The Link between Adverse Childhood Experiences (ACE) and Health in Adulthood

The Adverse Childhood Experiences (ACE) Study is one of the largest public health studies to examine the relationship between exposure to trauma and neglect in childhood and health across the lifespan. The study began in the mid-1990’s as a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente’s HMO.

Approximately 17, 500 patients were recruited for the study and asked whether they had experienced any of the following events in childhood:

1. Abuse: 

  • Emotional
  • Physical
  • Sexual

2. Neglect

  • Emotional
  • Physical

3. Household dysfunction

  • Mother treated violently
  • Household substance abuse
  • Parental separation or divorce
  • Incarcerated family member

For each of  these experiences a participant reported, they were given an ACE score of one. Over two-thirds of participants had an ACE score of one or more, and 87% of this group had actually experienced two or more adverse events (ACE score > 2). Apparently, exposure to childhood adversity of this nature is common.

The study found a direct link between experiencing these adverse events in childhood and being at risk for serious health and social problems later in life. In fact, compared to an ACE score of zero, an ACE score of four or more was linked to higher rates of heart disease and diabetes, as well as a:

  • 240% increased risk of hepatitis
  • 390% increased risk of chronic lung disease
  • 460% increased risk of depression
  • 1,220% increased risk of suicide

An ACE score above six was associated with a 30-fold increase in attempted suicide and a reduced life expectancy by 20 years compared to those with an ACE score of zero.

Why the increased health risks? In a nutshell, high levels of stress activate the body’s hardwired fight or flight response system. When fight or flight is activated, the body is washed in adrenaline and cortisol, hormones designed to help us fight the threat or escape it.

The body’s emergency response system is designed for short-term use. When someone is in a situation of chronically high stress, these hormones are released frequently, negatively affecting both nervous system development and long-term physical health. Social, cognitive and emotional development can also be disrupted, and a child or adolescent may turn to coping mechanisms such as substance use. Over time, all this can add up to poor health, social problems, and possible premature mortality:


It is important to remember that a high ACE score does not doom you to poor health outcomes. A person with a rough childhood may also develop resilience by exposure to people (helpful teachers, caring grandparents, an attentive physician) or experiences (counseling, financial help, education) that help mitigate stress.

The CDC estimates that the lifetime financial cost for each confirmed childhood maltreatment case is $210,012, comparable to serious health conditions such as stroke ($159,846) or type 2 diabetes ($181,000 to $253,000).  This breaks down into:

  • $32,648 in childhood health care costs
  • $10,530 in adult medical costs
  • $144,360 in productivity losses
  • $7,728 in child welfare costs
  • $6,747 in criminal justice costs
  • $7,999 in special education costs

Of course, these numbers in no way measure the very real human suffering experienced by people who have faced significant adversity in childhood.

To learn more about this important study, follow these links:





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Licensed psychologist in San Antonio, Texas.
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