Adverse childhood experiences

Art by MissLunaRose

Adverse childhood experiences are negative childhood experiences that may impact health later on. These experience happen before age 18 and cause a child to feel helpless, terrified, or in danger. Examples include being abused, witnessing someone else being harmed, parental divorce, mental illness in the family, and more.

Almost 2/3 of American adults have experienced one ACE, while nearly 1/6 have experienced 4 or more.

ACEs scale

The ACEs scale asks yes-no questions about whether someone experienced different things during childhood.

Original ACEs

The original scale asks about 10 ACEs in 3 categories.

• Abuse
  • Physical abuse
  • Emotional abuse
  • Sexual abuse
• Neglect
  • Physical neglect
  • Emotional neglect
• Dysfunction at home
  • Mental illness in a family member
  • Incarcerated family member
  • Witnessing domestic abuse
  • Witnessing substance abuse
  • Divorce

Limitations of the original scale

The ACEs scale asks simple yes/no questions. It doesn't measure factors like severity, duration, and age(s) at which the events happened. Thus, a child who briefly stayed with a caregiver who hit them and a child who was hit weekly for a decade would receive the same score for that question.

The original ACEs assessment asks if a child's mother or stepmother was abused. However, abuse can happen to caregivers of any gender. It also does not ask about other potentially traumatic stressors such as natural disasters, watching a family member get deported, or being unhoused.

While the original was groundbreaking in its time, more detailed measures can provide a clearer picture.

Expanded ACEs

A 2019 paper sought to expand the definition of ACEs to cover additional difficult childhood experiences. The Philadelphia expanded ACEs scale includes questions on bullying, witnessing violence, neighborhood safety, racism, and living in foster care.

Unofficial ACEs

Official ACEs lists don't cover every possible difficult childhood experience. Other unofficial adverse experiences not mentioned in the ACEs scale include:

• Exposure to war or terrorism
• Being homeless
• Natural disasters
• Having an undocumented family member who could be deported
• Discrimination (sexism, ableism, etc.)

Effects

People who experience more ACEs are more likely to experience higher psychological distress. While some people develop small or no problems, others develop toxic stress.

Toxic stress involves excessive activation of the body's stress-response system. It negatively impacts the mind and body and can cause epigenetic changes. This can lead to:

• Diseases: cancer, diabetes, stroke, heart disease, lung disease, liver disease
• Mental illness: anxiety, depression, PTSD, mood disorders, eating disorders, suicide attempts
• Lifestyle: poor exercise habits, risky sexual behavior, poor decision-making
• Pregnancy: teen pregnancy, unwanted pregnancy, complications, and miscarriage
• Difficulty forming stable, healthy relationships
• Unemployment and work difficulties
• Financial struggles
• Involvement in violence
• Alcohol or substance abuse
• Exposing their own children to ACEs

Not all people who experience ACEs are doomed to struggle in life. Some people with high ACE scores do well.

Reducing the effects

Building resilience and coping skills can help.

Social support can fight against the negative impacts of ACEs. Social support is key for the long-term health of kids with ACEs.

ACEs in different groups

In general, a stressed family is more likely to experience crises. The CDC describes demographic, caregiver habit, and community issues associated with a higher risk of ACEs. These include:

• Demographics: low income, young/single caregivers, poor caregiver education, disabled child in the family, caregivers who were abused or neglected as children
• Caregiver habits: spanking or other forms of corporal punishment, inconsistent discipline, low levels of supervision, isolation, poor understanding of children's needs, poor communication with children
• Community: high crime rates, low income and opportunities, easy access to drugs and alcohol, food and housing insecurity, few community activities for young people

Similarly, children in stable, supportive families in positive communities are less likely to experience ACEs.

Disabled youth

Children with developmental disabilities, especially autistic children and those with intellectual disability, are at higher risk of ACEs. So are children with special healthcare needs.

Disabled children may not know how to to identify abuse, defend themselves, or report abuse. They may be isolated, dependent on others, and conditioned to be compliant. Even if they can report it, people may blame them or say that abuse by caregivers is understandable because helping disabled children is stressful. "Diagnostic overshadowing," or people blaming everything on the disability, is another risk.

Youth in foster care

Children who spend time in foster care are more likely to experience ACEs. Those with more ACEs are less likely to have stable foster home placements and to be reunified with their birth families.

LGBTQPIA+ youth

Kids in the LGBT+ community are at increased risk for ACEs, especially abuse. They are disproportionately likely to have suicidal behaviors.

Coping with ACEs

Since ACEs have long-reaching effects, many adults experience stress over what happened to them in childhood.

Ways to cope with ACEs include:

• Counseling
• Trauma-informed therapy
• Support groups
• Healthy lifestyle: meditation, breathing exercises, journaling, exercise
• Talking to a doctor about symptoms and treatment

See also

• Child abuse
• Chronic mental illness
• Non-violent child discipline
• Spanking
• Trauma in childhood