What do we know about ACEs?

Adverse Childhood Experiences (ACEs) refer to all types of abuse, neglect, and other potentially traumatic experiences.

There are known to be five direct​ and five indirect examples of ACEs.

Direct examples

• Sexual abuse by parent/carer
• Emotional abuse by parent/carer
• Physical abuse by parent/carer​
• Emotional neglect by parent/carer​
• Physical neglect by parent/carer​

Indirect examples

• Parent/carer with an alcohol or drug addiction
• Living in a household where abuse occurred​
• Family member in prison​
• Family member with a mental illness​
• An absent parent/carer ​

Lifelong impact

The Centers for Disease Control and Prevention (CDC) published a ground-breaking study on Adverse Childhood Experiences in 1998.

It found that ACEs can have long term effects on brain development, behaviours, and mental and physical health. 

• Brain development: difficulty concentrating, anxiety, depression, irritability, mood swings.
• Behaviours: smoking, excess alcohol intake, drug addiction, perpetrator of violence, sedentary.
• Mental health: depression, suicide, victim of violence.
• Physical health: chronic conditions including heart disease, cancer, COPD, diabetes, many autoimmune diseases and early death.

ACEs have also been linked to poor academic achievement and work performance, financial stress, obesity, multiple sexual partners and STIs.

ACEs score

ACEs can affect anyone and do not commonly occur in isolation. The more ACEs you have, the higher your ACEs score is. 

There is a dose-response relationship between ACEs and lasting negative impact. This means that the more ACEs a child experiences the more likely the lifelong risks to their behaviours, physical and mental health and academic and work performance are.

Childhood toxic stress

Not all stress we experience is damaging. Learning how to cope with adversity, stress and things not going our way helps to build resilience and are important parts of development for a child.

Experiencing one or more ACEs, without the protection and support of trusted adults, has been linked to what is known as toxic stress. Toxic​ stress can be caused by one or more ACEs and can impact the brain and every part of the body, leading to chronic health conditions, autoimmune diseases, and mental health issues.

Toxic stress is one of three responses to stress highlighted in a study by Harvard University. 

1. Positive 
2. Tolerable 
3. Toxic 

The study identified these terms to describe the effects on both the brain and body.

Positive stress

• A necessary aspect of healthy development occurring with the protection of stable, supportive relationships​.
• Causes brief increases to heart rate and mild changes to stress hormone levels.

Tolerable stress

• Stress responses could disrupt brain architecture but are buffered by supportive relationships.
• If this stress response is temporary, the brain and body are given the opportunity to recover from potentially damaging effects​.
• If this stress response is prolonged it can potentially result in longer-lasting difficulties.

Toxic stress

• Strong, prolonged activation of the body’s stress response systems without the protection of adult support.
• Can damage the structure and functioning of a child’s developing brain, as well as internal organs and systems, potentially resulting in lasting behavioural, physical and mental health problems. ​

Raising awareness

ACEs do not discriminate; they can happen to people at all income and social levels. Not all those with one or more ACEs will suffer negative long-term mental and physical health effects. Likewise, not all those who do not experience ACEs will avoid mental or physical health problems later in life.  

It is important to be aware of the conditions that put children at risk of ACEs so that staff are alert to risk factors and ACEs can be prevented before they happen.

Changes in behaviour, increased anxiety or disengagement are just some of the things to be aware of which may indicate a safeguarding issue. 

Management is multidisciplinary. Recognising the vulnerabilities of a child with one or more ACEs cannot be the job of one person alone. Ensuring a child/young person-centred approach to safeguarding in school and working with social workers, the police and other external agencies is essential.