The Impact Of Adverse Childhood Events (ACEs)


What Are Adverse Childhood Events (ACEs)?

Studies are increasingly identifying the importance of early life experiences to people’s health throughout the life course. Individuals who have adverse childhood events tend to have more physical and mental health problems as adults than do those who do not have ACEs and ultimately greater premature mortality. ACEs include: harms that affect children directly (eg, abuse and neglect) and indirectly through their living environments (eg, parental conflict, substance abuse, or mental illness).

What Are The 10 ACES’s?

The CDC-Kaiser study categorised ACE’s as follows:

  • Physical abuse
  • Emotional abuse
  • Sexual abuse
  • Physical neglect
  • Emotional neglect

And household dysfunction including:

  • Mental illness
  • Mother treated violently
  • Divorce
  • Incarcerated relative
  • Substance abuse

Studies are increasingly establishing how childhood exposure to chronic stress leads to changes in development of nervous, endocrine, and immune systems, resulting in impaired cognitive, social, and emotional functioning and increased allostatic load (ie, chronic physiological damage). Thus, individuals who have ACEs can be more susceptible to disease development through both differences in physiological development and adoption and persistence of health-damaging behaviours.

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What Is My ACE Score?

Click here for a quick questionnaire you can complete.

What Health Problems Are Associated With Adverse Childhood Events?

The first major ACE study examined relations between the number of ACEs reported by more than 17 000 individuals in the USA and their health as adults. It found that the more ACE types that individuals reported, the greater their risks of health-harming behaviours (eg, smoking or sexual risk taking) and both infectious and non-communicable diseases (NCDs). Supported by international work to standardise measurement of ACEs and their effects on health, these findings have since been replicated in studies from low-income and middle-income, and high-income countries.

To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building.

We found that individuals with at least four ACEs were at increased risk of all outcomes examined. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes , moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease, strong for sexual risk taking, mental ill health, and problematic alcohol use, and strongest for problematic drug use and interpersonal and self-directed violence.

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Protecting Our Children From Adverse Childhood Events

The literature puts forward several protective factors, such as mother-child relations, parental health, community engagement, mindfulness practice, and recently (2020) a paper put forward the potential of regular nature engagement as a possible additional protective factor.

The 7C Model of Resilience can be helpful to consider here too:

Competence – Building their understanding of their skills.
Confidence – Helping kids grow a true belief in their own abilities.
Connection – Connecting children with other people, schools and communities to further build their support system.
Character – Helping them comprehend a clear sense of right and wrong, and teaching them moral values.
Contribution – Offering children a chance to contribute to the well-being of others. They learn that giving service feels good and then feel more confident to ask others for help as well.
Coping – Discovering a variety of healthy coping strategies to prevent children from dangerous “quick fixes” to stress.
Control – Teaching children to make decisions on their own so they can experience a sense of control.


  1. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis: click here.
  2. Accumulation of adverse childhood events and overweight in children: A systematic review and meta-analysis: click here.
  3. The Role of Mindfulness in Reducing the Adverse Effects of Childhood Stress and Trauma: click here.
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