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The Cleveland Clinic (2023) defined adverse childhood experiences (ACEs) as negative experiences, typically traumatic events, that occur between the ages of one and 17 years old. The Centers for Disease Control and Prevention (CDC) (2024) also included in its definition of ACEs any event that impacts a child's sense of safety, stability, and bonding. ACEs are associated with negative impacts on an individual's health later in life, such as mental health conditions, chronic physical health conditions, and substance abuse disorder (The Cleveland Clinic, 2023).

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ACEs during childhood are associated with an overall negative impact on physical health, quality of life, and access to opportunities, such as career and education throughout adulthood (The Cleveland Clinic, 2023). Individuals who experience ACEs during childhood are at an increased risk for developing chronic health conditions such as cancer, diabetes, heart disease, and high blood pressure. ACEs are also associated with behavioral and mental health conditions into adulthood, including anxiety, depression, PTSD, phobias, insomnia, mood disorders, substance abuse disorder, and eating disorders (The Cleveland Clinic, 2023). The Cleveland Clinic (2023) reported that "ACEs can decrease a person’s overall life expectancy by nearly 20 years compared to a person who doesn’t have any ACEs."

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The Cleveland Clinic (2023) reported that, according to one study, 60% to 80% of adults in the United Sates have experienced at least one type of adverse childhood experience. According to the same study, 1 in 6 adults in the United States reported that they experienced four or more ACEs between the ages of 1 and 17 (The Cleveland Clinic, 2023). The CDC (2024) reported similar findings, reporting that about 64% of adults in the United States reported they experienced at least one adverse childhood experience before age 18 and 17.3% of adults reported experiencing four or more.

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All children are at risk for experiencing adverse childhood experiences. Research supports, however, that girls, minority racial or ethnic groups, children living in homes experiencing socioeconomic challenges, children of parents/caregivers experiencing stress, and children with family members or friends diagnosed with substance abuse disorder or a mental health condition are more likely to experience ACEs than other children (The Cleveland Clinic, 2023). The CDC (2024) also identified females, non-Hispanic American Indian or Alaska Native adults, and adults who are unemployed or unable to work as the most common adult groups to report having experienced adverse childhood experiences in their youth. These inequities are related to the historical, social, and economic environments in which many racial/ethnic minority groups and economically disadvantaged families live and work (CDC, 2024).

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Traumatic events can be particularly harmful to children's development because the brain is still growing and developing (The Cleveland Clinic, 2023). When children experience ACEs, they experience toxic stress from an over production of stress hormones responsible for the fight-or-flight stress response, such as adrenaline and cortisol. The brain spends too long in "survival mode", negatively impacting the development of the hippocampus (responsive for memory), amygdala (responsible for processing emotions), and prefrontal cortex (responsible for logical thinking) by weakening these areas of the brain (The Cleveland Clinic, 2023). Disruptions to these areas of brain development affects children’s attention, decision-making, and learning (CDC, 2024). In addition to brain development, toxic stress can also negatively affect the immune system and stress-response systems (CDC, 2024).

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According to the Cleveland Clinic (2023), the most common causes of adverse childhood experiences (ACES) include: violence, abuse (physical, emotional, sexual), neglect, loss of a friend or family member, missing parental figure or divorce, disrupted living situation, lack of access to healthcare, financial challenges, being unhoused or moving frequently, and discrimination. Other examples of ACEs include having a family member attempt or die by suicide, food scarcity, or instability due to a household member being incarcerated in jail or prison (CDC, 2024). It is important to note, however, that not every child reacts to the same experience in the same way (The Cleveland Clinic, 2023). For example, it is possible for two children to experience the same traumatic event but for only one of those children to develop long-term stress and later impact to their health as a result of the event (The Cleveland Clinic, 2023).

