ACES: How who you were can impact who you become

What if I were to tell you that there is something out there that affects more than two-thirds of youth, causes emotional and mental health issues like anxiety, depression, suicidality, and substance abuse, and causes physical health concerns like cardiovascular disease, obesity, and cancer?

This something is out there. It is called childhood trauma.

What is Trauma?

Many people have ideas about what trauma means. As a therapist, when I refer to trauma I am referring to events that create a lasting and significant change in a child’s brain function.

The National Child Traumatic Stress Network defines a traumatic event as an experienced or witnessed event that is frightening, dangerous, or violent and poses a threat to someone’s life or security.  

These are things like:

  • Psychological, physical, or sexual abuse
  • Community or school violence
  • Witnessing or experiencing intimate partner/domestic violence
  • National disasters or terrorism
  • Commercial sexual exploitation
  • Sudden or violent loss of a loved one
  • Refugee or war experiences
  • Military family-related stressors (e.g., deployment, parental loss or injury)
  • Physical or sexual assault
  • Neglect
  • Serious accidents or life-threatening illness

What are ACES?

The CDC and Kaiser Permanente created a study on Adverse Childhood Experiences (ACES), one of the largest investigations of childhood abuse and neglect and their effects on later life and wellbeing.  It was conducted at Kaiser Permanente from 1995 to 1997 with over 17,000 participants in Southern California.  The idea behind this study is that experiences in childhood form the framework for development and behaviors later in life.

Part of this study and one of the lasting outputs of it was the ACE Questionnaire. This questionnaire collected data on various traumatic events occurring before the age of 18.

These events fell into three categories of adverse experiences:

  1. Childhood abuse, which included emotional, physical, and sexual abuse
  2. Childhood neglect, including both physical and emotional neglect
  3. Childhood household challenges, which included growing up in a household were there was substance abuse, mental illness, violent treatment of a mother or stepmother, parental separation/divorce or had a member of the household go to prison.  

The higher the number of ACEs a person had, the more likely they were to experience these adverse health outcomes. It is important to note that while the original ACES study covered these specific traumatic events, there are many other types of trauma and adverse experiences. As a result, subsequent ACE surveys have expanded the types of ACES to include new categories like:

  • Climate and community experiences
  • Personal household experiences.

These experiences include things like trauma stemming from poverty, living in a war zone, or from the chronic stress of racial or gender discrimination.

ACEs are incredibly common.  In fact, two-thirds of participants reported at least one ACE, and more than one in five reported three or more ACES.  28% of participants reported experiencing physical abuse, and 21% reported experiencing sexual abuse.  27% reported growing up in a house with substance abuse.  

The presence of various risk and protective factors influences a child’s susceptibility to having an adverse childhood experience impact them later in life. In 2015, the national average of child abuse and neglect victims was 683,000, or 9.2 out of every 1,000 children.  Additionally, more than two-thirds of children reported at least one traumatic event by age 16.

So how do these traumatic events during childhood make the impacts like I referenced earlier on?

The ACE study found major correlations between the presence of ACEs and various health outcomes.  As the number of ACEs increases, so does the risk of negative health outcomes.

These could include injury, like TBI, fractures, and burns, mental health issues, like depression, anxiety, and PTSD, maternal health issues, infectious disease like HIV and other STIs, chronic disease like cancer and diabetes, and high-risk behaviors like substance abuse.  

In addition to these physical health concerns, mental health symptoms are also common in response to ACEs. Humans are biologically conditioned to react to danger, from the time we were cavemen, in what is referred to as the fight/flight/freeze response. While this response is helpful when a trauma is occurring, it can often go haywire when that trauma is unresolved or trauma occurs on a regular basis.

When this occurs, humans begin to live in this fight/flight/freeze response and are unable to discern between ordinary stressors and those stressors that are traumatic. Essentially, a hangnail becomes as threatening as being held at gunpoint. 

So what does this all mean? Are you doomed if you have a high ACE score?

I’m here to tell you that this is not necessarily the case.

First of all, remember that the ACE score isn’t a crystal ball; it’s just meant as guidance. It tells you about one type of risk factor among many. It does not take into account various other risk and protective factors.

It’s important to remember that ACE scores don’t tally the positive experiences in early life that can help build resilience and protect a child from the effects of trauma. The good news about these positive experiences and protective factors is that these often lead to a certain amount of resiliency.

The reason that is so wonderful is that human brains are like plastic and our bodies want to heal. The brain is continually changing in response to the environment. If the toxic stress stops and is replaced by practices that build resilience, the brain can slowly undo many of the stress-induced changes.

Research suggests that just one caring, safe relationship early in life gives any child a much better shot at growing up healthy. Having a grandparent who loves you, a teacher who understands and believes in you, or a trusted friend you can confide in may mitigate the long-term effects of early trauma.

These relationships are like poison control for ACEs.

There are people with high ACE scores who do not see these effects as significantly. Research shows this is often due to resiliency. Resilience is something that builds throughout life and branches out from protective factors each individual has. At the heart of that resiliency is these close relationships and healthy attachment.

So, what else can we do?

Obviously, those protective factors are not always present, but that does not mean there are no other things you can do to help mitigate the effects of that trauma.

Just as we are biologically equipped to deal with threatening situations, that fight/flight/freeze response, our bodies are also equipped with these beautiful things called neurotransmitters, such as serotonin or dopamine, that provide feelings of security, happiness and motivation.

We can activate these positive feelings through self-care. There is well-documented research on how individuals’ brains and bodies become healthier through various self-care practices.

These can include things like mindfulness practices, exercise, good nutrition, adequate sleep, and healthy social interactions.

But these interventions may not be sufficient by themselves. Active counseling, the use of cognitive-behavioral therapy and in some cases medications or other health interventions may be needed. Recent research also suggests that “trauma-informed” therapy — which can center on art, yoga or mindfulness training for adults and things like play therapy for children— can be helpful and necessary as well.

The silver lining in all of this is that while ACES CAN define who you become, they do not have to. Interrupting the cycle of abuse and neglect must first begin with adults. It will require an integrative, preventative, and multigenerational approach that empowers individuals to heal their bodies, minds and spirits. Each and every one of us can help make a difference in someone’s life.

Want to know your ACE score?

Take the questionnaire for yourself at: