What are adverse childhood experiences?
Adverse childhood experiences (ACEs) are abuse and household dysfunction experienced before age 18. The term became widely known through the ACE Study, published in 1998 by Vincent Felitti of Kaiser Permanente, Robert Anda of the Centers for Disease Control and Prevention (CDC), and colleagues.
- Meaning
- Abuse and household dysfunction before age 18
- Landmark study
- Felitti et al. (1998), the ACE Study
- Key finding
- Health risks rise in a graded way with the number of categories experienced
- Related ideas
- Protective factors, resilience, post-traumatic growth
What did the ACE Study find?
The researchers mailed questionnaires to adults who had completed a medical evaluation, and 9,508 responded. Childhood exposure was measured in seven categories.
| Group | Categories |
|---|---|
| Abuse | Psychological, physical, sexual |
| Household dysfunction | Substance abuse, mental illness or suicide risk, violent treatment of the mother, criminal behavior (incarceration) |
Is childhood experience really linked to adult health? The ACE Study found a graded relationship between the number of categories experienced and adult health risks. People who had experienced four or more categories, compared with those who had experienced none, had 4- to 12-fold increased risks for alcoholism, drug abuse, depression and suicide attempt.
Later research and CDC surveys added categories such as neglect, and a ten-item ACE score is now common.
Interpreting an ACE score
- An ACE score describes risk at the population level. A high score does not determine an individual’s future.
- It does not capture severity, timing, duration, or adversities left off the list, such as bullying or poverty.
- It relies on adults’ recall of childhood events.
Protective factors
Even after adversity, a stable relationship with at least one trusted adult, safe schools and communities, and skills for naming feelings and seeking help are widely seen as protective factors. See the Olson circumplex model and family systems theory for family communication and flexibility, Baumrind’s parenting styles for parenting, and post-traumatic growth for growth after hardship.
Where to get help
In the United States, the Childhelp National Child Abuse Hotline is 1-800-422-4453. In an emergency, call your local emergency number.
Frequently asked questions
- What are adverse childhood experiences?
- Abuse (psychological, physical, sexual) and household dysfunction (substance abuse, mental illness, domestic violence, incarceration and others) experienced before age 18.
- What did the ACE Study find?
- The more categories people experienced, the higher their adult health risks; four or more categories were associated with 4- to 12-fold increased risks for alcoholism, drug abuse, depression and suicide attempt.
- Does a high ACE score mean problems are inevitable?
- No. It reflects population-level risk, and protective factors such as stable relationships support recovery.
References
- Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.