom and on the playground.



ACE Score

Probability of having a learning disorder



4 or more


6 or 7


Family Policy Council


They have more behavioral problems; a greater number of  days absent; a greater risk for speech and language impairments;  are more often  in special education; have impaired test taking ability; are more likely to fail or have to repeat a year; and are at greater risk of being suspended or expelled.



Children with an ACE score of 6 have a 100% chance of having a developmental/learning disorder!




ACEs not only lead to problems in the classroom, they carry over into problems in the workplace. 

As the number of ACEs increases, so does the likelihood that someone will face problems in the workplace.

·         6% with 0 ACEs miss more than two days of work each month and only 5% of those had serious job problems

·         15% with 4 or more ACEs miss more than two days of work each month and almost 20% of those had serious job problems



Working together to Reduce and Prevent ACEs.

We must take action to prevent the devastating effects of ACEs by:


·         Providing resources and linkage to needed supports for families                               

·         Helping parents to overcome their own history of ACEs

·         Increasing parental knowledge and capacity in order for them to provide a safe, stable,  nurturing environment for their children

·         Delivering care from a      trauma informed      perspective

A Theory of Change



The Center for the Developing Child at Harvard University



Check out CDC's Essentials for Parenting  for tips on parenting toddlers and preschoolers and ways to provide safe, stable, nurturing environments for children to grow and thrive in.

Building Resiliency in Our Children


Resilience - the ability to become strong, healthy, or successful again after something bad happens





BestStart.org has great tips on Building Resilience in Young Children.

                Calculate Your Resilience Score Here

Ways to Increase Resiliency in Children


·         Saying I love you

·         Teaching children how to express their feelings

·         Working together 

·         Responding to your child’s needs

·         Learning to trust

·         Giving a child a sense of belonging

·         Teaching a child to communicate

·         Asking for help if needed

·         Experiencing success

·         Learning emotional control


·         Giving a child choices

·         Setting and maintaining clear boundaries

·         Establishing consequences

·         Encouraging positive self- esteem

·         Giving a child responsibility

·         Teaching kids how to solve problems and make decisions

·         Getting involved in the community

·         Having nurturing relationships




Do You Need Help?


Find local community resources                            here



Trauma Informed Care


To be trauma informed is to have awareness and understanding of trauma and the impact it has on an individual’s life. 


Trauma informed care is a growing movement among providers that focuses on “what happened to you” as opposed to “what is wrong with you?” It is an understanding that experience and the impact it has on the individual impacts decision making ability, learning capacity, and social and emotional development.







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