Understanding Adverse Childhood Experiences

What are “ACEs”?

In the 1990’s, the CDC-Kaiser Permanente conducted a research study to explore the relationship between adversity before the age of 18 and later life health outcomes. To see the original questionnaire, click here. These experiences, known as “ACEs”, or Adverse Childhood Experiences, included:

Physical Abuse

Emotional Abuse

Sexual Abuse

Physical Neglect

Emotional Neglect

Mental Illness

Experiences of Domestic Violence


Incarcerated Relative

Substance Abuse

There were two main take-aways from this study:
• ACEs are common experiences in the lives of our children
• There is a “dose-response” relationship. Meaning, the more experiences of adversity that a child has, the higher their risk of later life health problems, like diabetes, obesity, smoking, missed work, heart disease, stroke, cancer and/or depression.

The limitations of the original study continue to be explored, however the results continue to be replicated today. It is important to recognize that the scope of adversity that our children and families can and do experience goes well beyond the original 10 ACEs. To learn more about ACE research and the  impacts on our developing mind, bodies, and brains, listen to Dr. Nadine Burke Harris’s, “How Childhood Trauma Affects Health Across the Lifetime”

Adverse Childhood Experiences are Preventable

Although a higher number of experiences of adversity places children at greater risk for health problems as adults, we must recognize that “risk does not equal destiny”, and with a greater understanding of the science of resilience, there are also ways to reduce the associated risks (Wallace, 2020).

The more healthy relationships that a child has, the more likely they will be able to recover from trauma and thrive. Relationships are the agents of change and the most powerful therapy is human love
– Dr. Bruce Perry

What can individuals do?

Research and practice on resilience and protective factors continue to confirm that safe, consistent, and predictable relationships help to provide a strong buffer against the impacts of early adversity. As adults, we can:

  • Change our thoughts and narratives from “what’s wrong with you” to “what happened to you? What was your experience?”
  • Recognize that a child’s behavior is their way of communicating. Lets wonder, “what is this behavior trying to tell me”?
  • Help children to understand the connection between our thoughts, experiences, and behaviors. Help them to learn words to describe the “big emotions”, and “big feelings”.
  • Teach skills and strategies for coping and problem solving.
  • If you see something concerning, say something. Connect families to professionals in the community for extra support.

Remember, the ACEs Questionnaire was originally a research tool, and children should not be asked to complete it. The ACE Questionnaire should only be used as an assessment tool to inform interventions by trained medical or mental health professionals. Attending community training or webinars on the ACEs Questionnaire does not constitute the training required to promote the use of the questionnaire in that way.

What can communities do?

The work of preventing or responding to ACEs on an individual level is intertwined with community level responses, as well as intentional themes of diversity, equity, and inclusion. As stated by the Center for Disease Control and Prevention,

By addressing the conditions that give rise to ACEs and simultaneous addressing the needs of children and parents, these strategies take a multi-generation approach to prevent ACEs and ensure safe, stable, nurturing relationships and environments (2019)”.

For example, consider “The Pair of ACEs” Tree by The Building Community Resilience Collaborative:

aces tree

Community-level Strategies:

How do communities approach the adverse community environments in order to ultimately reduce the prevalence of ACEs for children and families? The Center for Disease Control and Prevention has proposed the following approaches and strategies, described in greater depth in Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities:

community aces

To continue to understand this multi-level approach to address and prevent ACEs, visit:

Need Local Support?

New York State Children’s Alliance (NYSCA)- Statewide Map of Child Advocacy Centers

A New York State ACEs Curriculum for Early Care and Education Settings

With generous funding from the New York State Office of Children and Family Services, ECLC is proud to partner with The La Salle School and Brightside Up for the development of an Adverse Childhood Experiences trainers curriculum for CCR&R staff to share with their respective communities. The “101 Level”, which will focus on building a foundation of understanding as to the impacts of ACEs on later life development, will be available to child care providers and communities following regional train-the-trainer experiences in 2020. By participating in a local training with this curriculum, child care providers and communities will be able to:

  • Identify at least 2 ways in which brain development of young children is affected by ACEs
  • Differentiate between the physiological responses that ACEs may cause
  • Describe how children with two or more ACEs are affected in classroom setting.

This training has been approved by both Aspired and by PDP.


For more information on regional implementation dates for the 101 curriculum, see below:

Region 1 (Buffalo) – October 2020

Region 2 (Rochester) – October 2020

Region 3 (Syracuse) – October 2020

Region 4 (Albany) – September 2020

Region 5 (NYC) – August 2020

Region 6 (Westchester) – August 2020

Region 7 (Long Island) – August 2020


*COMING SOON: Trauma Champions in the CCR&R Network*

Additional Resources: