Adverse Childhood Experiences (ACEs) and Their Prevention

Adverse Childhood Experiences (ACEs) are traumatic events occurring before age 18 that can have lasting effects on health and wellbeing. Learn what ACEs are, how common they are, and what can be done to prevent them.

Every child deserves to grow up feeling safe, loved, and supported. Yet for millions of children around the world, early life is marked by experiences of abuse, neglect, household dysfunction, or violence. These deeply damaging events are collectively known as Adverse Childhood Experiences, or ACEs, and their effects can last an entire lifetime.

Understanding the meaning of Adverse Childhood Experiences is not merely an academic exercise. It is a public health imperative. Research consistently demonstrates that ACEs trauma shapes brain development, disrupts hormonal systems, weakens immune responses, and fundamentally alters a child’s relationship with the world. The consequences ripple outward, affecting not just individuals but entire families, communities, and societies.

The Child Protection Global Network (CPGN) exists precisely to address this crisis. By advocating for trauma-informed policies, supporting survivors, and educating communities, CPGN works tirelessly to break the cycle of childhood adversity before it begins — and to support those already living with its consequences.

This article offers a comprehensive look at what ACEs are, where the concept came from, what the data tells us, and — most critically — what can be done to prevent ACEs from shaping the next generation of children.

What Are ACEs? Definition and Explanation

So what is an Adverse Childhood Experience, exactly? The term refers to potentially traumatic events that occur in childhood — typically defined as before the age of 18. These are not minor hardships or everyday disappointments. ACEs are serious, often repeated experiences that threaten a child’s sense of safety, stability, and belonging.

What does ACE stand for? The acronym ACE stands for Adverse Childhood Experience. The plural, ACEs, is used to capture the fact that these events rarely occur in isolation — one form of adversity often co-exists with others, compounding the harm done to a child’s developing mind and body.

The original research framework identified ten categories of ACEs, grouped into three broad domains:

Abuse

Physical abuse — being hit, kicked, punched, or physically harmed by an adult in the household
Emotional abuse — being humiliated, threatened, or made to feel worthless by a household member
Sexual abuse — contact sexual abuse by anyone, regardless of whether they lived in the household

Neglect

Physical neglect—failure to provide adequate food, shelter, clothing, or medical care
Emotional neglect—failure to provide love, belonging, emotional support, or a sense of importance

Household Dysfunction

Domestic violence — witnessing a parent or guardian being abused by an intimate partner
Substance misuse — living with a household member who abused alcohol or drugs
Mental illness — living with a household member who suffered from mental illness, depression, or suicidality
Parental separation or divorce — having parents who were separated, divorced, or never together
Incarceration — living with a household member who was imprisoned

It is important to note that contemporary public health researchers have expanded the definition beyond these original ten categories. Community-level ACEs — such as exposure to community violence, poverty, discrimination, and systemic racism — are increasingly recognized as equally significant sources of childhood adversity.

Understanding the ACEs Score

The ACEs score is a simple count of how many of the ten original ACE categories a person experienced before the age of 18. An ACEs score of 0 means no adverse experiences were reported. A score of 4 or more is considered high and is associated with substantially elevated risks for a wide range of negative health and social outcomes throughout life.

An ACEs test — sometimes called the ACE questionnaire — is a brief screening tool used by healthcare providers, educators, and researchers to identify individuals who may carry the burden of childhood trauma. It consists of ten questions corresponding to the ten original ACE categories, with each “yes” answer adding one point to the final ACEs score.

“ACEs are not destiny. But they are a powerful predictor of health and wellbeing across the lifespan. Understanding a person’s ACEs score gives healthcare providers an invaluable window into the roots of chronic illness, mental health struggles, and social challenges.”

The History of ACEs Research

The concept of Adverse Childhood Experiences as a formal research category emerged from a groundbreaking collaboration in the mid-1990s between the U.S. Centers for Disease Control and Prevention (CDC) and Kaiser Permanente’s Department of Preventive Medicine in San Diego, California.