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It is not possible to prevent children from experiencing all traumatic events (The Cleveland Clinic, 2023). The risk of exposing children to trauma can be reduced by parents and caregivers, however, by providing safe and nurturing home environments, building positive relationships, meeting children's physical and emotional needs, and seeking and accepting support as needed as a caregiver (The Cleveland Clinic, 2023).

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ACEs Aware. (2025). Benefits of screening for ACEs. https://www.acesaware.org/learn-about-screening/benefits-of-ace-screening/

Bhushan, D. (2021, September 9). How educators can address childhood adversity and toxic stress. Kaiser-Permanente. https://thrivingschools.kaiserpermanente.org/how-educators-can-address-childhood-adversity-and-toxic-stress/

Centers for Disease Control and Prevention (CDC). (2021, April 6). About the CDC-Kaiser ACE study. https://www.cdc.gov/violenceprevention/aces/about.html

Centers for Disease Control and Prevention (CDC). (2024, 2024, October 8). About adverse childhood experiences. https://www.cdc.gov/aces/about/index.html

Harvard University. (2018, August 3). ACEs and toxic stress: Frequently asked questions. https://developingchild.harvard.edu/resources/infographics/aces-and-toxic-stress-frequently-asked-questions/

Murphey, M. & Sacks, V. (2019). Supporting students with adverse childhood experiences: How educators and schools can help. https://www.aft.org/ae/summer2019/murphey_sacks

Spokane Regional Health District. Stress and early brain growth: Understanding adverse childhood experiences (ACEs). https://gucchd.georgetown.edu/projects/docs/handout-ACES_Stress%20and%20Early%20Brain%20Growth.pdf

The Cleveland Clinic. (2023, April 4). Adverse childhood experiences (ACEs) & childhood trauma. https://my.clevelandclinic.org/health/symptoms/24875-adverse-childhood-experiences-ace

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According to the CDC (2024), three in four (75%) high school students reported experiencing at least one adverse childhood experience, while one in five (20%) reported experiencing four our more. The most common adverse childhood experiences reported among high school students were emotional abuse, physical abuse, and living in a household affected by substance abuse or a mental health disorder (CDC, 2024).

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Prolonged, or "toxic" stress, refers to the excessive activation of the stress response system (National Scientific Council on the Developing Child, as cited by Harvard University, 2018). Prolonged, toxic stress impacts brain development, the immune system, metabolic regulatory systems, and cardiovascular system (Harvard University, 2018). Damage to the developing brain can reduce a child's ability to respond, lowers tolerance for stress, increases difficulty in making friends and maintaining relationships, and increases problems with learning and memory (Spokane Regional Health District).

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handout-ACES_Stress and Early Brain Growth

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The CDC (2024) reported that up to 1.9 million heart disease cases and 21 million depression cases could potentially have been avoided by preventing ACEs. Additionally, "preventing ACEs could reduce suicide attempts among high school students by as much as 89%, prescription pain medication misuse by as much as 84%, and persistent feelings of sadness or hopelessness by as much as 66%." (CDC, 2024). ACEs also pose an economic burden. It is estimated that $748 billion annually are spent in the United States, Canada, and Bermuda for treating ACEs-related health concerns (CDC, 2024).

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ACEs can have lifelong effects on an individual's health, well-being, and life opportunities, including education and job potential (CDC, 202). Individuals who have experienced ACEEs are at in increased risk of injury, sexually transmitted diseases, involvement in sex trafficking, maternal and child health problems, teen pregnancy, pregnancy complications, and fetal death (CDC, 2024). Additionally, individuals may also have difficulty forming healthy and stable relationships, have unstable work histories as adults, struggle with finances and job stability, and suffer from depression throughout life (CDC, 2024). The impacts of ACEs can be biologically passed down to an individuals own children and future generations (CDC, 2024).

