Adverse Childhood Experiences

At the March 2018 GPP, guest speaker Jennifer Parker, PhD, LPC, Director Child Advocacy Studies, Professor Psychology at University of South Carolina Upstate asked attendees to think of their earliest memories. Most reported memories from when they were three years old, which included a first visit to Santa Claus, a tonsillectomy, and the wedding of a dear relative. Parker said it’s common for early memories to be connected with an event that is strongly emotional, whether for its joy, excitement, or fright. Years later, these memories and the feelings associated with them, can be easily summoned.

So consider a child whose early memories involve seeing his mother violently abused by her partner, or experiencing this violence himself. Or being a victim of sexual abuse. Or being told she’s stupid or worthless or a failure. Or seeing strangers come in and out of his house to use drugs. Or seeing a father arrested and put in prison.

It seems obvious that these childhood traumas would have a lasting impact on a young person as he matures and becomes an adult. But it’s only recently that these so-called Adverse Childhood Experiences, or ACES, are becoming a part of the language of prevention, early identification, and treatment of a wide array of issues.

ACES include:

  • Physical abuse
  • Sexual abuse
  • Emotional abuse
  • Physical neglect
  • Emotional neglect
  • Intimate partner violence
  • Mother treated violently
  • Substance misuse within household
  • Household mental illness
  • Parental separation or divorce
  • Incarcerated household member

ACEs, whether experienced in utero or during childhood, lead to social, emotional, and cognitive impairment, which can lead to the adoption of risky behaviors, which can lead to disease, disability, and social problems, which can lead to early death.

ACEs were first identified in a landmark study conducted between 1995 and 1997 through the Centers for Disease Control and Prevention in partnership with Kaiser Permanente, which looked at ACEs in more than 17,000 enrollees. It found:

ACEs are common. Physical abuse was reported by 28% of participants and 21% reported experiencing sexual abuse.  Many also reported divorce or having a parent with a mental health and/or substance abuse issue.

ACEs cluster. Almost 40% of study participants experienced two more more ACEs and 12.5% experienced four or more.  Many subsequent studies have explored the cumulative effects of ACEs rather than the singular effects of any one ACE.

ACESs have a dose-relationship with many health problems. Over time, “a person’s cumulative ACEs score has a strong, graded relationship to numerous health, social, and behavioral problems throughout their lifespan…Furthermore, many problems related to ACEs tend to be comorbid or co-occuring” (SAMSHA).

The array of physical and mental health problems that can result from ACEs is wide, including early alcohol use, illicit drug use, smoking, suicide attempts, depression, sleep disturbance, and more.


But in the face of these alarming statistics regarding ACEs, there is hope. Front line professionals in the community are becoming educated on ACEs, how to identify children who may be experiencing them, and how to intervene.  Parker reported that it turns out, teachers and school staff and administrators have most eagerly embraced the concept of ACEs and have used it to reframe their approach to children’s behavior. A child who has been affected by trauma may show signs of stress, such as acting out in the classroom or appearing to be distracted or withdrawn.

Dr. Josh Patterson, principal at the Sterling School and host of the meeting, said his faculty and staff participated in the Compassionate Schools training. Afterwards, they worked to include their understanding of prolonged trauma and stress within the school’s integrated, holistic approach of meeting the needs of the Whole Child. “A compassionate school’s mantra, requires asking ‘what happened to this child?’ rather than ‘what’s wrong with this child?’ when reflecting on student behavior.” He also reported ACEs and the Compassionate Schools approach are being widely promoted and instituted through OnTrack Greenville.


Is a high ACE score a guarantee of poor outcomes in life?  Dr. Parker said not at all.  She had the meeting’s attendees take and anonymously submit their ACE scores, and the group learned that 26% of them had one ACE and 28% had four or more ACEs.  Outcomes aren’t merely dependent on whether a child has experienced any trauma, but whether he has the opportunity to work through it successfully.  A caring relative, a teacher, or another professional or friend can mitigate the effects of trauma.


For GPP members, it’s a reminder that things in which we invest –whether it’s front line programs to support children and their parents or efforts to make families more successful (such as reducing poverty to thus reduce parents stress and increase access to health care) can reap benefits much later, both reducing costs for society and making for much happier and successful adulthoods.  Blue Cross Blue Shield Foundation of SC, for instance, has funded The Children’s Trust of SC to strengthen the integration of data, develop community-friendly action tools and enhance ACE Master trainings to prevent and address adverse childhood experiences. This project will assess the need for family resource centers in South Carolina and providing a better understanding of emotional abuse and neglect in South Carolina, one of the most common types of both ACEs and maltreatment.

An excellent resource for practicing trauma-informed philanthropy can be found here.


Many resources exist to learn more about ACES:

Find your ACEs score

CDC study and resources on ACES

The film Resilience: the Biology of Stress and the Science of Hope



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