What are adverse childhood experiences?

Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years). For example:

• experiencing violence, abuse, or neglect
• witnessing violence in the home or community
• having a family member attempt or die by suicide

Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding, such as growing up in a household with:

• substance use problems
• mental health problems
• instability due to parental separation or household members being in jail or prison

Please note the examples above are not a complete list of adverse experiences. Many other traumatic experiences could impact health and wellbeing.

ACEs are linked to chronic health problems, mental illness, and substance use problems in adolescence and adulthood. ACEs can also negatively impact education, job opportunities, and earning potential. However, ACEs can be prevented.

How big is the problem?

ACEs are common. About 61% of adults surveyed across 25 states reported they had experienced at least one type of ACE before age 18, and nearly 1 in 6 reported they had experienced four or more types of ACEs.

Preventing ACEs could potentially reduce many health conditions. For example, by preventing ACEs, up to 1.9 million heart disease cases and 21 million depression cases could have been potentially avoided.

Some children are at greater risk than others. Women and several racial/ethnic minority groups were at greater risk for experiencing four or more types of ACEs.

ACEs are costly. The economic and social costs to families, communities, and society totals hundreds of billions of dollars each year. A 10% reduction in ACEs in North America could equate to an annual savings of $56 billion.

What are the consequences?

ACEs can have lasting, negative effects on health, well-being, as well as life opportunities such as education and job potential. These experiences can increase the risks of injury, sexually transmitted infections, maternal and child health problems (including teen pregnancy, pregnancy complications, and fetal death), involvement in sex trafficking, and a wide range of chronic diseases and leading causes of death such as cancer, diabetes, heart disease, and suicide.

ACEs and associated social determinants of health, such as living in under-resourced or racially segregated neighborhoods, frequently moving, and experiencing food insecurity, can cause toxic stress (extended or prolonged stress). Toxic stress from ACEs can negatively affect children’s brain development, immune systems, and stress-response systems. These changes can affect children’s attention, decision-making, and learning.

Children growing up with toxic stress may have difficulty forming healthy and stable relationships. They may also have unstable work histories as adults and struggle with finances, jobs, and depression throughout life. These effects can also be passed on to their own children. Some children may face further exposure to toxic stress from historical and ongoing traumas due to systemic racism or the impacts of poverty resulting from limited educational and economic opportunities.

How can we prevent adverse childhood experiences?

ACEs are preventable. To prevent ACEs, we must understand and address the factors that put people at risk for or protect them from violence.

Creating and sustaining safe, stable, nurturing relationships and environments for all children and families can prevent ACEs and help all children reach their full potential. CDC has produced a resource, Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidence, to help states and communities use the best available evidence to prevent ACEs. It features six strategies from the CDC Technical Packages to Prevent Violence.

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.

Let’s help all children reach their full potential and create neighborhoods, communities, and a world where every child thrives.

Did you know that negative experiences in childhood and the teenage years may put children at risk for chronic health problems, mental illness, and substance use in adulthood? These negative experiences are known as adverse childhood experiences (ACEs). ACEs are potentially traumatic experiences, such as neglect, experiencing or witnessing violence, and having a family member attempt or die by suicide, that occur in childhood (birth to 17) that can affect children for years and impact their life opportunities. Fortunately, we can prevent ACEs and we can educate parents, communities, and policymakers about how to help children grow up in a safe and stable environment.

This page explores risk factors (things that increase the likelihood of experiencing ACEs) and protective factors (things that protect people and decrease the possibility of experiencing ACEs). Individual, family, and community factors can affect the likelihood of these experiences, but they may or may not be direct causes of ACEs. Because ACEs include many different types of experiences, including abuse, neglect, household challenges, and other traumatic events that may occur outside the home such as bullying, teen dating violence, and witnessing community violence, there are many risk and protective factors that apply to the range of different ACEs. This page lists examples of the many common risk and protective factors that are related to multiple ACEs, but may not be related to all ACEs. This list is not meant to be exhaustive. It is also important to note that experiencing some ACEs can increase the risk of experiencing other ACEs. Although some risk and protective factors are at the individual and family level, no child or individual is at fault for the ACEs they experience.

Please note the term “caregiver” will be used throughout to refer to parents and those who care for children but may not be biological parents.

Risk Factors

Individual and Family Risk Factors

• Families experiencing caregiving challenges related to children with special needs (for example, disabilities, mental health issues, chronic physical illnesses)
• Children and youth who don’t feel close to their parents/caregivers and feel like they can’t talk to them about their feelings
• Youth who start dating early or engaging in sexual activity early
• Children and youth with few or no friends or with friends who engage in aggressive or delinquent behavior
• Families with caregivers who have a limited understanding of children’s needs or development
• Families with caregivers who were abused or neglected as children
• Families with young caregivers or single parents
• Families with low income
• Families with adults with low levels of education
• Families experiencing high levels of parenting stress or economic stress
• Families with caregivers who use spanking and other forms of corporal punishment for discipline
• Families with inconsistent discipline and/or low levels of parental monitoring and supervision
• Families that are isolated from and not connected to other people (extended family, friends, neighbors)
• Families with high conflict and negative communication styles
• Families with attitudes accepting of or justifying violence or aggression

Community Risk Factors

• Communities with high rates of violence and crime
• Communities with high rates of poverty and limited educational and economic opportunities
• Communities with high unemployment rates
• Communities with easy access to drugs and alcohol
• Communities where neighbors don’t know or look out for each other and there is low community involvement among residents
• Communities with few community activities for young people
• Communities with unstable housing and where residents move frequently
• Communities where families frequently experience food insecurity
• Communities with high levels of social and environmental disorder

Protective Factors

Individual and Family Protective Factors

• Families who create safe, stable, and nurturing relationships, meaning, children have a consistent family life where they are safe, taken care of, and supported
• Children who have positive friendships and peer networks
• Children who do well in school
• Children who have caring adults outside the family who serve as mentors/role models
• Families where caregivers can meet basic needs of food, shelter, and health services for children
• Families where caregivers have college degrees or higher
• Families where caregivers have steady employment
• Families with strong social support networks and positive relationships with the people around them
• Families where caregivers engage in parental monitoring, supervision, and consistent enforcement of rules
• Families where caregivers/adults work through conflicts peacefully
• Families where caregivers help children work through problems
• Families that engage in fun, positive activities together
• Families that encourage the importance of school for children

Community Protective Factors

• Communities where families have access to economic and financial help
• Communities where families have access to medical care and mental health services
• Communities with access to safe, stable housing
• Communities where families have access to nurturing and safe childcare
• Communities where families have access to high-quality preschool
• Communities where families have access to safe, engaging after school programs and activities
• Communities where adults have work opportunities with family-friendly policies
• Communities with strong partnerships between the community and business, health care, government, and other sectors
• Communities where residents feel connected to each other and are involved in the community
• Communities where violence is not tolerated or accepted

ACEs don’t have a single cause, and they can take several different forms. Many factors contribute to ACEs, including personal traits and experiences, parents, the family environment, and the community itself. To prevent ACEs and protect children from neglect, abuse, and violence, it’s essential to address each of these factors.

Adverse childhood experiences (ACEs) can have lasting, negative effects on health, well-being, and opportunity. ACEs and their associated harms are preventable. Creating and sustaining safe, stable, nurturing relationships and environments for all children and families can prevent ACEs and help all children reach their full health and life potential.

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, we must understand and address these risk and protective factors.

CDC has produced a resource, Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidence, to help states and communities take advantage of the best available evidence to prevent ACEs. It features six strategies from the CDC Technical Packages to Prevent Violence. The strategies and their corresponding approaches are listed in the table below.

