What Are ACEs?

For many people, navigating their childhood may have been difficult. For people who have undergone adverse childhood experiences (ACEs), though, describing childhood as difficult may be an understatement.

ACEs are actually very common, affecting many children across the globe. Children with ACEs or childhood traumas may struggle every day. But what are ACEs?

Adverse childhood experiences (ACEs) encompass numerous harmful circumstances that occur in childhood. But as concise as this definition might be, it is still worth explaining further. With that said, the characteristics and types of ACEs will first be explored. Then, the prevalence of ACEs and their relationship with toxic stress will be discussed.

What Are ACEs?

The acronym ACEs is an umbrella term for traumatic acts inflicted upon a child that are detrimental to their health and well-being. It also refers to harmful conditions—either deliberate or accidental—that children are subjected to during childhood. Anyone under the age of 18 can suffer from ACEs.

Types of ACEs

There are many examples of adverse childhood experiences, such as abuse or neglect, divorce, death, parental mental illness or substance abuse, and domestic violence. Generally, though, this list of ACEs can be categorized into either one of three types: abuse, neglect, or household dysfunction.

Abuse

According to the Child Abuse Prevention and Treatment Act (CAPTA), abuse is defined as an act that leads to injury or harm, sexual exploitation, or death of a child [*]. Abuse can come in any one of three forms, namely the following [*]:

• Physical abuse
• Sexual abuse
• Emotional abuse

Physical abuse can be experienced in many ways, including slapping, shoving, and choking a child. Meanwhile, sexual abuse can range from inappropriate touching and fondling to even rape. Finally, emotional abuse occurs when the child becomes psychologically stunted, with their growth and development impaired [*].

Neglect

Neglect arises when a caregiver fails to care for their child’s physical and psychological needs. As with abuse, neglect has several subtypes, as follows [*]:

• Physical neglect
• Emotional neglect
• Educational neglect
• Medical neglect

Physical neglect pertains to the caregiver’s failure to provide the child with basic life necessities, such as food, clothing, safety and security, and shelter. A child may also feel neglected emotionally, which means that they do not receive adequate love, support, and care. Another type of neglect is educational; this involves a lack of supervision or provision with regard to the child’s education. Finally, refusing to bring a child to a doctor for a physical check-up or for treatment of any injuries is considered medical neglect.

Household Dysfunction

Household dysfunction relates to circumstances in the family that may negatively affect the child’s physical health or psychological well-being. Although there are more instances of ACEs involving household dysfunction, the CDC-Kaiser study—a well known study conducted on ACEs—recognizes five. The following is a list of ACEs that fall under the category of household dysfunction [*]:

• Mental illness of a family member
• The imprisonment of a relative
• Witnessing domestic violence
• Parental substance abuse
• Divorce or separation

Although it may not have as much of a negative impact as do abuse and neglect, many studies have found that household dysfunction can still lead to poor mental health [*].

How Common Are ACEs?

Given that the term ACEs represents various harmful circumstances that may occur in childhood, it is not surprising that they are a common occurrence. In fact, an epidemiological study conducted in 2010 indicated that approximately 39% of adults worldwide have suffered from at least one form of ACE [*]. More importantly, though, they undertook the task of investigating the most common types of ACEs. The following list of ACEs is arranged according to prevalence [*]:

1. Parental death (12.5%)
2. Physical abuse (8%)
3. Parental divorce (6.6%)
4. Family violence (6.5%)

Despite how frequently ACEs occur, many people are unfamiliar with this concept. Even worse, some individuals may not be aware that they have suffered from ACEs. But how can we possibly know whether we have undergone ACEs? Conveniently enough, there are many different ways of assessing ourselves for ACEs. The Adverse Childhood Experiences (ACEs) Questionnaire is one of them.

How are ACEs Measured?

The Adverse Childhood Experiences (ACEs) Questionnaire is a 10-item self-report measure that was created by researchers to measure childhood adversity by assessing 10 ACEs [*]. If an individual scores 4 or higher on the questionnaire, then that score indicates their likelihood of developing the risks that are associated with ACEs. Such risks include substance abuse, depression and suicidal behaviors, and poor physical health [*].

The ACEs questionnaire is just one of several ways to determine whether you have had ACEs. Another way of assessing whether or not you have undergone childhood adversity is to reflect upon whether your experiences in childhood still negatively affect you today. In other words, if you are experiencing signs of childhood trauma—such as hypervigilance and addiction—then it is possible that you have suffered from adverse childhood experiences.

