Children grow up with a wide range of experiences. Some of these experiences help them feel safe, loved, and confident. Other experiences can be hurtful. Adverse Childhood Experiences (ACEs) are types of difficult experiences that are linked to negative outcomes later in life.
If you’re concerned that a child may be experiencing ACEs, this page is a good place to start learning more. You’ll understand what ACEs are and their impact, what an ACE score is, and ways to prevent ACEs from happening.
What are Adverse Childhood Experiences?
ACEs are stressful or traumatic events that happen to a child between the ages of 0 and 17 years. These experiences can include being abused, neglected, or living in an unstable home.
Research shows that ACEs are common. In fact, nearly half of children (45.3%) experience at least one ACE. Children of color, children from low-income families, and children living in certain parts of the United States are more likely to experience these challenges [*].
For example, more than half of Black and Hispanic children have experienced at least one ACE, compared to about 40% of White children.
That being said, ACEs can happen to any child, no matter who they are or where they live. Some groups face a higher risk because of broader social and environmental factors, but no family is completely immune.
Types of Adverse Childhood Experiences
ACEs are usually grouped into three main types. Each type includes different experiences that can affect a child’s safety and stability [*]:
Abuse
Abuse happens when a child is intentionally harmed by a parent, caregiver, or another trusted adult. It can involve actions that cause physical pain, emotional harm, or fear. A child may experience one or more types. These include [*]:
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Physical abuse - When a child is physically hurt on purpose. This can include hitting, kicking, shaking, burning, or causing injuries that cause pain or leave marks.
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Emotional abuse - Consistent behaviors that damage a child’s emotional health and self-esteem, such as belittling, verbal aggression, threats, or rejection.
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Sexual abuse - Refers to any sexual interaction involving a child, including physical contact, non-contact behaviors such as exposure to sexual material, or observing a child for sexual purposes.
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Medical abuse - Involves causing harm by exaggerating, fabricating, or inducing medical symptoms in a child. This may include unnecessary medical visits, tests, medications, or treatments that are not needed.
Neglect
Children have basic needs that must be met to grow and stay healthy. These needs include food, safe housing, clean clothing, medical care, and supervision. Neglect happens when these basic needs are not consistently met.
Neglect can be difficult to identify because it does not always leave visible signs. Families facing challenges such as unemployment or food insecurity may be at higher risk.
Forms of neglect can include [*]:
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Physical neglect - Not providing enough food, safe shelter, clean clothing, or proper supervision. For example, a child may be left alone for long periods, not have regular meals, or live in unsafe housing.
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Emotional neglect - Lack of affection, comfort, attention, or emotional support. A parent may rarely show warmth or ignore the child when they are upset.
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Medical neglect - Not getting the child the medical care they need, regardless of the reason or circumstances. For example, not taking a child to the doctor when sick or injured, or missing important follow-up visits.
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Educational neglect - When a child does not receive consistent schooling or needed learning support. One example is a child who frequently misses school and a parent who makes no effort to change this pattern.
Household Dysfunction
Household dysfunction includes stressful experiences in a child’s home that are not directed at the child in the same way as abuse or neglect. However, the child can still be strongly impacted.
Household dysfunction can include:
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Substance use in the home - Ongoing alcohol or drug use in the household that affects a child’s daily routines.
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Mental health challenges - One or more adults in the home struggles with anxiety, depression, or other mental illnesses (like bipolar disorder or schizophrenia). This may also include a history of suicide attempts.
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Domestic violence - Living in a home where adults frequently argue, threaten each other, or become physically aggressive. For example, yelling, throwing objects, or pushing.
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Incarceration of a parent or caregiver - A parent or caregiver is jailed or imprisoned, which disrupts the child’s daily life. This may include sudden separation, new living situations, or frequent changes in who is responsible for the child.
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Economic difficulties - Ongoing financial hardship in the home, such as unemployment, housing instability, or difficulty paying for basic needs.
Impact of Adverse Childhood Experiences
The short-term impact of ACEs can vary depending on the type of experience a child goes through.
Some effects may be physical. For example, sexual abuse can increase the risk of sexually transmitted infections, while physical abuse may lead to injuries such as bruises or broken bones. Physical neglect can result in poor nutrition, illness, or unmet medical needs.
Other short-term effects may include changes in the child’s behavior, trouble concentrating in school, sleep problems, or strong emotional reactions. These responses are a child’s way of coping with stress.
ACEs can also have long-lasting effects. Research shows that high exposure to ACEs is linked to an increased risk of chronic diseases and some of the leading causes of death, including heart disease, diabetes, and cancer [*].
This happens because ACEs can interfere with healthy brain development. When a child is exposed to continued trauma, their brain’s stress response system stays activated for long periods of time. This can affect their immune system and metabolism.
In addition to physical health concerns, ACEs can impact relationships. Some children may struggle to trust others. Depression, anxiety, and other mental health challenges are also more common among those with high ACE exposure.
Without support and healing, these patterns can continue into adulthood.
Signs of Adverse Childhood Experiences
ACEs can create toxic stress, which means a child’s body and brain are under constant strain without enough support or protection. Every child responds differently, but there are common signs to look for if you suspect a child may be experiencing ACEs.
Possible signs may include:
- Frequent mood changes, sadness, or fear
- Aggressive behavior or emotional outbursts
- Trouble sleeping or having nightmares
- Withdrawal from friends, family, or activities they used to enjoy
- Delays in language skills
- Physical complaints such as headaches or stomachaches without a clear cause
- Risk-taking behaviors, such as substance use or unsafe sexual behavior
- Acting much older or younger than their age
What is an ACE Score?
An ACE score is simply a way to understand how many difficult or stressful experiences a person may have gone through during childhood. It’s based on a short questionnaire with 10 questions that ask about experiences at home and in relationships growing up. These 10 questions come from a 1998 study that identified specific childhood experiences linked to long-term health outcomes [*].
Lower scores suggest less risk, while higher scores mean the body’s stress response may be working overtime and could impact the child’s health. The goal is to spot stress early and offer trauma-informed support to help the child heal.
It's important to note that an ACE score is not used to diagnose trauma or predict an individual child's future. Instead, it helps researchers and healthcare providers understand how early stress can affect health over time.
Prevention
It’s important to know that many ACEs are preventable. The foundation of prevention is making sure that a child grows up in a safe, stable, and supportive environment. Strong, consistent relationships with caring adults can help children feel they are protected. These kinds of supportive experiences are sometimes called Positive Childhood Experiences (PCEs), and research shows they can help buffer the long-term effects of ACEs.
Open conversations about mental health also play a key role. Parents and caregivers can talk with children about emotions and emotional regulation in ways that fit their age. Simple practices like naming feelings, teaching calming strategies, and checking in regularly can strengthen connection.
Prevention isn’t just something families must do alone. Communities can support children by offering resources that help parents stay stable. These include paid family leave, flexible work hours, and more affordable childcare and schooling [*].
And if ACEs do happen, it’s not the end of the story. Therapy and trauma-informed treatment can prevent the cycle of trauma from continuing.
Resources
If you’d like more guidance or support, the resources below can help you learn more about ACEs:
