Adverse Childhood Experiences (ACEs): Examples and Effects

Written by Carlie Olenick
Medically Reviewed by Dan Brennan, MD on May 29, 2025
12 min read

Adverse childhood experiences (ACEs) can potentially cause trauma. ACEs aren’t specific. They can include any distressful event between birth and age 17.

These experiences often happen within your family or with another person. Many common types of neglect and abuse count as ACEs. But your risk factors for trauma differ. 

ACE risk can include nonmedical conditions called social determinants of health (SDOH). These life factors can change your access to safe and stable relationships. And without nurturing bonds, you’re at a higher risk for ACEs.

Learn how these factors play a part in raising your risk for childhood trauma. And find out how you can offset the effects and heal from your past.

Adverse childhood experiences can occur from different life challenges. These social determinants of health can play a major role in shaping your overall well-being. 

Although the risk factors don’t directly cause ACEs, they raise childhood trauma risk.

Child-level risk factors

A child can have higher risk for an ACE if they:

  • Have a disability, chronic illness, or mental health condition
  • Are under 18 years old
  • Are assigned female at birth
  • Date early or have early sexual experiences
  • Lack an emotional connection with their caregiver (can’t open up about feelings)
  • Feel isolated from peers
  • Spend time with aggressive peers
  • Engage in risky behavior

Family-level risk factors 

Caregivers include anyone taking care of a child. When families split up, the risk for trauma can go up, too. Some other family risk factors include:

  • Caregiver challenges for children with a disability, chronic illness, or mental health condition 
  • Limited understanding of child development
  • Caregivers who haven't healed from a personal history of abuse or neglect 
  • Very young or single caregivers
  • Low caregiver education level 
  • High financial or parenting stress levels 
  • Physical punishment (spanking)
  • Not being consistent or lack of discipline 
  • Not having support or social connection (no extended family, friends, or neighbors)
  • Frequent family conflict or unhealthy talk between family members

Community-level risk factors

Here are some common community risk factors that may raise your risk for ACEs:

  • High levels of neighborhood crime and violence 
  • Widespread lack of opportunity and lower income
  • High unemployment
  • Easy access to drugs and alcohol
  • Low community engagement or support 
  • Lack of youth programs or recreational activities
  • Unstable housing and frequent moves
  • Environmental neglect or disorder in the community
  • Being part of an underrepresented group like a racial, ethnic, or religious minority or the LGBTQ+ group
  • Higher number of deaths or loss in your community
  • Pandemic, war, or natural disasters

But there are also protective factors, too. Sometimes called resilience, certain actions in your life have a positive effect. These resilient actions help you positively adapt to ACEs.

Difficult (adverse) events can impact your ability to manage stress. Traumatic events often happen at home or in your community. Over time, the events can build up. The memories can make it harder for you to feel safe, supported, or secure.

Importantly, ACEs often connect to larger community issues. It's not just individual choices or actions. Childhood trauma can show up in many ways. You may have experienced one or more ACEs if you: 

  • Were physically, emotionally, or sexually abused
  • Felt your physical needs weren't met or your emotional needs were ignored (neglected)
  • Grew up in a home where money was tight or basic needs weren’t always met 
  • Lived with a parent or caregiver who struggled with drug or alcohol use
  • Had someone in your home with serious mental health challenges 
  • Faced discrimination because of your identity or background
  • Didn’t feel safe in your neighborhood
  • Were bullied at school or in other settings 
  • Saw or heard violence at home, in your community, or elsewhere

How you react to stress and trauma is unique. Sometimes signs of childhood trauma can show up right away. But often, the symptoms appear later in life. 

Many times, you'll need time to process what happened. If you've had a traumatic event, you may have: 

  • Fear or discomfort around other people
  • Trouble falling asleep or frequent nightmares
  • Bed-wetting, even after being potty trained
  • Sudden or frequent changes in mood
  • Struggles to show affection or connect with loved ones 
  • Avoiding specific places, situations, or people reminding you of the event 
  • Difficulty focusing, learning, or keeping up in school

Certain people, places, or situations can also trigger you. These can bring certain feelings back. And you may react, sometimes called posttraumatic stress disorder (PTSD).

The ACE test adds up your childhood abuse, neglect, and serious challenges. The scoring system ranges from 0 to 10. A higher ACE score may predict your risk for health problems later in life.

For example, just one ACE can double your chance for alcohol use problems. And you may be three times more likely to get depression with an ACE of 4 or more.

ACEs scoring

Each point of the ACE score (0 to 10) stands for a specific trauma type. The highest ACE score adds up to 10. Read through the list below. See if any events happened before you turned 17. Each counts as one point toward your total ACE score. 

Types of abuse

  • Emotional abuse: An adult regularly insulted, swore at, or threatened you. 
  • Physical abuse: An adult hit, pushed, or injured you. 
  • Sexual abuse: An adult or person at least 5 years older touched you sexually or tried to. 

