Adverse Childhood Experiences (ACEs)
What is an ACE?
An adverse childhood experience (ACE) describes a traumatic experience in a person’s life occurring before the age of 18 that the person remembers as an adult.
In a 2011 Minnesota telephone survey, individuals were asked if they had experienced any of nine types of ACEs, which are:
- physical abuse
- sexual abuse
- emotional abuse
- mental illness of a household member
- problematic drinking or alcoholism of a household member
- illegal street or prescription drug use by a household member
- divorce or separation of a parent
- domestic violence towards a parent
- incarceration of a household member
The ACE score is a measure of cumulative exposure to adverse childhood conditions. Exposure to any single ACE condition is counted as one point. If a person experienced none of the conditions in childhood, the ACE score is zero. Points are then totaled for a final ACE score. It is important to note that the ACE score does not capture the frequency or severity of any given ACE in a person’s life, focusing instead on the number of ACE conditions experienced. In addition, the ACE conditions used in the ACE survey reflect only a select list of experiences.
Stress and ACEs
ACEs have an effect on the developing brain.
Stress in reasonable doses promotes growth and brain development throughout childhood. Stress is a normal part of daily life and learning how to manage stress and regulate stress responses is critical to a child’s development. However, acute or prolonged stress can become toxic to the developing brain and body. ACEs can cause toxic stress.
Children’s stress response systems are immature at birth and therefore vulnerable to maltreatment and neglect. If the adults in a child’s life are not able to buffer the stress or are themselves the source of the stress, the child may begin to experience the world as dangerous and uncertain. In the face of danger, the body reacts by producing excess surges in stress hormones, such as cortisol.
In childhood, persistent and intense stress stemming from ACEs actually influences how the brain develops. Toxic stress strengthens connections in the parts of the brain that are associated with fear, arousal, and emotional regulation. Additionally, toxic stress negatively impacts parts of the brain associated with learning and memory. Continuous activation of the stress response system can also produce disruptions of the immune and metabolic systems. This can result in a lifetime of greater susceptibility to physical illness as well as mental health problems.
A person’s reaction to ACEs depends on the person’s own biological stress reactions, the person’s own protective characteristics, the intensity and duration of the ACE, and the strength of the person’s childhood bond to a stable, responsive, and nurturing caregiver. Throughout our childhood, but particularly from infancy through preschool, children depend on sensitive, responsive caregivers to help maintain the normal daily rhythm of the stress hormone, cortisol.
Prevalence of ACEs
ACEs are common among Minnesota adults.
Results indicate that ACEs are common among Minnesota adults.
Over half (55 percent) of the Minnesotans responding to ACE module questions reported experiencing at least one ACE in childhood.
The five most common ACEs reported by Minnesotans in the survey are:
- emotional abuse (28 percent)
- living with a problem drinker (24 percent)
- separation or divorce of a parent (21 percent)
- mental illness in the household (17 percent)
- physical abuse (16 percent)
Occurrence of ACEs
Minnesotans with ACEs are more likely to report several than just one.
Minnesotans reporting one ACE are more likely to report other ACEs in childhood. For those Minnesotans with at least one ACE, 60 percent have two or more ACEs, and 15 percent have five or more ACEs.
- Among those with at least one ACE:
- 40 % have one ACE
- 22 % have two ACEs
- 15 % have three ACEs
- 9 % have four ACEs
- 15 % have five ACEs
Impact of ACEs
ACEs cumulatively impact adult Minnesotan's health and wellbeing.
- As the number of ACEs increases, the risk for health problems increases in a strong and graded fashion in areas such as alcohol and substance abuse, depression, anxiety, and smoking.
- The risk for anxiety, depression, and smoking increases as the numbers of ACEs increases.
- There is also a clear increase in reported chronic drinking for Minnesotans with four or more ACEs.
- The correlation between ACEs and obesity or diabetes is not as evident among Minnesotans.
- While there is a definite increased risk of asthma for Minnesotans with five or more ACEs, there is no clear pattern for those with four or fewer ACEs.
- Minnesotans with more ACEs are more likely to rate themselves as having fair or poor health as compared to those with no ACEs.
Resilience to ACEs
Some children thrive despite ACEs.
Adversity is only one part of the equation. Children may also have their own characteristics and experiences that protect them and help them develop resilience despite exposure to ACEs. Resilience is positive adaptation within the context of significant adversity. In the face of adversity, neither resilience nor disease is a certain outcome.
Resilience is the result of a dynamic set of interactions between a person’s adverse experiences and his or her protective factors. This interaction is what determines the developmental path towards health and well–being or towards illness and dysfunction. No child is magically resilient or invulnerable to ACEs, just as no individual child is automatically doomed in the face of ACEs. These protective factors can include a person’s own biological and developmental characteristics. But protective factors can also include characteristics of the family, community, and systems that mitigate the negative impacts of ACEs. Protective factors help explain how some people who have sustained a great deal of adversity as children have fared relatively well in adulthood.
The presence of protective factors, particularly safe, stable, and nurturing relationships, can often mitigate the consequences of ACEs. Individuals, families, and communities can all influence the development of many protective factors throughout a child’s life that can impact his or her development.
How does resilience develop? There are multiple pathways to resilience. Resilience researchers continue to refine understanding about the ingredients and processes involved in supporting resilience. However, there is agreement about a variety of important individual, family and community conditions that support resilience. Here is a list of protective factors:
- Close relationships with competent caregivers or other caring adults
- Parent resilience
- Caregiver knowledge and application of positive parenting skills
- Identifying and cultivating a sense of purpose (faith, culture, identity)
- Individual developmental competencies (problem solving skills, self–regulation, agency)
- Children’s social and emotional health
- Social connections
- Socioeconomic advantages and concrete support for parents and families
- Communities and social systems that support health and development, and nurture human capital
Protective factors help a child feel safe more quickly after experiencing the toxic stress of ACEs and help to neutralize the physical changes that naturally occur during and after trauma. If the child’s protective networks are in good working order, development is strong even in the face of severe adversity.
If these major systems are impaired, either before or after the ACE, then the risk for developmental problems is much greater. This is particularly true if the environmental hazards are prolonged. In sum, even the negative consequences of toxic stress from ACEs can be buffered with the support of caring, competent adults and appropriate intervention and support.