The ACE Study was led by Dr. Vincent Felitti, Chief of Preventive Medicine at Kaiser Permanente, and Dr. Robert Anda of the CDC. The research began in 1995 and enrolled over 17,000 adults — primarily middle-class, college-educated, and employed — who were patients at a Kaiser health maintenance organization. Participants completed detailed questionnaires about their childhood experiences and their current health status, behaviors, and social circumstances.

The results, published beginning in 1998, were startling. Not only were ACEs far more common than most clinicians had assumed — even among the relatively advantaged study population — but the relationship between ACEs and adult health outcomes was deeply consequential. People with higher ACEs scores were significantly more likely to suffer from heart disease, cancer, depression, obesity, substance use disorders, and many other conditions.

The original ACE study also revealed that ACEs almost never occur alone. If a child experienced one type of adversity, the probability that they experienced others was substantially higher. This “clustering” of ACEs meant that a single adverse experience was often the visible tip of a much larger iceberg of household dysfunction.

In the decades since the original research, the ACE framework has been embraced by pediatricians, public health officials, trauma therapists, educators, and policymakers around the world. The CDC now conducts large-scale, ongoing surveillance of ACEs through its Behavioral Risk Factor Surveillance System (BRFSS), tracking the prevalence and impact of childhood adversity across U.S. states and territories. International researchers have extended the work to diverse populations across Europe, Asia, Africa, and Latin America, consistently finding that the ACE meaning — and the harm it describes — transcends national and cultural boundaries.

Adverse Childhood Experience (ACEs) Statistics: What the Data Tells Us

The ACEs statistics are sobering. They reveal not a rare or marginal phenomenon but a widespread public health crisis that quietly shapes the health trajectories of hundreds of millions of people worldwide.

ACES in the United States

According to the CDC’s most recent data drawn from the Behavioral Risk Factor Surveillance System:

Approximately 64% of U.S. adults report having experienced at least one ACE before the age of 18.
Nearly 1 in 6 U.S. adults — approximately 17% — report having experienced four or more ACEs.
Women and members of racial and ethnic minority groups consistently report higher ACE prevalence than white men.
Adults with household incomes below $15,000 per year are more than twice as likely to report four or more ACEs compared to adults with household incomes above $125,000.

Long-Term Health Consequences

The Economic Cost of ACEs

The higher a person’s ACEs score, the greater their risk for a broad range of harmful health outcomes. Research published in the American Journal of Preventive Medicine and subsequent CDC analyses have documented that, compared to individuals with no ACEs, those with four or more ACEs are:

About 7 times more likely to report alcohol dependence
About 10 times more likely to have used illicit intravenous drugs
Up to 12 times more likely to have attempted suicide
More than twice as likely to be diagnosed with heart disease, cancer, or stroke
More likely to develop chronic obstructive pulmonary disease (COPD) and liver disease

The harm caused by ACEs is not only personal — it carries a massive economic price tag. A 2019 study published in Child Abuse & Neglect estimated that ACEs cost the United States approximately $748 billion per year in direct costs (such as child welfare and healthcare expenditures) and indirect costs (such as lost productivity and criminal justice expenses).

Global Picture

Adverse childhood experiences (ACEs) are a global public health priority. These experiences are common worldwide, with a large meta-analysis of data from 22 countries reporting that 60% of adults had at least one ACE and significant proportions reporting multiple ACEs. In lower-income countries, high ACEs prevalence is compounded by limited access to mental health services, trauma-informed care, and child protection systems.

ACEs statistics are not just numbers. Behind every data point is a child whose sense of safety was violated, whose development was shaped by fear rather than security. Understanding these figures is the first step toward a collective commitment to change.

Preventing Adverse Childhood Experiences: What Works

The most important message from decades of ACEs research is this: ACEs are not inevitable. Adversity is not a fixed feature of childhood. With the right strategies — applied at the right levels of society — we can prevent ACEs from occurring in the first place, and we can build resilience in children who have already been exposed to them.

