Aces Pyramid

The Adverse Childhood Experiences (ACEs) Pyramid--Centers for Disease Control and Prevention (CDC)

Aces Graph

Association between ACEs and Negative Outcomes--CDC and Kaiser ACEs Study

Adverse Childhood Experiences

Adverse Childhood Experiences (ACEs) are stressful or traumatic events outside of the child’s control whose negative effects can be long lasting and severe. ACEs include such things as physical and emotional abuse and neglect, sexual abuse, violence, substance misuse or mental illness in the household, parental separation, and death or incarceration of a household member. But ACEs also include more subtle and prevalent adverse experiences including economic hardship and discrimination.

ACEs are related to short- and long-term negative physical and mental health consequences among children and adults. Studies over the last three decades have emphasized the impact of ACEs and stressed the importance of focusing on prevention efforts and addressing trauma in care planning and implementation.

ACEs Research

ACEs research stems from a landmark 1997 study led by the Centers for Disease Control (CDC) and Kaiser Permanente, which surveyed 17,000 health maintenance organization (HMO) members about their childhood experiences. The study, and subsequent research, demonstrated a strong relationship between ACEs, substance use conditions, and mental health conditions, such as depression and anxiety.

When children are exposed to chronic stressful events, their neurodevelopment can be interrupted. High exposure to ACEs is also correlated with increased risk of social, emotional and cognitive impairment, and educational, social and emotional challenges. In adolescence, children who have been exposed to ACEs may adopt negative and risky coping mechanisms such as substance use, violence and self-harm that can affect long-term health conditions in adulthood.

ACEs also are associated with many chronic physical diseases, such as heart disease and stroke, lung cancer, COPD and liver disease. In addition, studies have indicated that there appears to be a correlation between the number and intensity of adverse childhood experiences an individual is exposed to– the cumulative dose – and the propensity for having a number of health, social and behavioral problems throughout their lifetime (CDC-Kaiser).

Given the numerous studies and associated evidence that link ACEs to negative impacts on physical and emotional health outcomes throughout one’s lifetime, it is imperative that policy makers focus on efforts to prevent such experiences and to intervene as early as possible when they occur.


of study participants reported physical abuse


of study participants reported sexual abuse


of study participants reported two or more ACEs


of study participants reported four or more ACEs