Childhood adversity (ACEs)

Adverse childhood experiences, or ACEs, are hard and often frightening things that happen before age 18. They include abuse, neglect, and growing up in a home where a parent struggled with drinking, mental illness, violence or prison.¹ Many adults who read this page lived through some of these things. If you are one of them, you are not alone. What happened to you as a child was not your fault.

Research shows that ACEs can raise the risk of health problems later in life. But risk is not fate. Many people who had hard childhoods live full, healthy lives, and healing is possible at any age.^2,3 This page gives you the big picture and points you to our detailed pages.

What are adverse childhood experiences?

The term comes from the CDC–Kaiser Permanente ACE Study. In the 1990s, researchers asked thousands of adults in a large health plan about their childhoods and their current health.⁵ Their list of hard experiences fell into three groups:

• Abuse: emotional, physical or sexual abuse
• Neglect: a child's basic emotional or physical needs not being met
• Household challenges: for example, a parent with a drinking or drug problem, a parent with mental illness, violence between adults at home, parents separating, or a family member in jail or prison

Today the CDC also lists seeing violence in the community and having a family member attempt or die by suicide. It notes that hunger, homelessness and unstable housing can harm children too.¹ Researchers have also studied bullying, discrimination, foster care and poverty. See Types of childhood adversity.

Talking about ACEs is not about blaming parents. Hard childhoods often grow out of hard conditions. The CDC notes that differences in ACEs are tied to the social and economic conditions families live in.¹ Understanding what happened is a step toward healing, not a search for someone to blame.

How common are ACEs?

ACEs are much more common than many people think.

• A CDC analysis looked at a national health survey from 2011 to 2020. It included about 265,000 adults across all 50 states and Washington, DC. About 64% (nearly 2 in 3) reported at least one ACE. About 17% (1 in 6) reported four or more.⁴
• The most common were emotional abuse (about 1 in 3 adults), parents separating or divorcing, and living with someone who misused alcohol or drugs.⁴
• Four or more ACEs were more common among women, American Indian and Alaska Native adults, multiracial adults and adults with low incomes.⁴
• ACEs are still common for young people today. In a 2023 survey, about 3 in 4 high school students reported at least one ACE, and 1 in 5 reported four or more.¹

Why ACEs matter

The first major report from the ACE Study came out in 1998. More than half of about 9,500 adults reported at least one ACE. The more kinds of ACEs people reported, the higher their rates of many health problems. Researchers call this a graded, or "dose–response," link.⁵

Since then, many studies have found the same pattern. A 2017 review combined 37 studies with more than 250,000 adults. People with four or more ACEs had higher rates of every outcome studied, from smoking and heart disease to depression, problem drinking and drug use.⁶

Why would childhood affect adult health? Severe stress that goes on for a long time, without enough adult support, can affect how a child's brain, immune system and stress response develop. Experts call this toxic stress.¹ Lost chances at school and work can play a part too.¹ So can ways of coping, such as smoking or drinking, which were more common among people with more ACEs.⁵ Read more in How childhood adversity affects health.

ACEs are not destiny

This may be the most important point on this page. The links between ACEs and health are averages across large groups. They do not tell you what will happen to you.

• The count is a poor crystal ball. One study followed two large groups of people from birth into adulthood. ACE scores did only a little better than chance at picking out which individuals would develop health problems.²
• Good experiences count too. In a Wisconsin survey of about 6,200 adults, those who recalled six or seven positive childhood experiences had 72% lower odds of depression or poor mental health than those who recalled two or fewer. Examples include feeling safe with an adult at home and feeling supported by friends. The link held at every level of ACEs.⁷
• One caring adult can matter a great deal. Children who do well despite hardship usually had at least one steady, caring relationship with a supportive adult. Researchers say the skills behind resilience can be strengthened at any age.⁸
• Treatment helps. A review of 29 depression treatment studies found that people who reported childhood trauma started out more depressed. But they improved about as much as people without that history.⁹
• It is never too late. The VA's National Center for PTSD says trauma treatments work for older adults too.³

See Protective factors and resilience.

The ACE questions in MindCheck

Our free WhySigh MindCheck includes an optional section for adults with the 11 core ACE questions from a CDC health survey. You can skip any question, or the whole section. Your answers add context to the rest of your report. They are never scored as a problem or shown as a warning, and MindCheck shows places to get support right after the section. It is not a test you pass or fail.

Your answer is not a diagnosis, and it is not a forecast of your future. ACE questions were built for research on large groups, not for judging one person.² If the question stirs up painful memories, it is fine to stop. Take a few slow breaths, and come back later or not at all. Our grounding practice can help you feel steady in the moment.

What helps

There are many paths to healing. The badges show how strong the research is (see how we rate evidence).

Where to get help

You can get help whether the hard times happened last year or 60 years ago. A good first step is a doctor, counselor or therapist. See how to find a therapist.

All childhood adversity pages

• Types of childhood adversity and the ACE score
• How childhood adversity affects health
• Protective factors and resilience
• Healing as an adult: self-help
• Treatment for the effects of childhood trauma
• Parenting with your own history
• Childhood adversity in later life

Related: PTSD, Emotion regulation, Self-esteem, Substance use, Suicide and self-harm, Resilience and Support for caregivers.

Explore childhood adversity

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.