Positive and Adverse Childhood Experiences (PCEs/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.

• 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

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.

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.

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. 

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.

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 (cdc.gov), featuring six strategies to prevent ACEs from happening as well as strategies to mitigate the harms of ACEs.

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.

• Hotlines
  • Illinois Perinatal Depression MOMsline - (866) 364-MOMS (6667)
  • Illinois Domestic Violence Helpline - (877) 863-6338
• National Resources
  • Adverse Childhood Experiences Prevention Strategy (CDC)
  • CDC ACEs webpage
  • Child Welfare Information Gateway
  • Kaiser ACE Study (CDC)
  • Preventing Adverse Childhood Experiences Technical Package (CDC)
  • Preventing Child Abuse and Neglect: A Technical Package (CDC)
  • The National Child Traumatic Stress Network
  • VetoViolence - ACEs Resources
  • VetoViolence - ACEs Training (modules for mental health providers, pediatric medical provider, educator, and faith, spiritual, and religious communities)
  • What is Epigenetics? (Center on the Developing Child-Harvard University)
  • Youth.gov - Violence Prevention
• State Resources
  • Action Plan to Address Childhood Adversity in Illinois
  • Collaborative on Child Homeless – Illinois (Illinois Chapter of the American Academy of Pediatrics)
  • Illinois ACEs Response Collaborative
  • Illinois Childhood Trauma Coalition
  • Illinois Children’s Mental Health Partnership
  • Prevent Child Abuse Illinois
  • Why Young Children and Pregnant Persons Should be Prioritized for Housing (Illinois Chapter of the American Academy of Pediatrics)
• Data-related resources (National and State)
  • ACEs - CDC Vital Signs
  • ACEs Data Brief (HRSA)
  • ACEs Data Crosswalk and PCEs Data Crosswalk
  • ACEs Infographic (CDC)
  • ACEs/PCEs in IL: Public Health Surveillance Data Crosswalk Report
  • Data to Action: Preventing ACEs (CDC)
  • Illinois Behavioral Risk Factor Surveillance System (IDPH)
  • National Survey of Children’s Health (Data Resource Center for Child & Adolescent Health)
• Injury Control Research Centers with ACEs as a Core Research Project
  • Columbia University Center for Injury Science and Prevention (ACEs is a Core Research Project)
  • Penn Injury Science Center (ACEs is a Core Research Project)

• Prevalence of ACEs Using PCA
• Special Emphasis Report: Adverse Childhood Experiences 2023