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Positive and Adverse Childhood Experiences (PCEs/ACEs)

What are ACEs?

ACEs are defined as traumatic experiences that occur in childhood and the teenage years (0-17 years) that may put children at risk for violence, chronic health problems, mental illness, and substance abuse in adulthood. ACEs can have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity; in addition to negatively impact education, job opportunities, and earning potential.

ACEs may include:

  • Experiencing violence, abuse, or neglect
  • Witnessing violence in the home or community
  • Having a family member attempt or die by suicide

The child’s environment may also play a role if their sense of safety, stability, and bonding is impacted. Examples may include growing up in a household with:

  • Substance abuse
  • Mental health problems
  • Instability due to parental separation
  • Instability due to incarceration of a parent, sibling, or other member of the household
Types of ACEs


  • Emotional
  • Physical
  • Sexual


  • Emotional
  • Physical

Household Challenges*

  • Substance use
  • Mental illness, including attempted suicide
  • Divorce or separation
  • Incarceration
  • Intimate partner violence or domestic violence

Other Adversity

  • Bullying
  • Community violence
  • Natural disasters
  • Refugee or wartime experiences
  • Witnessing or experiencing acts of terrorism
*The child lives with a parent, caregiver, or other adult who experiences one or more of these challenges.

ACEs are common and the effects can add up over time.

  • 61% of adults had at least one ACE and 16% had four or more types of ACEs.
  • Females and several groups who identify as a racial/ethnic minority were at greater risk for experiencing four or more ACEs.
  • Many people do not realize that exposure to ACEs is associated with increased risk for health problems across the lifespan.

Some groups are more likely to have experienced ACEs. Multiple studies show that people who identified as members of these groups as adults reported experiencing significantly more ACEs:

  • Black, Hispanic/Latino, or multiracial people
  • People with less than a high school education
  • People making less than $15,000 per year
  • People unemployed or unable to work
  • Lesbian, gay, bisexual, or transgender people

Preventing ACEs can help children and adults thrive and potentially:

  • Lower risk for conditions like depression, asthma, cancer, and diabetes in adulthood.
  • Reduce risky behaviors like smoking and heavy drinking.
  • Improve education and job potential.

Raising Awareness of ACEs

A step in helping young people at risk for ACEs is educating communities, youth-serving and faith-based organizations, coaches, and caregivers to gain a better understanding of these experiences.

Raising awareness of ACEs can help:

  • Change how people think about the causes of ACEs and who could help prevent them.
  • Shift the focus from individual responsibility to community solutions.
  • Reduce stigma around seeking help with parenting challenges or substance misuse, depression, or suicidal thoughts.
  • Promote safe, stable, nurturing relationships and environments where children live, learn, and play.

Understanding the Lasting Impact of ACEs

ACEs can accumulate and the effects last beyond childhood and can add up over time and affect a person throughout their life. Children who repeatedly and chronically experience adversity can suffer from TOXIC STRESS. Toxic stress happens when the brain endures repeated stress or danger, then releases FIGHT-OR-FLIGHT HORMONES like cortisol. The INTERNAL ALARM SYSTEM increases heart rate and blood pressure and damages the digestive and immune systems. Toxic stress can disrupt ORGAN, TISSUE, AND BRAIN DEVELOPMENT. Over time this can limit a person’s ability to process information, make decisions, interact with others, and regulate emotions. These consequences may follow a person into adulthood.

ACEs are associated with at least 5 of the 10 leading causes of death. 

ACEs can increase risk of poor social outcomes, disease, and death.
Research shows that experiencing a higher number of ACEs is associated with many of the leading causes of death, like heard disease and cancer.

Chronic Health Conditions

  • Coronary heart disease
  • Stroke
  • Asthma
  • Chronic obstructive pulmonary disease (COPD)
  • Cancer
  • Kidney disease
  • Diabetes
  • Obesity

Health Risk Behaviors

  • Smoking
  • Heavy drinking or alcoholism
  • Substance misuse
  • Physical inactivity
  • Risky sexual behavior

Social Outcomes

  • Lack of health insurance
  • Unemployment
  • Less than high school diploma or equivalent education

Mental Health Conditions

  • Depression
  • Suicide or attempted suicide

The consequences of ACEs can be passed down from one generation to the next if children don’t have protective buffers like positive childhood experiences or a caring adult in their lives. Also, the effects of ACEs can add up over time when families experience such events like historical and systemic racism or living in poverty for generations.

How to Help Prevent ACEs

Everyone has a role in preventing ACEs and it is important to know that ACEs and the associated harms are preventable. Creating and sustaining safe, stable, nurturing relationships and environments for children and families can prevent ACEs and help children reach their full health and life potential. There are several strategies that involve people from all sectors of society that can prevent ACEs from happening and lessen the harmful effects of ACEs that have already occurred.

Different types of violence are connected and often share the same root causes. ACEs are connected to other forms of violence through shared risk and protective factors. To prevent ACEs, it is imperative to understand and to address factors that put people at risk for or protect them from violence.

The harmful effects of ACEs can affect everyone in the community and everyone can be helpful in preventing them.

Preventing ACEs from occurring and taking quick action when an ACE happens can help all children reach their full potential.

The Centers for Disease Control and Prevention (CDC) produced a resource, Preventing Adverse Childhood Experiences (, featuring six strategies to prevent ACEs from happening as well as strategies to mitigate the harms of ACEs.

Preventing ACEs
Strategy Approach
Strengthen economic supports to families
  • Strengthening household financial security
  • Family-friendly work policies
Promote social norms that protect against violence and adversity.
  • Public education campaigns
  • Legislative approaches to reduce corporal punishment
  • Bystander approaches
  • Men and boys as allies in prevention
Ensure a strong start for children.
  • Early childhood home visitation
  • High-quality child care
  • Preschool enrichment with family engagement
Teach skills.
  • Social-emotional learning
  • Safe dating and healthy relationship skill programs
  • Parenting skills and family relationship approaches
Connect youth to caring adults and activities.
  • Mentoring programs
  • After-school programs
Intervene to lessen immediate and long-term harm.
  • Enhanced primary care
  • Victim-centered services
  • Treatment to lessen the harms of ACEs
  • Treatment to prevent problem behavior and future involvement in violence
  • Family-centered treatment for substance use disorders

How to Create Positive Childhood Experiences (PCEs) -- a Strategy to Prevent ACEs

Strengthen families' financial stability

  • Paid time off
  • Child tax credits
  • Flexible and consistent work schedules

Promote social norms that protect against violence

  • Positive parenting practices
  • Prevention efforts involving men and boys

Help kids have a good start

  • Early learning programs
  • Affordable preschool and  child care programs

Teach healthy relationship skills

  • How to handle conflict
  • Negative feeling management
  • Pressure from peers
  • Healthy non-violent dating relationships

Connect youth with activities and caring adults

  • School or community mentoring programs
  • After school activities

Intervene to lessen immediate and long-term harms

  • ACEs education
  • Therapy
  • Family-centered treatment for substance abuse

Healthy childhoods have benefits throughout life. What can happen if ACEs are prevented?

  • 15% REDUCTION in the number of adults who are UNEMPLOYED.
  • 16% REDUCTION in the number of adults with KIDNEY DISEASE.
  • 24-27% REDUCTION in the number of adults with respiratory problems, such as ASTHMA and COPD.
  • 33% REDUCTION in the number of adults who SMOKE.
  • 44% REDUCTION in the number of adults with DEPRESSION.

Positive childhood experiences can help the economy. The primary prevention of ACEs — stopping ACEs before they start — would benefit the economy and relieve pressures on health care systems. ACEs-related health consequences cost an estimated economic burden of $748 billion annually in Bermuda, Canada, and the United States. A 10% reduction in ACEs could equate to an annual savings of $56 billion.