“(Adverse Childhood Experiences) are the single greatest unaddressed public health threat facing our nation today.”
Dr. Robert Block
For decades, public health professionals focused primarily on treating symptoms: heart disease, depression, substance use, diabetes, and other chronic health conditions. However after the 1990s, awareness began to shift.
The groundbreaking Adverse Childhood Experiences (ACE) Study changed that conversation by asking a simple but powerful question: What happened to you before these problems began?
Today, the ACE Study remains one of the most influential public health discoveries of our time, helping researchers, educators, healthcare providers, and organizations like Resources For Resilience understand the lifelong impact of childhood adversity and the critical role that resilience education plays in prevention and healing.
The landmark ACE Study was one of the primary inspirations for Resources For Resilience’s founding in 2017.
What Is the ACE Study?
The CDC-Kaiser Permanente ACE Study, conducted by researchers from the Center for Disease Control and Prevention and Kaiser Permanente between 1995 and 1997, surveyed more than 17,000 adults about experiences they had before the age of 18. It became one of the largest investigations ever conducted into the relationship between childhood adversity and lifelong health outcomes.
In the study researchers examined several types of adverse chilhood experiences, or ACEs, including abuse, neglect, violence, mental illness, and more.
What they found was remarkable: ACEs were incredibly common, and the more ACEs a person experienced, the greater their risk for a wide range of physical, mental, and behavioral health challenges throughout life.
CDC estimates suggest that preventing ACEs could significantly reduce rates of depression, heart disease, suicide attempts, and other major health concerns.
The 10 ACE Categories
The original CDC-Kaiser ACE Study grouped adverse childhood experiences into three broad categories: abuse, neglect, and household challenges.
Abuse
- Emotional abuse
- Physical abuse
- Sexual abuse
Neglect
- Emotional neglect
- Physical neglect
Household Challenges
- Household substance use
- Household mental illness
- Witnessing domestic violence
- Parental separation or divorce
- Incarceration of a household member
These ten experiences were used to calculate an individual’s ACE score and helped researchers identify the powerful connection between childhood adversity and later-life health outcomes.
Since the study, research has also identified additional types of adversities as important factors influencing long-term health and development:
- Poverty
- Racism
- Food insecurity
- Housing instability
- Homelessness
- Natural disasters
- Community violence
- Discrimination
- Bullying
- The loss of a parent or caregiver
Even though these additional adverse experiences were not included in the original ACE Study, many experts today recognize them as having the same long-term negative impacts on health, opportunity and well-being.
“Twenty years of medical research has shown that childhood adversity literally gets under our skin, changing people in ways that can endure in their bodies for decades. The single most important thing is recognizing what the problem is in the first place.”
Dr. Nadine Burke Harris
The ACE Study fundamentally shifted how many professionals think about behavior. Rather than asking, “What’s wrong with this person?” trauma-informed approaches now ask, “What happened to this person?”
The ‘Dose-Response’ Relationship
One of the most important findings of the ACE Study was the discovery that the higher a child’s ACE score, the greater their likelihood of experiencing negative outcomes later in life.
Researchers found links between ACEs and various types of well-being:
- Physical health: heart disease, diabetes, lung disease
- Mental health: depression, anxiety, substance use, suicide
- Social health: reduced educational achievement, reduced economic opportunity
The ACE Study helped illuminate what scientists now understand about toxic stress: When a someone experiences ongoing adversity without adequate support, the body’s stress response system can become overactivated. Over time, this can affect brain development, immune function, hormonal regulation, and overall health.
About 64% of adults report at least one ACE factor, and roughly 12% have four or more.
Reminder: ACEs are not predictive of any one person’s future. Rather, they help us understand risk, recognize the importance of prevention, and highlight the role that supportive, protective relationships and experiences play in helping people thrive.
Your ACE Score Is Not Your Destiny
One of the most important lessons from ACE research is that adversity increases risk, but it does not determine a person’s future.
Human beings are remarkably adaptable. Protective relationships, supportive communities, and resilience-building experiences can buffer the effects of stress and help people thrive despite adversity. Research consistently shows that resilience can be strengthened throughout life.
The CDC emphasizes that children thrive when they have access to “safe, stable, nurturing relationships and environments.” These supportive conditions help prevent ACEs and promote positive childhood experiences.
Awareness opens the door for greater healing and growth. When people understand how stress affects the nervous system and overall health, they are better equipped to support themselves and others.
Stress At Any Age
What makes ACEs unique is that they occur during critical periods of brain and body development, when children are especially dependent on supportive relationships and safe environments.
While ACEs specifically refer to adverse experiences that occur before the age of 18, as we all know- adversity does not stop in childhood.
- Divorce or relationship breakdown
- Job loss
- Financial hardship
- Serious illness
- Caregiving burden
- Exposure to violence
- Death of a loved one
- Housing instability
- Discrimination
People can encounter significant stress and trauma throughout their lives, so education and tools that support healing and well-being are useful at any age.
An important evolution of ACE research is the study of Positive Childhood Experiences (PCEs). Researchers have found that supportive relationships, belonging, and feeling safe can help buffer the effects of adversity. This aligns closely with resilience education because it shifts attention from risk factors alone to protective factors and strengths.
What This Means for Resilience Education
The ACE Study revealed the profound impact of trauma and stress on our brains and bodies. Resilience education focuses on what can actually be done about it.
This looks like:
1) Translating neuroscience into everyday practice. Once people understand the biology of stress, they can recognize a stress response in themselves and others and respond in an informed way.
2) Learning and practicing tools to help people regulate their nervous systems, strengthen healthy relationships, and reconnect with their own capacity for well-being.
Whether in schools, workplaces, healthcare settings, faith communities, or families, this knowledge and these skills help people:
- UNDERSTAND how the nervous system responds to challenge
- NOTICE signs of stress earlier
- DEVELOP healthy coping strategies
- STRENGTHEN social connection and community
- INCREASE feelings of safety and belonging
- SUPPORT recovery after adversity
Reminder: Resilience is not a trait that some people have and others do not. It is a set of skills, relationships, and experiences that can be nurtured over time.
From Prevention to Preparedness
The bottom line: A preventiative approach of community building and support can buffer the effects of stress and trauma.
Just as we invest in public health measures to prevent physical illness, we can invest in resilience-building practices that help prevent the harmful effects of chronic stress before they become crises.
This is exactly why we’re here: to empower individuals and communities with practical, science-based tools that promote health, connection, and well-being.
We believe that while adversity may be common, so is the human capacity to learn, heal, grow, and thrive.
We have a long way to go, and we can’t do it with you. Thank you for supporting this work!
The ACE Study taught us that adversity can have lifelong consequences, but that proactive support can have lifelong benefits.
REFERENCES
- Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults | American Journal of Preventive Medicine
- Preventing Adverse Childhood Experiences (ACEs): Leveraging the Best Available Evidence | National Center for Injury & Violence Prevention
- Adverse Childhood Experiences (ACEs) | VitalSigns | CDC Veto Violence – ACEs Infographic
- About the CDC-Kaiser ACE Study | Violence Prevention| CDC
- About Adverse Childhood Experiences | Adverse Childhood Experiences (ACEs) | CDC
- Adverse Childhood Experiences: Mechanisms of Risk and Resilience in a Longitudinal Urban Cohort | PMC
- Adverse Childhood Experiences (ACEs): Preventing Early Trauma to Improve Adult Health: CDC Vital Signs
- The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead | PMC
- Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample