Adverse Childhood Experiences (ACEs)

Adverse Childhood Experiences: How Childhood Can Affect Adult Health

Childhood experiences can influence how we respond to stress, relate to other people and experience ourselves. They can also have consequences for physical health long after childhood has ended.

Adverse Childhood Experiences (ACEs) are potentially traumatic experiences occurring before the age of 18. They include abuse, neglect and circumstances that undermine a child’s sense of safety, stability or care, such as violence at home, parental separation or living with someone affected by substance misuse.

How can childhood experiences affect adult life?

When a child repeatedly faces threat or distress without sufficient protection and support, the stress response may remain activated for prolonged periods. This is sometimes described as toxic stress. It can affect developing stress-response and immune systems, as well as attention, learning and emotional functioning.

In later life, a history of trauma may be associated with difficulty regulating emotions, persistent alertness to danger, emotional withdrawal, sleep problems or difficulties with trust and closeness. These responses vary considerably: people with similar childhood histories can experience very different outcomes.

What does research tell us about health?

The original CDC–Kaiser Permanente ACE study found that exposure to more categories of childhood adversity was associated with higher rates of several health problems and behaviours that can harm health in adulthood. These included depression, suicide attempts, problematic alcohol and drug use, smoking and several physical illnesses.

Subsequent research has found associations with conditions including coronary heart disease, stroke, asthma, chronic obstructive pulmonary disease and diabetes. These are statistical associations, not evidence that childhood adversity caused a particular person’s illness. Physical health, mental health, relationships and social circumstances can interact over time.

A history of adversity does not mean that illness is inevitable. Equally, physical symptoms should not automatically be attributed to trauma: they may require medical assessment and treatment.

ACE screening questions

The following questions summarise the ten areas covered by the ACEs Aware adult questionnaire. The wording has been simplified for this page.

For each question, consider your experiences before your 18th birthday. You can read the questions without submitting anything. If they bring up distress, you can pause or leave them for another time.

  1. Basic care: Were food, clean clothing, protection or someone to care for you missing from your childhood?
  2. Loss of a parent: Was a parent lost to you because of separation or divorce, abandonment, death or another reason?
  3. Mental health in the household: Did someone you lived with experience depression or mental illness, or make a suicide attempt?
  4. Alcohol or drug problems: Did someone in your household have difficulties with alcohol, drugs or the misuse of prescribed medication?
  5. Violence between adults: Did parents or other adults at home physically attack one another or threaten physical harm?
  6. Imprisonment: Was someone you lived with sent to jail or prison?
  7. Emotional abuse: Were you subjected to insults, humiliation or verbal abuse by a parent or another adult at home?
  8. Physical abuse: Were you physically harmed by a parent or another adult at home, for example through beating or kicking?
  9. Emotional neglect: Did you feel unloved within your family, or that nobody regarded you as special?
  10. Sexual abuse: Were you subjected to unwanted sexual touching or sexual acts, including oral, anal or vaginal penetration?

What does an ACE score mean?

Each “Yes” response contributes one point, giving a total from 0 to 10. The score counts categories of experience, rather than individual incidents.

It does not measure how severe or prolonged those experiences were, how they affected you, or what protection and support were available. It also leaves out other potentially significant experiences, such as bullying, discrimination and violence outside the home.

An ACE score is not a diagnosis, a measure of personal damage or a reliable prediction of an individual’s future health. Research shows that ACE scores can identify differences in average risk between groups while predicting individual outcomes poorly. A low score does not rule out significant trauma; a high score does not determine your future.

Complete the questionnaire

If you would like to explore how childhood experiences may relate to your current difficulties, you can complete the questionnaire using the link below and submit your responses to us.

Your answers can provide a starting point for a conversation about your history, its possible effects and the support that may be useful now.

Complete and submit the ACE questionnaire

More about ACEs in Ted Talk

 

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