How Do ACEs Relate to Toxic Stress?

Based on the previous discussion, it is apparent that ACEs and childhood trauma have certain commonalities. One of these similarities is that they both have a relationship with stress. But how does stress play a role in childhood adversity?

First, it should be taken in consideration that not all stress is harmful. In fact, there are three types of stress, two of which are normal or manageable [*]:

• Positive stress
• Tolerable stress
• Toxic stress

The type of stress that should be looked out for in particular is toxic stress. Toxic stress occurs when the body’s stress response is activated for a prolonged period of time due to intensely difficult, or even traumatic, events [*]. In other words, if a child is exposed to domestic violence at home, for example, then their body will work overtime for a longer time than usual to cope with the stress it is experiencing [*]. This leads to their body and brain suffering long-lasting effects over time.

To understand ACEs is to learn about toxic stress because the two terms are interrelated. An adverse childhood experience such as parental mental illness or physical abuse can make the body and brain “toxic.” Thus, when researchers conclude that ACEs lead to negative consequences such as poor health and psychiatric difficulties [*], it is actually toxic stress resulting from the ACEs that does [*].

Coping With ACEs and Toxic Stress

Although learning about ACEs and toxic stress is important, it does not necessarily give us the tools to cope with them. Fortunately, there are coping strategies to minimize the negative impact of ACEs and toxic stress.

Psychotherapy

Not only does therapy provide people with the opportunity to vent, it is also beneficial for one’s brain and body. According to the American Psychiatric Association, psychotherapy is associated with better emotions and behaviors. Some other benefits of therapy include a decreased risk of disability and medical concerns, as well as increased satisfaction at work [*]. For individuals with ACEs in particular, the positive effects of psychotherapy can be enhanced by the use of trauma worksheets in or between sessions. Regardless of how one plans to approach their sessions, going to therapy in itself can help individuals cope with ACEs and toxic stress.

Meditation

Meditation was initially practiced by people who want to broaden their understanding. Nowadays, though, it can be used by individuals who want to relax and decrease their stress. Practicing meditation is more complex than it seems, but essentially, it requires great concentration that can be achieved by clearing one’s mind. Just like psychotherapy, meditation has several benefits, including a sense of inner peace, a fresh perspective, and self-awareness.

To see how meditation is beneficial for trauma survivors, consider adults who have repressed childhood trauma. One of the distressing signs of repressed trauma in adults is anxiety, an emotion marked by fear and apprehension. If meditation is practiced as a coping mechanism, this anxiety will dissipate. This is just one application of meditation, among many others.

Physical Exercise

Exercising does not just help us maintain a healthy weight and strengthen our body. It can also be an asset to our mental health. By releasing chemicals such as serotonin and endorphins, exercise can improve people’s mood and overall well-being.

Spending Time in Nature

Immersing oneself in nature is more than just a soothing and therapeutic activity. Spending time in nature can relax a person’s mind and reduce stress and other negative emotions such as anger. More importantly, spending time in nature benefits our mental health by boosting our self-confidence and self-esteem.

The Bottom Line

Adverse childhood experiences can be challenging to overcome. After all, moving on from experiences such as domestic violence and physical abuse cannot be achieved overnight. However, if you have ever suffered from ACEs, then know that you are not alone. You can survive despite having experienced childhood trauma. And above all else, you can learn how to cope and manage your trauma. Although your experiences of childhood adversity can be difficult to digest and move past, is not impossible to move on and move forward.

References:

1. Joining Forces for Children. What are ACEs?
2. McDonald KC. Child abuse: Approach and management. 15 January 2007.
3. Negriff S. ACEs are not equal: Examining the relative imapct of household dysfunction versus childhood maltreatment on mental health in adolescence. 21 November 2019.
4. Basto-Pereira M, Gouveia-Pereira M, Pereira CR, et al. The global impact of adverse childhood experiences on criminal behavior: A cross-continental study. 8 January 2022.
5. El Centro Measures Library. Adverse childhood experiences (ACEs) questionnaire.
6. ACE Response. Who we are.
7. Center on the Developing Child at Harvard University. ACEs and toxic stress: Frequently asked questions.
8. Centers for Disease Control and Prevention. Fast facts: Preventing adverse childhood experiences. 6 April 2022.
9. American Psychiatric Association. What is psychotherapy?