Youth-serving and faith-based organizations, coaches, and caregivers can help prevent adverse childhood experiences (ACEs). Raising awareness of ACEs in communities about how to prevent these experiences can help children and youth grow up and thrive in a safe, stable environment.

What are ACEs?

Traumatic experiences in childhood and teenage years may put children at risk for violence, chronic health problems, mental illness, and substance abuse in adulthood. These traumatic experiences are known as adverse childhood experiences (ACEs). These experiences can affect children for years and impact their potential in life.

ACEs may take many forms, including:

• experiencing violence, abuse, or neglect
• witnessing violence in the home or community
• having a family member attempt or die by suicide

Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding such as growing up in a household with:

• substance use problems
• mental health problems
• instability due to parental separation or household members being in jail or prison

Raising Awareness of ACEs

The first step to helping young people at risk for ACEs is for everyone in our communities to better understand these experiences. ACEs are far more common than many people realize. About 6 in 10 adults surveyed reported experiencing at least one ACE before age 18, and nearly 1 in 6 of them reported experiencing four or more different types of ACEs.

ACEs have many long-term consequences. ACEs put individuals at risk for chronic health problems, mental illness, and substance use problems in adulthood. For example, there is evidence that these childhood stresses can put people at risk for heart disease and depression later in life. ACEs can also negatively impact education and job opportunities.

Fortunately, educating youth-serving and faith-based organizations, coaches, and caregivers and raising community awareness about ACE prevention and helping children and youth who have experienced ACEs, can help children and youth grow up and thrive in a safe, stable environment.

How to Help Prevent ACEs

The good news is that ACEs are preventable. The harmful effects of ACEs can affect everyone in our communities, and everyone can help prevent them. By implementing ACE prevention strategies and acting quickly when an ACE happens, communities can help all children and youth reach their full potential.

Here are some strategies to help prevent ACEs:

Strengthen families’ financial stability

Community organizations such as faith-based and youth-serving organizations can promote policies that support families facing financial problems or help parents balance work and family responsibilities, which reduce stress and allow parents to meet children’s basic needs.  Examples include:

• Policies that support employers offering paid time off to care for a newborn or family member
• Policies that provide families assistance with childcare costs and healthy nutrition
• Providing income or child tax credits for working families
• Offering flexible and consistent work schedules

Promote social norms that protect against violence

Encourage community organizations such as youth-serving and faith-based organizations, coaches, and caregivers to promote non-violent attitudes, beliefs, and behaviors. Examples include:

• Supporting parents and positive parenting practices
• Encouraging people to speak up when they see violence
• Involving men and boys in prevention efforts
• Educating parents and caregivers that it’s okay to ask for help

Help kids have a good start

Involved parents, strong preschool programs, and good quality childcare get children started on the right foot and help them succeed later. Youth-serving and faith-based organizations can contribute to this as well. Examples include:

• Getting caregivers involved in early learning programs
• Ensuring childcare facilities at faith-based or youth-serving organization are licensed and accredited
• Helping improve access to affordable, high-quality childcare and preschool programs
• Offering in-home support and training in child health and development

Teach healthy relationship skills

Children and caregivers can both learn how to create healthy relationships and manage their emotions. Teens, while participating in faith-based or youth organizations, can learn about safe dating. Examples include:

• Teaching children and youth how to handle conflict(s), negative feelings, and peer pressures
• Offering programs that teach skills for developing healthy, non-violent dating and peer relationships
• Teaching healthy parenting skills to parents and caregivers
• Helping parents or caregivers learn ways to support their children and set a good example with their behaviors

Connect youth with caring adults and activities

Community organizations connect young people with positive role models and provide activities for young people to learn leadership and other new skills. Communities can help young people grow and succeed at school and in life. Examples of ways organizations can connect youth to caring adults and activities include:

• Enrolling them in school or community mentoring programs
• Getting them involved in after-school activities
• Giving them opportunities to build confidence and practice leadership skills
• Offering a training opportunity in the arts, media, sports, science, or technology