The CDC organizes ACE prevention into four complementary levels of action: strengthening economic supports, promoting social norms that protect children, ensuring strong starts for children and families, and connecting youth to caring adults and activities. Below, we explore each of these.

1. Strengthening Economic Supports for Families

Poverty is one of the strongest predictors of ACEs. Financial stress erodes parental capacity, disrupts stable housing, limits access to healthcare and nutritious food, and increases exposure to neighborhood violence. Policies that increase the minimum wage, expand access to affordable childcare, offer paid family leave, and support housing stability for low-income families directly reduce the conditions that make ACEs more likely.

2. Promoting Social Norms That Protect Children and Support Parents

ACEs are more likely to occur — and less likely to be reported — when communities normalize harsh punishment, stigmatize help-seeking, or silence survivors of abuse. Public awareness campaigns that challenge acceptance of violence against children, that promote positive parenting as a learnable skill, and that reduce the shame associated with asking for help are critical prevention tools.

Supporting survivors in sharing their stories is a powerful form of norm change. When adults speak openly about the ACEs trauma they experienced in childhood — and about how they sought help and built resilience — it helps other survivors recognize they are not alone and encourages communities to take childhood trauma seriously.

3. Ensuring Children Have Strong, Stable, Nurturing Relationships

Research in developmental neuroscience is unambiguous: the single most powerful buffer against the harmful effects of ACEs is the presence of at least one stable, caring, responsive adult in a child’s life. Programs that teach parenting skills, reduce harsh discipline, promote secure attachment, and support caregivers under stress directly protect children.

Early home visiting programs — where trained nurses or social workers visit families with newborns and young children — have been shown to significantly reduce rates of physical abuse and neglect. Quality early childhood education programs provide children with safe, stimulating environments and connect families to needed services.

4. Teaching Children and Youth Life Skills

Social-emotional learning (SEL) programs, delivered in schools and community settings, teach children how to manage difficult emotions, resolve conflicts peacefully, resist peer pressure, and build healthy relationships. These skills make children more resilient in the face of adversity and less likely to perpetuate cycles of violence and dysfunction in their own families.

5. Creating Safe, Stable, Nurturing Schools and Communities

Children spend a large portion of their waking hours at school. Schools that are trauma-informed — meaning that all staff understand ACEs, respond to challenging behaviors with compassion rather than punishment, and connect students to mental health support — can serve as powerful protective environments for children experiencing adversity at home.

Community-level interventions that reduce neighborhood violence, expand access to mental health services, and create green spaces and community gathering places also reduce the total burden of adversity experienced by children.

6. Treating ACEs Trauma — The Role of Healing

Prevention is not only about stopping ACEs from happening — it is also about reducing their long-term impact for those who have already experienced them. Trauma-focused cognitive behavioral therapy (TF-CBT), eye movement desensitization and reprocessing (EMDR), and other evidence-based therapeutic approaches have been shown to significantly reduce the psychological and physiological effects of ACEs trauma. Access to affordable, culturally competent mental health care is, therefore, an essential pillar of a comprehensive prevention strategy.

What CPGN Is Doing to Prevent ACEs

The Child Protection Global Network (CPGN) is an international organization dedicated to ending child abuse, neglect, and exploitation in all its forms. CPGN understands that preventing Adverse Childhood Experiences requires action at every level — from individual families to international policy — and its programs reflect that holistic vision.

Raising Awareness and Educating Communities

A core part of CPGN’s work is ensuring that people understand what ACEs are, how common they are, and how profoundly they shape life outcomes. Through digital content, public campaigns, and community training events, CPGN translates the ACE meaning and the research into accessible, actionable knowledge for parents, teachers, healthcare providers, and community leaders.

CPGN works to reduce the stigma that prevents families from seeking help and to build communities where protecting children is a shared, visible value — not a private matter left to individual families in crisis.

