What is the ACE Study?

In 1998, the Centers for Disease Control and Prevention (CDC-P) and San Diego’s Kaiser Permanente studied the link between adverse childhood experiences (ACE’s) and future negative health outcomes in adulthood.Dr. Vincent Felliti teamed up with Dr. Robert Anda to form a dynamic group that would forever change the way adversity was understood from a public health perspective. The research staff sought to discover what (if any) correlations existed between events in childhood that were typically considered traumatic and some of the leading causes of early death. They wanted to know what instances were connected to future negative health outcomes and at what rate and why were these factors aligned with health risks.

“ACE Study | Safe and Sound | KET”

The “ACE Study | Safe and Sound | KET” video was produced by Kentucky Educational Television (KET) as a community initiative to inform citizens of the ACE Study. The video gives a brief overview of the dynamics of the ACE Study from its beginning origins to its final results. The cartoon characterization provides a concise depiction of events, connecting research findings to the reality of this public health crisis.

ACE Study Quotes

“Toxic stress response can occur when a child experiences strong, frequent, and/or prolonged adversity—such as physical or emotional abuse, neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship—without adequate adult support. This kind of prolonged activation of the stress-response system can disrupt the development of brain architecture and other organ systems, and increase the risk for stress-related disease and cognitive impairment, well into the adult years.” – Dr. Nadine Burke Harris (The Deepest Well)

“As the ACE study has shown, child abuse and neglect is the single most preventable cause of mental illness, the single most common cause of drug and alcohol abuse, and a significant contributor to leading causes of death such as diabetes, heart disease, cancer, stroke, and suicide.” – Dr. Bessel van der Kolk (The Body Keeps the Score)

“How childhood trauma affects health across a lifetime”

Dr. Nadine Burke Harris, a pediatrician and public health advocate, discusses the influence childhood adversity has on the future of one’s health over their lifespan. In this groundbreaking TED Talk, Dr. Nadine Burke Harris explains the consequences associated with childhood adversity and how its scope has revealed a public health crisis of massive proportions. The original ACE study is overviewed, with connections being made between major findings and research on the alterations of biological processes (specifically the brain’s stress response system). The complex realities of brain architecture and functioning are broken down into manageable pieces, which are relatively easy to understand and informative. With over 5 million views, this video has been a leader in changing the way trauma and health are interpreted around the globe. Since its inception, Dr. Nadine Burke Harris has written a book on the subject, titled The Deepest Well, and she was appointed as California’s first Surgeon General.

What are adverse childhood experiences (ACE’s)?

ACE’s are categories of adverse (i.e. potentially harmful, abnormal, or traumatic) events, which occurred during a person’s childhood before reaching the age of 18. These types of adversity can generally be considered sources of maltreatment or household dysfunction and they can be divided into a total of 10 classifications (or ACE’s).

Maltreatment: 

  • Physical Abuse
  • Sexual Abuse
  • Emotional Abuse
  • Physical Neglect
  • Emotional Neglect

Household Dysfunction:

  • Parental Separation or Divorce
  • Witnessing Domestic Violence
  • Household Member Incarceration
  • Household Member Mental Illness 
  • Household Member Substance Abuse

Why does this study matter?

There were two distinct and significant findings in the ACE Study:

1. the commonality of ACE’s in the population

2. the “dose-response” relationship between ACE’s and future negative health outcomes.

The Commonality of ACEs

  • 2/3 of the sample had one or more ACEs
  • 1/2 of the sample had two or more ACEs
  • 1/6 of the sample had 4 or more ACEs

The “Dose-Response” Relationship

As the number of ACEs rises so does the likelihood for adopting maladaptive coping behaviors (i.e. substance abuse, overeating, self-harm, etc.) and the risk of developing physiological health conditions (i.e. heart disease, cancer, COPD, etc.) and psychological health problems (i.e. depression, anxiety).

ACE Online Resources

Centers for Disease Control and Prevention (CDC-P) – Violence Prevention/Abuse & Neglect: Adverse Childhood Experiences

  • The Centers for Disease Control and Prevention is a government-sponsored public health organization with the goal of addressing health concerns and improving outcomes for the masses. The CDC-P, being one of the main researching entities in the original study, led the effort in recognizing the scope and reach of ACE’s. This online platform provides users access to easy-to-understand research data, information on other social determinants of health, and strategies for the ACE prevention and intervention. 

Center on the Developing Child at Harvard University – “ACE’s and Toxic Stress: Frequently Asked Questions”

  • The Center on the Developing Child at Harvard University gives users a glimpse into the scientific research behind childhood adversity, illustrating the consequences trauma can have on all aspects of health and well-being. This resource guides individuals through the process of understanding why childhood adversity is a threat to physiological and psychological health, the quality of one’s life, and one’s ultimate longevity. Harvard academics present stakeholders with information on how ACE’s carry dramatic consequences to child development, brain architecture, heredity and gene activation, along with many other insights.

Center for Youth Wellness – “The Science”

  • The Center for Youth Wellness was founded by Dr. Nadine Burke Harris, a trailblazer in advocating for ACE awareness and a public health pioneer in addressing this crisis on multiple systemic levels. This resource provides users with ACE research data by breaking it down into manageable pieces that are easy comprehend and informative. Using this method of instruction allows users to build a foundation of understanding, with the option for gradual competency in becoming an expert.

ACE’s Too High – “News”

  • ACE’s Too High is a news site centralized upon childhood adversity that offers users stories and articles on issues pertinent to conceptualizing ACE’s and changing their influence over human life. This site interprets ACE data and research from various different professional and academic frameworks, from brain development in neuroscience to the health trends in epidemiology. The purpose is to offer the opportunity to expand one’s knowledge into other ACE related areas and distribute information that is relevant to their individual experience or profession.

“We Can Prevent ACE’s”

The Centers for Disease Control and Prevention (CDC-P) developed the “We Can Prevent ACE’s” video in hopes of expanding population awareness and promoting prevention strategies in communities. Addressing childhood adversity is a collective effort found in building trauma-informed communities, strengthening and advancing social relationships, and empowering the formation of resilience in individuals and families.