Intervene to lessen immediate and long-term harms

When ACEs occur, community organizations, can offer services and support to reduce harms and help break the cycle of adversity. Examples include:

• Learning more about ACEs and what support is available for kids, teens, and adults
• Offering medical, legal, housing, and other crisis intervention services as needed
• Providing therapy to reduce symptoms of depression, fear or anxiety, and behavior problems.
• Using family-centered treatment for substance misuse

Benefits of preventing ACEs

Creating safe, stable, nurturing relationships and environments while youth participate in faith-based or youth organizations can prevent ACEs and help all children and youth reach their full health and life potential. Some of the many benefits of preventing ACEs include:

• Healthier relationships
• Better performance in school
• Higher graduation rates
• Fewer mental health problems
• Less substance use
• Fewer behavior problems and less violence
• Fewer arrests for violent crimes
• Less burden and cost from violence for everyone

Everyone can play an important role in supporting a better future for kids, teens, and their families.

Healthy and happy childhoods start now. Learn how you can help!

Children and families thrive when they have access to safe, stable, nurturing relationships and environments. These relationships and environments are essential to creating positive childhood experiences and preventing adverse childhood experiences.

What are adverse childhood experiences?

Early negative events impact the health and well-being of children and the adults they become. These negative events are known as adverse childhood experiences, or ACEs. ACEs are potentially traumatic events that occur in childhood (0-17 years). For example:

• Experiencing violence or abuse
• Witnessing violence
• Having a family member attempt or die by suicide

ACEs also include aspects of the environment like growing up in a household with:

• Substance misuse
• Mental health problems
• Instability due to parental separation or household members being in jail or prison

Some adversity and stress are normal and can even be helpful so that children learn how to react to future challenges. However, if children are repeatedly exposed to adversities like abuse and neglect and unstable relationships or environments, they may experience toxic stress. Discover how toxic stress develops and evolves.

Everyone has a role to play

We all benefit when children have safe, stable, nurturing relationships and environments. Everyone can help prevent ACEs and promote positive childhood experiences by supporting children and families where you live and work.

Parents and caregivers:
Parenting is hard work! There are many things you can do to create positive childhood experiences.

• Establish a routine. Children feel secure and thrive when the environment is structured for them.
• Praise your child when she does something right. The more you praise a behavior, the more likely it is your child will behave the same way again.
• Pay attention to your child when he is trying to communicate with you. Giving him your full attention will make him feel like you care about what he has to say.
• Set aside time each day to talk and play with your child. Creating a special time lets your child know she is important and strengthens the bond between the two of you.

We know that every child and every parent is unique. You may face many different situations and challenges every day. It’s ok to ask for help.

• Reach out to babysitters, family members, or close friends.
• Discuss your concerns with your child’s doctor.
• Find out if your community offers support groups or programs for parents and caregivers.

Friends, family, and neighbors:

As a friend or neighbor, you can develop nurturing, supportive relationships with the children in your life. Offer to babysit, make a meal, or drive a parent or child where they need to go.

Coworkers:
As a coworker, you can listen and support your colleagues by encouraging them to take breaks or seek additional help if needed. You can also offer to help with their workload.

Everyone:
We can all recognize challenges that families face and offer support and encouragement to reduce stress. Everyone can promote social norms that discourage violence and help ensure the safety of all members of a community.

• Let people know that violence is unacceptable and steps will be taken to protect the victim of violence.
• Encourage people to stand up and speak up, if they can safely do so, when a person is being harassed or hurt or needs support.

We can also support community programs and policies that provide safe and healthy conditions for all children and families.

• Examples include supporting family friendly work policies like paid leave and flexible work schedules and supporting policies that strengthen household financial security based on the best available evidence.

Working together, we can help create neighborhoods, communities, and a world in which every child can thrive.