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ACES

Helping Children With Adversity

Adverse childhood experiences and environments (ACEs) are common. If children don’t get support when facing adversity, it can cause long-lasting harm. There are things we can all do together to buffer the impact of adversity. 

The single most important factor is having a safe, stable and nurturing adult in the home and community for a child to lean on. 

There are a number of ways we can create positive childhood experiences and together promote the health and well-being of our children. 

What are ACEs

The original ACE Study examined 10 childhood adversities: forms of child abuse and neglect – physical abuse, physical neglect, emotional abuse, emotional neglect and sexual abuse, as well as household challenges – domestic violence, divorce, serious mental illness, substance use disorder or incarceration of a household member.

Adverse childhood and community experiences (ACEs) can occur in the family/household, community or environment. Remember we can work together as parents and grownups, policy makers and community partners to make a difference! 

Maryland community members talking about ACEs
Dr. Anda of ACE Interface Study talking at Policy Maker Reception
Dr. Robert Anda, CDC's principal investigator on ACE Study at EFC ACE & The Family Tree's Interface Policy Maker Reception

What did the original ACE Study tell us?

In the mid-1990’s Dr. Robert Anda at the CDC and Dr. Vincent Felitti at Kaiser Permanente in San Diego, California were co-investigators of the groundbreaking ACE Study.  It was one of the largest studies of childhood adversity and its connection to life-long health and well-being of its kind, involving 17,000 participants.

There are 3 ACE Study findings:  

  1. ACEs are common.  
  2. ACEs are rarely found in isolation--- where you find one, you are likely to find others.  
  3. ACEs have a strong effect on later health and well-being.

In the original ACE Study:

  • 67% of study participants reported having at least one ACE. 
  • 26% reported having three or more ACEs. 
  • 24% reported having three or more ACEs.

In Maryland...

approximately 60% of survey participants reported at least one ACE. Review SCCAN Annual Reports for more Maryland-specific data on ACEs. 

 

Expanding knowledge of ACEs

Subsequent ACE surveys and advances in sciences have expanded our knowledge.

  1. The ACE Study and subsequent ACE surveys found that ACEs are common and impact lifelong health and well-being (epidemiology).
  2. Toxic stress from ACEs can damage children’s developing brains and affect our short- and long-term health (neurobiology or brain science).
  3. We can pass ACEs from generation to generation through our genes (epigenetics).
  4. Our brains are “plastic” – can reorganize their structure, functions, and connections – and our bodies can heal through implementing protective factors and resilience-building practices based on ACEs science. (neuroplasticity and resilience)

Expanded ACE surveys like the Philadelphia ACE Survey investigated additional adverse childhood and community experiences like bullying, community violence, living in foster care, experiencing racism and neighborhood safety.

Learn how community conditions like poverty, racism and violence affect children. 

Working together to prevent ACEs

We can work together as parents and grown-ups, policy makers and community partners to make a difference! Maryland Essentials for Childhood (EFC) is working with The Family Tree and our community partners to train people across the state on ACEs and the ways we can work together to decrease them.

Bring an ACE training to your community.

ACE Instructor Training

Helping children and adolescents cope with severe stress

POSITIVE

Brief increases in heart rate, mild elevations in stress hormone levels.

TOLERABLE

Serious, temporary stress responses, buffered by supportive relationships.

TOXIC

Prolonged activation of stress response systems in the absence of protective relationships.

When children are exposed to ACEs and other adversities like racism, poverty, bullying and other forms of violence, and adults aren’t there to help them cope, their stress systems can over-activate. Their developing bodies and brains are flooded with harmful levels of stress hormones.

This excessive activation of the stress response system produces wear and tear on the child's developing body and brain. This “toxic stress response” is similar to revving a car engine for days and weeks at a time and can increase the risk of later health problems.      

However, children can tolerate even severe stress -- if safe, stable, and nurturing adult relationships are in place to buffer the negative impact.

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ACEs literally "get under the skin"

Watch this video on how they can impact the brain, body and behavior.

View this infographic and read more about ACEs and toxic stress from The Center on the Developing Child.

Child receiving asthma treatment with breathing mask

How do ACEs impact health - physical, mental, social and behavioral?

ACEs can have a strong effect on later health and well-being.  

More severe or more frequent adverse experiences in childhood make it more likely that people will experience physical, mental, and behavioral health problems as adolescents or adults. 

As the number of ACEs build up, the risk for some diseases, chronic health problems and less healthy behaviors also increases. 

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ACEs Can Increase Risk for Poor Social Outcomes, Disease, and Death

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Research shows that experiencing a higher number of ACEs is associated with many of the leading causes of death like heart disease and cancer.

Chronic Health Conditions

  • Coronary heart disease
  • Stroke
  • Asthma
  • Chronic obstructive pulmonary disease (COPD)
  • Cancer
  • Kidney disease
  • Diabetes
  • Obesity

Health Risk Behaviors

  • Smoking
  • Excessive alcohol use
  • Substance misuse
  • Physical inactivity
  • Sexual risk behaviors
  • Suicidal thoughts and behavior

Social Outcomes

  • Lack of health insurance
  • Unemployment
  • Less than high school diploma or equivalent education

Mental Health Conditions and Substance Use Disorders

  • Depression
  • Substance use disorder including alcohol, opioids, and tobacco

How communities can help prevent ACEs

To nurture children’s potential, it is important that we work together to prevent serious adversity through good policies and programs.      

We can also ensure that every community is equipped to support people who have faced severe adversity, making resilience a real possibility.

Maryland $15 minimum wage rally
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What can WE ALL do to prevent ACEs?

We ALL have the tools we need to prevent the impact of ACEs on a child. When we work together on these factors, we can make a difference! Grown-ups can ensure they:

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Provide safe, stable and nurturing relationships at home and in the community.

It’s the single most important factor in preventing ACEs and mitigating their impact.

Meet the essential needs of a child. If you need help, connect to community resources.

Calling 2-1-1 or search for local support

Create opportunities for positive childhood experiences and buffer children from the impact of ACEs.

They promote healthy development and buffer children from the impact of ACEs. Keep learning.

The community also plays a role.

Go deeper on policies that matter to children, families and the community. Keep reading about other protective factors.

 

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What can Parents do to prevent ACEs?

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Reach out for resources in your community. ACEs are common, healing is possible, and you are not alone.

Connect with other grown-ups who are parenting with PACEs.

Join this online community.

Bring an ACE training to your community.

Schedule a training.

Talk to your pediatrician.
Not all will know the significance, but make every effort to find one who does.

Use the CAMHI Well Visit Planner to prepare for a conversation with your child’s pediatrician

Watch this short-video to learn more about childhood adversity and trauma.

Adverse Childhood Experiences (ACEs), Public Health Network Cymru

Discover your ACE history.

It can impact your child's.