Household challenges

  • Violence toward parent or caregiver: You saw your parent or caregiver being physically hurt or threatened by a partner. 
  • Substance use: Someone in your home had a drinking or drug problem. 
  • Mental illness: Someone in your home was depressed, mentally ill, or attempted suicide. 
  • Parental separation or divorce: Your parents were separated or divorced. 
  • Prison: A household member went to prison.

The impact of neglect

  • Emotional neglect: You didn’t feel emotionally loved, supported, or cared for. 
  • Physical neglect: Your basic needs — like food, clean clothes, or medical care — weren’t consistently met. 

ACEs don’t just affect your body and mind. They can shape your life's direction. Everyone deals with trauma differently. And ACEs are all unique. Childhood trauma can contribute to ongoing stress, even in adulthood. 

Childhood trauma is outside your control. The events can change how your brain and body respond to stress. This can impact how you act sometimes as an adult. Learning about these effects can help your recovery and growth.

Short-term effects

Soon after the trauma, some short-term effects can change how you think and behave. With short-term effects, you may notice: 

  • Physical signs of extreme stress, shallow breathing, or a rapid heart rate
  • Trouble sleeping, frequent nightmares, or bed-wetting 
  • Mood swings or emotional outbursts
  • Struggling to learn in school
  • Trouble showing affection to loved ones
  • Fear or discomfort around other people
  • Challenges in forming emotionally safe or stable relationships
  • Getting injured more often
  • Teenage pregnancy, pregnancy complications, or loss
  • Sexually transmitted diseases (STDs)

Long-term effects

Trauma can change your emotions and how you behave. Long-term effects you may notice include:

  • Anxiety or depression
  • Posttraumatic stress disorder (PTSD)
  • Mood disorders
  • Fears or phobias
  • Eating disorders
  • Ongoing sleep issues or insomnia 
  • Substance use or alcoholism
  • High-risk behaviors or situations like smoking, unsafe sex, or sex trafficking
  • Self-harm or suicidal thoughts

If you or a loved one is thinking of self-harm or suicide, call or text 988. The Suicide and Crisis Lifeline is always open so you can talk to a trained counselor. Or you can go directly to the nearest emergency room for immediate help. 

Physical health effects

As your ACE score goes up, your risk for medical health problems gets higher. It may be connected to your body’s stress response.

Trauma can activate stress during your childhood. The response may change your normal brain development. Over time, chronic stress can become toxic. The toxic stress response can: 

  • Raise your blood pressure
  • Weaken your immune system
  • Put extra strain on your heart
  • Chronic health problems like cancer, diabetes, or heart disease
  • Affect how well you focus, learn, and make decisions
  • Getting injured more often

Your toxic stress response may especially impact your life if you:

  • Face discrimination

  • Live in an under-resourced area

  • Have fewer chances for employment

  • Have a harder time managing finances

Mental health effects 

Childhood trauma can alter your brain growth. This can make it harder to manage your emotions. You may notice that you have:

  • Difficulty handling stress

  • Challenges building stronger relationships 

  • Higher risk for depression, anxiety, and PTSD

  • Higher risk for substance use disorder 

  • Higher risk for self-harm or suicidal thoughts — even with trauma that happened long ago

These effects don’t always appear right away.

Healing from adverse childhood experiences is possible. It's never too late to care for you. You can start at any age, at any time.  Learning about ACEs and making healthy choices is a great first step.

Healing lifestyle changes

Making healthy lifestyle choices can help you feel more balanced. Even small changes can have a big impact over time. 

A few lifestyle changes to promote your physical and emotional well-being include: 

  • Get regular exercise, go for a walk, bike ride, or take a water aerobics class.
  • Eat nutritious foods like fruits, whole grains, and vegetables.
  • Prioritize sleep and get at least eight hours every night.
  • Schedule regular checkups with your health care provider.
  • Spend time outside and connect with nature to lower your stress levels.
  • Ask for help or access resources for harmful habits such as smoking or substance use.
  • Do something creative like taking up a hobby.

Types of therapy for healing

Different types of therapy focus on different needs. Here are a few common approaches proven for healing from ACEs:

Cognitive behavioral therapy (CBT). This helps you challenge negative thought patterns. Your therapist helps you replace self-blame or hopelessness with healthier thinking. CBT helps you manage your anxiety, depression, and trauma-related stress. 

Activity-based therapies. Use creative tools like art and music. This can help you express emotions that are hard to put into words. The therapy offers a nonverbal path to healing. It works well for younger children, too. 

Psychotherapy (talk therapy). This is a safe space for you to explore your experiences, relationships, and emotional challenges. With a trained therapist, you build self-awareness through open talks. 

“For young children (under the age of 6), I would recommend child-parent psychotherapy," says Chandra Ghosh Ippen, PhD, associate director and dissemination director of the Child Trauma Research Program at the University of California San Francisco. "It's a model that addresses both trauma experienced by the child and by the parent.”

Relationship-based therapies. Focus on strengthening your caregiver and child connection. The therapy helps improve attachment, trust, and communication. It can also help children who have had early neglect or treated poorly. 

