Adverse Childhood Experiences
Over the past decade, conversations around Adverse Childhood Experiences (ACEs) have grown louder—and for good reason. Research continues to show how childhood trauma can shape not only development but also long-term health and well-being.
So, what exactly are ACEs? At their core, ACEs are difficult or traumatic events that happen before the age of 18. These include experiences like physical, sexual, or emotional abuse, neglect, and household challenges such as parental separation, substance abuse, or domestic violence. When these events occur during critical stages of growth, they can disrupt healthy childhood development and leave lasting scars.
A Groundbreaking Study
The concept of ACEs first came to light in the mid-1990s through a landmark study conducted by the Centers for Disease Control (CDC) and Kaiser Permanente. Researchers wanted to explore how early trauma could affect health later in life.
To do this, they created a 10-question survey divided into three categories:
Abuse: emotional, physical, and sexual
Neglect: emotional and physical
Household challenges: domestic violence, parental separation/divorce, substance use, mental illness, or incarceration
Each “yes” answer added to a person’s ACE score. The higher the score, the higher the potential risk for negative outcomes.
The results were eye-opening:
64% of U.S. adults reported at least one ACE.
1 in 6 adults (17.3%) reported experiencing four or more ACEs.
And the impact? Tremendous. The study found a direct link between childhood trauma and later problems like chronic disease, incarceration, and employment challenges. In short, the more ACEs a person has, the greater their risk for long-term difficulties.
The Numbers That Shocked Researchers
Youth with 1–3 ACEs: average risk compared to peers.
Youth with 4 ACEs: significantly higher risk of developmental problems.
Youth with 7 ACEs: extremely high risk.
Those with 8 or more ACEs: placed in the 99.99th percentile of trauma, meaning their experiences were so severe that they could not be compared to the general population.
This research suggested that trauma is not just a private struggle—it is a public health crisis.
The Limits of the Original Study
While groundbreaking, the original ACE study had its blind spots. The participants were overwhelmingly white (nearly 75%), and the professionals who conducted the research also largely shared that background. As a result, the ACE questionnaire did not capture experiences more common in underrepresented groups.
For example, the study overlooked trauma tied to:
Systemic racism
Community violence
Financial hardship
Housing instability and homelessness
It also didn’t account for how long or how often traumatic situations occurred, which can make a huge difference in outcomes.
Expanding the Conversation
Thankfully, newer research has worked to fill these gaps. Projects like the Philadelphia ACE Study have broadened the definition of childhood adversity to include social and community factors that the original study missed. By expanding our understanding of ACEs, these efforts paint a fuller picture of how trauma shapes young lives—and how society can better support healing and prevention.
Why This Matters
Understanding ACEs is about more than numbers and statistics. It’s about recognizing that trauma has real, lasting effects—and that with awareness, advocacy, and the right support, those cycles can be interrupted. By expanding research, centering diverse voices, and building stronger safety nets, we can work toward healthier futures for children and adults alike.
Moving Forward
Childhood trauma is not destiny. The more we understand ACEs, the better we can advocate for systems, policies, and communities that nurture resilience and healing.
