Adverse Childhood Experiences (ACEs)? Growing up (prior to age 18) in a household with: Recurrent physical abuse. Recurrent emotional abuse. Sexual abuse. An alcohol or drug abuser. An incarcerated household member. Someone who is chronically depressed, suicidal, institutionalized or mentally ill. Mother being treated violently. One or no parents. Emotional or physical neglect.

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What are Adverse Childhood Experiences (ACEs)?
Growing up (prior to age 18) in a household with:
1. Recurrent physical abuse.
2. Recurrent emotional abuse.
3. Sexual abuse.
4. An alcohol or drug abuser.
5. An incarcerated household member.
6. Someone who is chronically depressed, suicidal, institutionalized or mentally ill.
7. Mother being treated violently.
8. One or no parents.
9. Emotional or physical neglect.

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The Adverse Childhood Experiences (ACE) Study is one of the largest
investigations ever conducted on the links between childhood maltreatment and
later-life health and well-being.
As a collaboration between the Centers for Disease Control and Prevention and
Kaiser Permanente’s Health Appraisal Clinic in San Diego, Health Maintenance
Organization (HMO) members undergoing a comprehensive physical examination
provided detailed information about their childhood experience of abuse, neglect,
and family dysfunction. Over 17,000 members chose to participate.
To date, over 30 scientific articles have been published and over 100 conference
and workshop presentations have been made.
The ACE Study findings suggest that these experiences are major risk factors for
the leading causes of illness and death as well as poor quality of life in the United
States. Progress in preventing and recovering from the nation's worst health and
social problems is likely to benefit from the understanding that many of these
problems arise as a consequence of adverse childhood experiences.

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The ACE pyramid represents the conceptual framework for the Study.
During the time period of the 1980s and early 1990s information about risk factors for disease had been widely researched
and merged into public education and prevention programs. However, it was also clear that risk factors, such as smoking,
alcohol abuse, and sexual behaviors for many common diseases were not randomly distributed in the population. In fact, it
was known that risk factors for many chronic diseases tended to cluster, that is, persons who had one risk factor tended to
have one or more others.
Because of this knowledge, the ACE study was designed to assess what we considered to be “scientific gaps” about the
origins of risk factors. These gaps are depicted as the two arrows linking Adverse Childhood Experiences to risk factors that
lead to the health and social consequences higher up the pyramid.
Specifically, the study was designed to provide data that would help answer the question: “If risk factors for disease,
disability, and early mortality are not randomly distributed, what influences precede the adoption or development of them?”
By providing information to answer this question, we hoped to provide scientific information that would be useful for the
development of new and more effective prevention programs.
The ACE Study takes a whole life perspective, as indicated on the orange arrow leading from conception to death. By
working within this framework, the ACE Study began to progressively uncover how childhood stressors (ACEs) are strongly
related to development and prevalence of risk factors for disease and health and social well-being throughout the lifespan.

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Childhood abuse, neglect, and exposure to other traumatic stressors which we term adverse childhood
experiences (ACEs) are common. Almost two-thirds of our study participants reported at least one
ACE, and more than one in five reported three or more ACEs. The short- and long-term outcomes of
these childhood exposures include a multitude of health and social problems. The ACE Study uses
the ACE Score, which is a count of the total number of ACEs respondents reported.
The ACE score is used to assess the total amount of stress during childhood and has demonstrated that
as the number of ACEs increase, the risk for the following health problems increases in a strong and
graded fashion:
1. alcoholism and alcohol abuse
2. chronic obstructive pulmonary disease (COPD)
3. depression
4. fetal death
5. health-related quality of life
6. illicit drug use
7. ischemic heart disease (IHD)
8. liver disease
9. risk for intimate partner violence
10. multiple sexual partners
11. sexually transmitted diseases (STDs)
12. smoking
13. suicide attempts
14. unintended pregnancies
In addition, the ACE Study has also demonstrated that the ACE Score has a strong and graded
relationship to health-related behaviors and outcomes during childhood and adolescence including
early initiation of smoking, sexual activity, and illicit drug use, adolescent pregnancies, and suicide
attempts. Finally, as the number of ACEs increases the number of co-occurring or “co-morbid”
conditions increases.

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