Adverse Childhood
Experiences (ACEs)
In the United States, 61% of Black children and 51% of Latinx children have experienced at least one ACE, compared to 40% of White children. Besides mental and emotional scars, ACEs can cause serious health risks into adulthood.
Visit the mental health urgent care clinic in your community and tell a friend where it’s located.
ANXIETY | DEPRESSION
HEALTH DISPARITIES FOR BMOC
Children experiencing adverse situations, and adults who experienced adversity when they were children, come from all walks of life. ACEs are not confined to any particular race, religion, socio-economic background, or nationality. Any child can experience the sustained toxic stress associated with untreated trauma and suffer negative mental and physical health effects.
The original study on Adverse Childhood Experiences conducted by the Centers for Disease Control and Kaiser Permanente in the mid-1990s unearthed this fact early in their research. Their study was conducted among 17,000 middle-class Americans living in Southern California. Even though these original participants were not necessarily representative of the average American, approximately half of them had still experienced at least one ACE.
Subsequent U.S.-based ACEs studies, including the largest study conducted to date between 2011 and 2014, have consistently shown the same general prevalence of ACEs among American children. This far larger sample group, and the data accumulated from many studies, highlighted some startling differences on who is most likely to suffer from ACEs. Children from minority backgrounds – whether based on race, socio-economic status, or sexual orientation – were at distinctly higher risk of ACEs and their devastating life-long effects than middle-class White children.
Moreover, ACEs can follow an intergenerational pattern. For example, research suggests that children who experience physical abuse may be more likely to commit violence, including abusing or neglecting their own children, and to be revictimized in the future. ACEs align with a shifting public health focus to upstream thinking and the prevention of negative behaviors and outcomes before they occur.
ACES MAY INCLUDE
- Abuse, which can be emotional, physical, or sexual.
- Neglect, either physical or emotional.
- Domestic violence.
- Substance misuse by a member of the household.
- Divorce or separation of parents or caregivers.
- Mental illness of a member of the household.
- Having a member of the household go to prison.
Since the original study, the list of ACEs in various measures has expanded with the goal of capturing diverse population data, particularly from children of color and those living in poverty. For instance, since 2011, ACEs questions on the National Survey of Children’s Health (NSCH) have incorporated familial death, neighborhood violence, economic hardship, and unfair treatment based on race or ethnicity, essentially declaring racism as a contributing ACE.
Children of different races and ethnicities across the country do not experience the same exposure to ACEs. In the United States, 61% of Black children and 51% of Latinx children have experienced at least one ACE, compared to 40% of White children. In every part of the country, the lowest rate of ACEs was among Asian children. In most areas, the population most at risk was Black children.
The original ACE study, and decades of research since, have linked ACEs to an increased risk of developing chronic diseases and behavioral challenges, including obesity, autoimmune disease, depression, and alcoholism. The greater the number of ACEs, the greater the risk for negative outcomes. Individuals with multiple ACEs may be more likely to perform poorly in school, be unemployed, and develop high-risk health behaviors like drug use. These high-risk behaviors account for nearly 50 percent of the increased risk of negative consequences associated with ACEs. In 2019, the CDC found that at least five of the top 10 leading causes of death are associated with ACEs.
The underlying mechanisms by which ACEs exert their effects on health are through the development of toxic stress, a prolonged or excessive activation of the stress response system. Nearly all people experience stress, such as the stress felt before an important test or a job interview. However, chronic stress sustained over time can be damaging to the body and the brain, particularly for children, because the earliest years are a critical time for development. The accumulation of excessive stress in the body interferes with the development of healthy neural, immune, and hormonal systems, and can alter the expression of our DNA. Multiple ACEs over time – especially without adequate adult support – can affect the nervous, endocrine, and immune systems, and have lasting effects on attention, behavior, decision-making, and response to stress throughout a lifetime.
Fortunately, researchers have identified strategies to avoid negative outcomes by preventing ACEs, some of which are identified in policy implications. The CDC estimates ACEs prevention could reduce chronic conditions, risk behaviors, socioeconomic challenges, and leading causes of death in the United States. There are also certain factors that can help mitigate long-term negative impacts after ACEs have already occurred, helping to strengthen the ability to overcome adversity, often referred to as resilience. Protective factors, including strong family bonds, cultivate greater resilience that can help protect children from the detrimental effects of adverse experiences. Safe, nurturing relationships and communities help support health across one’s lifespan.