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The CDC (2024) has identified several strategies for treating the effects of ACEs in children and adults, including trauma-informed practices and therapeutic interventions. However, the best approach to treating ACEs is prevention (CDC, 2024). Communities can prevent ACEs by reducing sources of stress through meeting children's basic needs, ensuring access to supportive and responsive relationships, and strengthening life skills (Harvard University, 2018). The CDC (2024) also emphasizes the importance of offering affordable and high-quality childcare, after school activities, economic supports for families, enhancing parenting skills, and intervening to lessen harms and future risk, particularly in those communities where children are at a higher risk for experiencing ACEs (CDC, 2024).

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Centers for Disease Control and Prevention (CDC)

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The CDC-Kaiser Permanente adverse childhood experiences (ACE) study was conducted at Kaiser Permanente from 1995 to 1997. In the study, 17,000 individuals completed confidential health questionnaires regarding their childhood experiences and current health status while receiving their physical exam. Information was collected on each individual's childhood experience with abuse, neglect, household challenges, and other socio-behavioral factors (CDC, 2021).

The Kaiser Permanente Study categorized ACEs into three categories: abuse, neglect, and household challenges (CDC, 2025). The study identified the following ACEs:

Abuse: Emotional, Physical, Sexual

Household Challenges: Mother treated violently, substance abuse in household, mental illness in household, parental separation or divorce, incarcerated household member

Neglect: Emotional, Physical

Nearly two-thirds of the study participants reported at least one ACE, and more than one in five reported three or more ACEs (CDC, 2021). The study also concluded tat certain populations are more likely to experience ACEs than others due to social and economic factors (CDC, 2021).

Another major finding concluded that as the number of ACEs an individual experiences increases, so does their risk for negative outcomes (CDC, 2021).

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An ACEs-based screener assessment can help identify individuals who have experienced adverse childhood experiences (Harvard University, 2018). Individuals are given an ACE score after completing the screener assessment to identify individuals who may benefit from services, such as therapeutic interventions, trauma-informed care practices, or social services (Harvard University, 2018). Screening adult and pediatric patients for ACEs helps to provide more effective and equitable healthcare with the appropriate targeted interventions tailored to individual's life experiences (ACEs Aware, 2025).

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The Pediatric ACEs and Related Life Events Screener (PEARLS) - CHILD - Caregiver Report is an assessment tool designed to evaluate adverse childhood experiences (ACEs) and social determinants of health for children (ACEs Aware, 2025). The PEARLS assessment is also available as a caregiver and self-report assessment for teenagers.

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Educators and schools can foster positive relationships with students who have experienced trauma to help students recover and build resiliency (Murphey and Sacks, 2019). It is important not to single out students who have experienced ACEs, but rather to create safe and supportive schools for all students. One way educators can achieve this through strengthening interpersonal relationships and social and emotional skills for students. Research supports that positive, supportive relationship with one or more adults is one of several protective factors that can prevent or mitigate the negative effects of childhood adversity (Murphey and Sacks, 2019). Additionally, educators must support students' physical and mental health needs, which requires sufficient training in trauma-informed practices and mental health concerns (Murphey and Sacks, 2019). Finally, educators can advocate for the discontinuation of existing school-wide practices that cause trauma or toxic stress for students (Murphey and Sacks, 2019).

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Bhushan stated that trauma-informed schools are "designed to create feelings of safety for all students, particularly for those students whose brains and bodies are in a state of hypervigilance via toxic stress" (2021). Educators can implement trauma-informed practices in their classrooms such as creating predictable routines and social interactions, calm physical environments, transparent and predictable rules, and clear, nonpunitive consequences for violating rules (Bhushan, 2021). It is also vital that educators explicitly teach and reinforce social-emotional skills to students and collaborate with families and communities (Bhushan, 2021).

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Explicitly Teach & Positively Reinforce Social-Emotional Skills

Build Positive Relationships with Students

Collaborate with Families and Community Partners

Establish Predictable Classroom Routines & Expectations

Use Clear, Nonpunitive Consequences for Violating Classroom/School Expectations