Understanding the ACEs Score: Its Origin, Implications, and Path to Healing

ACEs are a powerful tool in healing.

The ACEs score is a pivotal tool in understanding the deep-seated effects of adverse childhood experiences on an individual’s health and well-being. As the saying goes, “What happens to us in childhood doesn’t stay in childhood.” Our early years shape our life’s trajectory, and understanding the ACEs score can make a world of difference.

Where did the ACEs score come from?

The concept of the ACEs score arose from the Adverse Childhood Experiences (ACE) Study, which was a groundbreaking research initiative conducted between 1995 and 1997 by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente. The lead researchers were Dr. Vincent Felitti and Dr. Robert Anda. They aimed to explore the relationship between traumatic childhood experiences and health outcomes later in life.

You can also view numerous other studies on ACEs on the Center for Disease Control and Prevention’s website if you want to dig deeper. As well as they provide these resources:

Categories of ACEs

The ACEs are typically grouped into three categories:

  • Domestic violence.
  • Substance abuse in the household.
  • Mental illness in the household.
  • Incarceration of a household member.


  • Physical: Physical harm by a parent or another adult.
  • Emotional: Continuous criticism, humiliation, or rejection.
  • Sexual: Any inappropriate sexual behavior or misconduct imposed on the child.


  • Physical: Failure to provide basic needs like food, shelter, or safety.
  • Emotional: Lack of affection, comfort, or emotional support.

Household Dysfunction

  • Parental separation or divorce.
  • Domestic violence.
  • Substance abuse in the household.
  • Mental illness in the household.
  • Incarceration of a household member.

What are the ACEs?

The ACEs are ten specific categories of adverse experiences that a person may have encountered during their first 18 years of life. These are:

1. Physical Abuse

Physical abuse involves the deliberate application of force by a parent or another adult that results in bodily harm or injury to a child. It can range from slapping, hitting, and beating to more severe actions like burning or strangling.

Example: A child named Jenny often comes to school with bruises on her arms and legs. When asked, she mentions that her father loses his temper and hits her with a belt when he’s angry.

2. Emotional abuse

Emotional abuse is a consistent pattern of behavior that undermines a child’s emotional development and self-worth. It may include constant criticism, threats, rejection, or withholding of love and affection.

Example: Every time Kevin makes a small mistake, his mother calls him “worthless” or “stupid,” making him feel perpetually inadequate.

3. Sexual Abuse

Sexual abuse entails any sexual activity between an adult and a child or between two children where one exerts power over the other. This can range from touching to rape and also includes activities like exposing a child to adult sexual interactions without physical contact.

Example: Maria’s uncle touches her inappropriately during family gatherings and threatens her into silence.

4. Physical Neglect

Physical neglect refers to the failure of caregivers to provide a child’s basic physical needs, which can encompass food, clothing, shelter, medical care, or supervision.

Example: Despite having ample resources, Tom’s parents often leave him without food for extended periods and don’t provide appropriate clothing for winter.

5. Emotional Neglect

Emotional neglect occurs when caregivers don’t provide the necessary emotional support, affection, and comfort a child requires for healthy psychological development.

Example: Lucy often feels lonely and unheard. Her parents are always too busy with their lives and never listen to or comfort her when she’s upset.

6. Parental separation or divorce

This ACE pertains to the experience of a child whose parents separate, divorce, or have never lived together during their upbringing.

Example: Rahul’s parents divorced when he was five. The constant conflicts and transitions between homes have been emotionally taxing for him.

7. Domestic violence

Witnessing domestic violence involves seeing or hearing acts of physical harm (like hitting, slapping, or beating) against one parent or caregiver by another.

Example: Aisha often hides in her room when her father physically assaults her mother during heated arguments.

8. Substance abuse in the household

This refers to situations where a child resides in a household with an individual (often a caregiver) involved in substance misuse, be it alcohol, drugs, or other addictive substances.

Example: Eric’s mother is often intoxicated, and he’s had to call the ambulance multiple times due to her alcohol overdoses.

9. Mental illness in the household

Growing up with a family member who suffers from mental health disorders, including depression, anxiety, psychosis, or suicidal tendencies, is another ACE.

Example: Sarah’s brother has severe schizophrenia. The family often navigates through his unpredictable behaviors, hospitalizations, and the associated stigma.

10. Incarceration of a household member

This ACE involves having a household member go to jail or prison during a child’s upbringing.

Example: Maya’s elder sister was arrested and jailed for drug trafficking. The sudden absence and the social stigma have affected Maya’s emotional well-being.

What is my ACEs Score?

If you’re considering understanding your personal history and its potential impacts on your well-being, the ACEs quiz can be a beneficial tool. It provides insight into certain adverse experiences you may have encountered during your formative years. To take the quiz, you can download the form and go through each question at your own pace.

However, before embarking on this self-reflective journey, it’s essential to keep a few things in mind:

Your Score Doesn’t Define You: Having a high ACEs score doesn’t mean you’re destined for a troubled future. It’s merely an indicator of certain experiences you’ve had, and it doesn’t account for the positive experiences, personal strengths, or resilience you’ve developed.

