Understanding adverse childhood experiences (ACES) and the effect on children’s development.

What are ACES?

Adverse Childhood Experiences (ACES) are potentially traumatic events occurring during childhood. Examples of ACES include experiencing violence, abuse or neglect, or witnessing violence in the home or in the community. Environmental experiences of adversity can be a source of chronic stress. These experiences can include growing up in a household with substance misuse, household members with severe mental health issues, or instability in the household due to parental separation or incarceration.

What are the Effects of ACES?

A groundbreaking research study in 1998 found a strong relationship between exposure to ACEs during childhood and multiple risk factors for several of the leading causes of death in adults. This study was published in the American Journal of Preventive Medicine in May 1998 and describes "the long-term impact of abuse and household dysfunction during childhood on the following outcomes in adults: disease risk factors and incidence, quality of life, health care utilization, and mortality." Link to the CDC-Kaiser ACE Study The ACEs Questionnaire is comprised of ten 'yes or no' questions that serve as indicators for being at-risk for serious illness and disease. The higher the ACEs number, the higher the risk, with ACEs scores of 4 or more being high-risk indicators. You can find your ACES and Resilience Score on the "Aces Too High" website.

What is Toxic Stress?

Chronic stress, or trauma, engages the “flight or flight” response in the nervous system. This system is designed to keep us safe in times of danger. However, traumatic experiences can also engage this trauma response. ACES are likely to be considered chronic, persistent and recurring over a longer period of time. This can cause a child’s stress response system to be engaged for an extended period. When this occurs, the stress is considered to be “toxic” to the child’s overall health.

Effects of ACES on Child Development

Toxic stress/trauma from ACES can negatively impact child development and may present in children in the following ways:

• Challenging Behaviors at Home and/or School Children with Internalizing behaviors may appear withdrawn, complain of physical ailments, such as stomach aches or headaches, or may appear to be distant or away in a “daze” Children with Externalizing Behaviors may have angry or aggressive outbursts
• Executive Functioning: children may have difficulty following directions, starting and completing tasks, maintaining focus
• Attachment Difficulties: a child may have difficulty forming relationships with adults and other children or they may become overly attached to one person or have more intense separation anxiety
• Hypervigilance: child may startle easily or have difficulty tuning out environmental sounds; can resemble inattention  Hostile attribution bias: may tend to perceive others’ behavior as hostile and become easily upset because their nervous system is on the defensive

What if I have a high ACES score?

It is important to know that ACEs are common experiences. 61% of people surveyed indicated they had experiences at least one ACE, and 1 in 6 adults reported they had experienced four or more ACEs. There are ways to combat the effects of having a high ACEs score. Increasing resilience, or the ability to bounce back from stress, is an important way to reduce the effects of chronic stress and Adverse Childhood Experiences.

How Can I Prevent ACES?

Raise awareness of ACES and the effects of ACES. Create safe, nurturing environments for children. Research shows that just one positive, nurturing adult can help a child cope with adversity and dramatically change the outcomes for a child experiencing toxic stress.

What is Resilience?

Resilience is the ability to recover or adjust to misfortune or change. Resilient people have positive characteristics, or protective factors, that help them “bounce back” from stress. Protective factors include:

• Initiative: using independent thought and action to meet needs
•  Attachment/Relationships: mutual, strong, long-lasting relationship with caring adults and caregivers
• Self-regulation: regulate frustration, self-soothe, express and name feelings Protective Factors can be strengthened and nurtured in children with the support of the important and caring adults in a child’s life.

The great news is resiliency skills can be learned and strengthened! We can teach our children ways to cope to become resilient in the face of adversity. You can get support from a mental health professional to help you and your family find ways to increase resilience and buffer the effects of ACES and experiences of trauma.