Psychoeducational programs. Combines education and support to help you build emotional skills. You'll understand your emotions, behaviors, and coping strategies. Often offered in group settings, it can teach you practical tools to manage stress.

“One parenting model that helps parents think about changing intergenerational cycles is Circles of Security,” says Ippen. 

The program can help your parent-child bond get stronger. Ippen also suggests therapies such as Attachment Biobehavioral Catch-up and Parent-Child Interaction Therapy. 

Therapy can also support your relationships. And this helps you better control emotions for long-term success. For a broader look, the National Child Traumatic Stress Network has more therapy information.

Neurofeedback, EMDR, and brain spotting

Some therapies help your brain respond differently to trauma. They can retrain your body’s stress response. 

Neurofeedback uses sensors on your head. They track your real-time brain activity. During sessions, your brain learns to shift away from constant “fight-or-flight” mode. You'll learn to stay in a calmer state. It can be helpful for long-term or repeated trauma. 

EMDR (Eye Movement Desensitization and Reprocessing) therapy helps you process specific memories. It uses guided eye movements. Your therapist redirects your eyes as you talk about a traumatic event. Focusing on something else helps lower the emotional intensity of past events.

Brainspotting uses eye position to access specific points in your visual field. These "brain spots" are linked to stored emotional pain. Unlike EMDR, it focuses less on talking and more on physical sensations. Childhood trauma can get “stuck” in your body. Brainspotting may help release tension. And it may help your brain fully process what it couldn’t at the time. 

Preventing childhood trauma starts by being aware. Some factors can raise or lower your risk for ACEs. Family, caregivers, and community can also help provide protective factors.

Positive protective factors

Positive protective factors are your supportive relationships, environments, and experiences. Even with serious adversity, positive resilient factors can help you feel safe, connected, and capable. Resilience can prevent trauma and lower its impact. 

The good news is that resilience can be taught. If supported and reinforced, resilience can help you heal. In time, you can overcome the challenges of ACE. Here are some ways you can offset the long-term effects:

Build strong loving relationships with a caregiver. Feeling cared for and safe at home gives you a powerful sense of security.

Encourage friendships and social connections. This helps you build relationships with peers who are kind and accepting. 

Have a trusted adult around. Make sure you know there’s another trusted adult you can turn to. Find a trusted teacher, coach, or family friend when you need extra support. 

Stay involved in education. Celebrate efforts at school and talk to teachers about how things are going.

Teach and work through problems. Learn how to work through tasks. It can help you build a sense of confidence and self-esteem.

Believe in yourself and self-regulate. Learn to express your emotions. Talk about your feelings, write them down, or go exercise. Learn to deal with your feelings. It can help you believe in your own success.

Learn that life has meaning. Find a meaning or purpose for your life. This can help you set goals and take risks. And ask for help when you need it. This can teach you how to trust and build relationships, too. 

Where to find support

Here are some ways to find support:

  • Talk to your health care provider about therapy, medication, or a specialist 
  • Connect with school-based programs about counseling or academic support 
  • Join community activities like mentorship programs, sports, or clubs
  • Find a support group to connect with others who have similar challenges (substance use, grief, abuse, etc.) 
  • Use crisis services for help with housing, legal needs, or urgent emotional support 

Adverse childhood experiences (ACEs) are traumatic events that happen before you're 17. Higher ACE scores may predict health problems later in life. Learning about positive protective factors and practicing resilience can help lower your risk for ACEs. Healing is always possible with many types of therapy and creative outlets to choose from.

Does childhood trauma ever go away?

Childhood trauma is a life experience that doesn't go away. But you can heal using therapy and practicing resilience. Choosing to foster positive protective factors can help you heal, too. And with healing, your memories can get easier to live with and manage. 

How does childhood trauma show up in adulthood?

Childhood trauma can show up in adulthood and cause a toxic stress response. The stress can lead to chronic health problems like anxiety, depression, and more. 

Adverse childhood experiences (ACEs) can also impact how you think, feel, or relate to others. But fostering positive factors and practicing resilience can help you heal.

Is an ACE score of 7 high?

Yes, an ACE score of 7 is considered higher. The highest AEC score is 10. Higher ACE scores may raise your risk for health issues and chronic illness. But healing and change are still possible. Choosing positive protective factors, resilience, and finding support can offset the effects. 

Can ACEs lead to PTSD?

Yes, ACEs can lead to posttraumatic stress disorder (PTSD). Experiences like abuse, neglect, or violence can overwhelm your ability to cope. Your brain may respond to stressful events with anxiety. This can lead to flashbacks in adulthood. 

But not everyone with ACEs develop PTSD. That's because everyone reacts to stressful situations differently. 

Does a parent dying count as an ACE?

Yes, the National Survey of Children’s Health (NSCH) includes death of a parent or caregiver as an ACE. Losing a parent or caregiver can seriously impact your psychological well-being.

Can ACE cause ADHD?

Although not directly a cause, ACEs can raise your risk for attention deficit hyperactivity disorder (ADHD). Studies show higher ACE scores can raise your risk for moderate to serious ADHD.