You’re Not Alone: If you find that your score is higher than you expected, it’s crucial to understand that many others share similar experiences. It doesn’t signify weakness or isolation; everyone’s journey is unique, and many have faced and overcome significant adversities.

Support is Available: Recognizing and understanding your ACEs score is a courageous step. If you feel the need, professional help, such as counseling or therapy, can provide valuable support. Therapists trained in trauma-informed care can help process and heal from past adversities.

Knowledge is Power: Awareness is the first step towards healing. Understanding your ACEs score can provide a pathway to seek the necessary resources, therapies, or interventions suited for you. It’s never too late to seek help or adopt strategies to improve your well-being.


Personal Journey

Remember, everyone’s life journey is filled with challenges and triumphs. The ACEs quiz is a tool to understand certain aspects of your past, but it doesn’t capture the entirety of your experience, strengths, or potential. Taking the initiative to know more is already a significant step towards healing and self-awareness.

I hope this provides a compassionate and encouraging perspective for those considering taking the ACEs quiz.


Expanded ACEs:

The study of Adverse Childhood Experiences (ACEs) and its implications is expansive. Here are a few more aspects that might intrigue you: While the original ACE study identified ten specific experiences, researchers have since recognized that other types of adversity can also have significant impacts on children. This expanded list can include experiences such as:

  • Experiencing racism or discrimination
  • Living in an unsafe neighborhood
  • Experiencing bullying
  • Loss of a loved one to sudden death
  • Living in foster care

Brain Development

Traumatic experiences during childhood can physically change the brain. Chronic stress can affect areas like the amygdala (involved in emotional processing) and the prefrontal cortex (responsible for decision-making and impulse control). This can lead to difficulties with emotions, relationships, and even learning.


Recent studies suggest that trauma can lead to epigenetic changes. This means that while our DNA sequence remains the same, trauma can affect how our genes are expressed. Even more intriguing is the idea that these changes might be passed on to future generations, meaning the effects of trauma could potentially be seen in children and grandchildren.

The Importance of a Trauma-Informed Approach

As we understand more about the effects of ACEs, there’s a growing emphasis on trauma-informed care. This approach recognizes that problematic behaviors might be reactions to trauma. Institutions from schools to hospitals are adopting a trauma-informed approach to better support those with high ACE scores.

Economic Impact

ACEs don’t just affect individual health; they also have economic implications. From a societal perspective, ACEs lead to increased healthcare costs, decreased work productivity, and higher rates of crime. By addressing ACEs early on, communities can potentially save millions in future costs.

The Role of Community

It’s not just individual resilience that helps mitigate the effects of ACEs; community plays a pivotal role. Communities that offer support, resources, and interventions can buffer the effects of ACEs. Building strong community bonds, safe spaces, and accessible support systems can make a massive difference in the lives of those affected by ACEs.

Impact on Health and Well-being

Numerous studies have shown that the more ACEs an individual has, the higher their risk for health problems later in life. These include mental health disorders, chronic diseases, substance abuse, and even early death. ACEs can also affect education and job opportunities, making them a crucial public health issue.

Prevention and Intervention

Addressing ACEs is essential for the future health and prosperity of a nation. Communities are integrating ACEs science into education, public health, healthcare, human services, criminal justice, and the business community.

Prevention: Education and support for parents and families can prevent ACEs.
Intervention: Strategies include therapy, school-based counseling, and more.


While ACEs can have long-lasting impacts, resilience factors can help counteract these effects. Resilience is the ability to bounce back from challenging experiences, and it can be built at any age. Supportive relationships, adaptive skills, and positive experiences can foster this resilience.

Why learning about ACEs early can help children

When educators, parents, caregivers, and health professionals are aware of ACEs and their potential long-term effects, they can implement early interventions to support at-risk children. By recognizing signs and symptoms early on, these professionals can:
  • Provide emotional and psychological support.
  • Implement trauma-informed care.
  • Develop resilience-building programs.
Understanding ACEs can lead to a more compassionate, empathetic, and holistic approach to nurturing children, enabling them to thrive despite the odds.

How adults with high ACEs can heal

For adults who have experienced multiple ACEs, there is hope. Here are some steps one can take to begin healing:

  • Awareness: Recognizing and acknowledging the effects of ACEs is the first step toward healing.
  • Therapy: Working with a trained therapist can help one process traumatic memories and develop coping strategies.
  • Building resilience: Cultivating positive relationships, practicing mindfulness, and focusing on self-care can help bolster resilience.
  • Community support: Connecting with support groups or community organizations can offer understanding and companionship.
  • Physical health: Focusing on maintaining a healthy lifestyle can help mitigate some of the health risks associated with high ACEs.

How adults with high ACEs can heal

For adults who have experienced multiple ACEs, there is hope. Here are some steps one can take to begin healing:

  • Awareness: Recognizing and acknowledging the effects of ACEs is the first step toward healing.
  • Therapy: Working with a trained therapist can help one process traumatic memories and develop coping strategies.
  • Building resilience: Cultivating positive relationships, practicing mindfulness, and focusing on self-care can help bolster resilience.
  • Community support: Connecting with support groups or community organizations can offer understanding and companionship.
  • Physical health: Focusing on maintaining a healthy lifestyle can help mitigate some of the health risks associated with high ACEs.