Amplifying Survivor Voices

One of CPGN’s most powerful tools for driving cultural change is creating space for survivors to share their stories. CPGN recognizes that survivor testimony is uniquely effective at shifting public attitudes and inspiring policy change. When survivors speak openly about ACEs trauma — and about the pathways to healing they discovered — they help others recognize their own experiences, reduce isolation, and motivate communities to act.

CPGN offers a safe, anonymous platform where individuals can share their personal experiences with childhood adversity. These anonymous stories serve both as a source of connection and healing for the storyteller and as powerful evidence of the reality of ACEs for policymakers, funders, and the broader public.

Advocating for Trauma-Informed Policy

CPGN engages with governments, international bodies, and institutional partners to advocate for policies grounded in the ACEs evidence base. This includes pushing for funding for early childhood programs, mandatory training in ACEs awareness for teachers and healthcare providers, trauma-informed reforms in juvenile justice systems, and stronger child protection legislation.

CPGN also works to ensure that the voices of survivors and frontline child protection professionals are centered in policy conversations — bringing lived expertise, not only academic research, to the table where decisions are made.

Supporting Frontline Child Protection Work

CPGN connects its global network of members — professionals, advocates, survivors, and organizations working in child protection around the world — to share knowledge, tools, and resources. By facilitating this exchange, CPGN helps frontline practitioners access the most current research on ACEs prevention and treatment, even in resource-limited settings.

How You Can Support CPGN's Mission

Preventing Adverse Childhood Experiences requires sustained investment. CPGN’s ability to raise awareness, support survivors, and advocate for children depends on the generosity of donors who share the belief that every child deserves a safe, nurturing childhood.

You can support CPGN’s life-changing work by making a donation. Every contribution — of any size — helps fund programs that protect children, support survivors, and build communities where ACEs are the exception rather than the norm.

Conclusion: A Shared Responsibility

Adverse Childhood Experiences are among the most consequential public health issues of our time. They are common, they are harmful, and — crucially — they are preventable. The decades of research that have followed the original ACE Study leave no room for doubt: what happens to children in their earliest years shapes who they become, how healthy they are, and how long they live.

Understanding what is ACE, recognizing an ACEs score as a window into hidden suffering, and appreciating the full meaning of Adverse Childhood Experiences is the beginning of a societal commitment to doing better for children. But understanding alone is not enough. It must be translated into action — in families, schools, healthcare systems, communities, and governments.

The Child Protection Global Network (CPGN) is leading that translation. Through education, advocacy, survivor support, and global collaboration, CPGN is building a world in which every child has the safe, stable, nurturing relationships they need to thrive.

If you have experienced ACEs yourself, you are not alone. Your experiences were not your fault, and healing is possible. If you are a professional, a caregiver, or a concerned community member, your commitment to understanding and preventing ACEs makes a real difference in the lives of children.

Together, we can break the cycle. Share your story. Support CPGN’s mission. And stand with every child who deserves better.

FAQs

How do you heal from a high ACEs score?

Healing is possible at any age. The most effective routes include trauma-focused therapy (TF-CBT or EMDR), building safe and trusted relationships, regular exercise, mindfulness, and connecting with survivor communities. A high ACEs score is not a life sentence — it is a starting point for understanding and recovery.

What are the 10 types of ACEs trauma?

The original ACE Study identified ten categories across three groups:

Abuse

Physical abuse
Emotional abuse
Sexual abuse

Neglect

Physical neglect
Emotional neglect

Household Dysfunction

Domestic violence
Substance misuse in the home
Household mental illness
Parental separation or divorce
Incarcerated household member

What is a bad ACEs score?

A score of 4 or more is considered high-risk. Research shows it is linked to significantly elevated rates of depression, heart disease, substance misuse, and other serious health conditions. A score of 6 or above has been associated with a reduction in life expectancy of up to 20 years. That said, a high score is not a fixed outcome — protective relationships and proper support can make a profound difference.