Now that we have covered the definition and types of trauma, we need to discuss adverse childhood experiences (ACEs). If you’ve missed the discussion about trauma, you can find it here What is Trauma?.

Adverse childhood experiences, ACEs, are potentially traumatic experiences that have taken place in a child’s life before 18 (Felitti, et. al., 1998). The acronym came from a study conducted by Keiser Permanente and the Centers for Disease Control from 1995 to 1997. As a part of the ACEs study, there were ten experiences that were identified as adverse childhood experiences. These experiences were divided into three categories:

1. Abuse (sexual, emotional, physical)
2. Neglect (physical, emotional)
3. Household Characteristics (household member with a mental illness, substance addiction, incarceration, parents divorced or separated, mother treated violently)

Main Discoveries

This study revealed five main discoveries about adverse childhood experiences.

1. Adverse childhood experiences are common. Nearly two-thirds of adults have experienced an ACE before the age of 18. One in six have experienced over four (CDC, n.d.-a).
2. Adverse childhood experiences occur over all races, income levels, educational levels, and communities (n.d.-b).
3. ACEs cause chronic health problems, mental illness, and substance misuse in adulthood. If the impact of ACEs were prevented, we would see a decrease in 1.9 million cases of heart disease and 21 million cases of depression, along with a decrease in the top 10 leading causes of death, such as cancer, diabetes and intentional self-harm (CDC, n.d.-a).
4. As one experiences more ACEs, their risk of negative health outcomes increases. This is called a dose effect. Those with 4+ ACEs are two times more likely to be diagnosed with cancer, seven times more likely to be an alcoholic, 12 times more likely to commit suicide and all more likely to have shortened life-expectancy (CDC, n.d.-c).
5. ACEs are responsible for a large portion of workplace absenteeism and for costs in health care, mental health, and criminal justice (ACEs Too High, 2021).

Expanded ACEs

In addition to the original ten ACEs, more have been identified in additional research studies. These are called expanded ACEs and have a similar impact as the original 10 ACEs on health (Philadelphia ACE Project, 2013). They include:

• Economic hardship
• Racism
• Generational Racism/Historical Trauma
• Bullying
• Losing a caregiver
• Involvement in the foster care and juvenile justice system

Economic hardship is the most common ACE reported nationally, followed by divorce or separation of a parent or guardian (Sacks et al., 2014).

With the knowledge of expanded ACEs, we can now organize ACEs into three categories: Adverse childhood experiences, adverse community experiences, and adverse climate experiences ((ACEs Too High, 2021). This organization allows us to capture a better view of ACEs at an individual, family, and community level (Bruner,

2017). We now can examine the impact that poverty, violence, environmental hazards, neighborhood composition, and other ACEs that are found in a community and how they affect and jeopardize health (Philadelphia Urban ACE Project, 2013). The image to the left is a great visual representation of how Adverse Childhood Experiences and Adverse Community Experiences interact to affect an individual and their health.

ACEs can cause trauma and create toxic stress which leads to poor brain development that affects attention, decision-making, learning and how a body responds to stress.

The key concepts to remember about ACEs are: they are common, can affect all people from any background, their exposure can cause health outcomes, they can have a negative impact on education and job opportunities, and as exposure increases so does the chance of long-term risk factors to physical and mental health later in life (CDC, n.d.-a). Ultimately, adverse childhood experiences are determinants of who we become as adults.

This is a good time to note that ACEs are POTENTIALLY traumatic experiences (CDC, n.d.-c). Remember that trauma is defined by how one experiences an event and the effects on the individual. Just because you may have experienced an ACE, or many ACEs does not mean that you automatically experienced trauma or toxic stress. A gap in the ACE score is that it does not address the number of positive experiences that an individual has experienced (ACEs Too High, 2021). For example, if a family creates safe, stable, and nurturing relationships with each other, where members can feel supported, the impact of ACEs on a developing child can be lessened.

One important thing to note is that in 4-H, we don’t generally know about the experiences that our youth have experienced or are experiencing, and we don’t need to know. It’s not our job to speculate about experiences or analyze potential impact. However, we need to be aware that trauma is common, and it affects more youth than we think. This means that we need to be informed and implement practices that support all youth. We will cover these practices in upcoming blogs in this series.

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