The ACEs Study is always evolving

The study of ACEs is continually evolving as we learn more about human development, trauma, and resilience. As our understanding deepens, so does our capacity to intervene, support, and heal. It’s a testament to the interwoven nature of society – how early experiences shape us, and how, together, we can overcome adversity.

The realm of Adverse Childhood Experiences (ACEs) is expansive and continuously developing. Here are a few additional points to consider:


Positive Childhood Experiences (PCEs)

While ACEs emphasize traumatic or negative experiences, research is also exploring Positive Childhood Experiences and their ability to counteract the impacts of ACEs. PCEs can include supportive family environments, having a trusted adult outside the family, participation in community traditions, and feelings of belonging.

ACEs Worldwide

Though the original ACE study was conducted in the U.S., subsequent research has indicated that ACEs are a global concern, impacting individuals across different countries, cultures, and socio-economic statuses. This emphasizes the universal need for trauma-informed care and interventions.

ACEs and Substance Abuse

There’s a strong correlation between ACEs and an increased likelihood of substance abuse in adulthood. Understanding this connection can inform more effective, trauma-sensitive approaches to addiction treatment.

The Power of Intervention

The negative impacts of ACEs aren’t inevitable. Early interventions, like trauma-focused cognitive-behavioral therapy and other evidence-based treatments, can make a significant difference, even for those with high ACE scores.

Schools and ACEs

With increased awareness of ACEs, many educational institutions are incorporating trauma-informed practices to better serve students. This might include training teachers to recognize signs of trauma, creating safe spaces within schools, or implementing restorative justice practices.

Screening for ACEs

Some healthcare providers are integrating ACEs screenings into routine check-ups, especially in pediatrics. By identifying ACEs early, professionals can provide resources or referrals to support affected children and families.

The Hopeful Aspect

While understanding ACEs sheds light on the potential challenges faced by individuals, it also underscores the incredible resilience of the human spirit. Many people with high ACE scores lead productive, fulfilling lives, especially when provided with the right tools and supports.

The study and understanding of ACEs highlight the profound impact early experiences can have on a person’s life trajectory. Still, they also showcase the potential for growth, healing, and transformation with informed and compassionate intervention.


While the concept of ACEs reveals a critical aspect of public health, it also emphasizes the human ability to heal, change, and grow. It’s a powerful testament to the importance of early life experiences on future health and offers a lens through which we can understand and address many public health and social challenges.

While ACEs can have profound effects on an individual’s life, understanding and addressing them can pave the way for healing and growth. Knowledge is power, and with the right tools and support, individuals can overcome the shadows of their past to lead fulfilling, healthy lives.

Suggested Workshop

Embark on a captivating journey with us as we explore the transformative realm of “The Art of Healing.” This workshop, enriched by a harmonious blend of intimate personal narratives, deep insights, and robust scientific backing, illuminates the powerful confluence of art and wellness. Throughout this immersive experience, participants will gain knowledge of the Adverse Childhood Experiences (ACEs) and their lasting impact on well-being. Coupled with this, we’ll delve into a wealth of studies showcasing the profound therapeutic effects of art on mental and emotional health. Whether you are navigating your own path to healing, a professional bridging the worlds of art or psychology, or someone seeking to understand the evidence-based benefits of art on well-being, this workshop is tailored to offer you profound insights and a transformative experience. Join us and unveil the intricate tapestry where science, art, and healing intertwine.

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  1. Patty Meiners

    I would like to suggest that we as artists, often healing from painful experiences, that we get acquainted with Kelly Mahler and Introception. kelly-mahler.com
    I have been dealing and healing from ACEs for most of my life. As a 63 yr old woman, I wish I would have known this information years ago.
    Introception is the ability to connect with your body, identify feelings (stress, hunger, racing heart, constipation, etc). Your body within. Every organ within our bodies has feelings, but many neurodiverse individuals (Autism and ADHD) as well as trauma victims, do not associate with their bodies. Which I believe is on the increase as demonstrated by increased ‘difficult’ behaviors in today’s classrooms. Society is focused on the behavior instead of what the body is feeling and these people (myself included) are unable to name and even more unable to figure out ways to functionally self-soothe.
    I remember like it was yesterday, 30 years ago, in the shower, I suddenly ‘felt’ my bare feet on the floor of the tub. I was so shocked. Mostly because I didn’t even know that I hadn’t noticed that sensation before.
    I had ACEs training as a teacher. The knowledge is important, but to stop there, kept me from paying attention to why; I was mad, frustrated, fearful… and be able to name these feelings and feel them in a safe way.
    This is all my thoughts and feelings. I’m simply sharing what I have been learning and finding very important to me and to my clients on the spectrum.

    • Aunia Kahn

      Thank you so much for sharing your valuable insights!


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