ACEs: A Deeper Dive into Adverse Childhood Experiences

education parenting May 11, 2026

If you’ve been doing trauma-informed work for any period of time, you have likely come across the term ACEs: Adverse Childhood Experiences. While the acronym is widely used in education, healthcare, and mental health spaces, it’s worth slowing down to really understand what ACEs are and are not.

A landmark study published in 1998 by Kaiser Permanente and the CDC identified 10 adverse childhood experiences across three categories: abuse, neglect, and household challenges. These included experiences such as physical or emotional abuse, caregiver substance use, domestic violence, and parental separation. Participants in the study were asked to complete a comprehensive health history and indicate whether they had experienced any of these adversities before the age of 18.

Each participant received an ACE score ranging from 0 to 10, based on the number of categories they experienced. Researchers then examined the relationship between ACE scores and long-term health outcomes. What they found was remarkable.

Not only were ACEs incredibly common, but they were also strongly associated with health outcomes, decades later. Higher ACE scores were linked to increased risk for conditions such as diabetes, cancer, heart disease, and pregnancy complications, as well as mental health challenges including PTSD, depression, suicide, and substance use. The study fundamentally shifted how we understand the connection between early experiences and lifelong health.

However, like all research, the original ACE study had limitations. The participant pool was largely middle-class and white, leaving important questions about how adversity shows up across different communities.

In 2012, the Philadelphia ACE Project expanded on this work by examining both the original 10 ACEs and five additional indicators of community-level adversity, including bullying, discrimination, neighborhood safety, and exposure to violence. This study included a more racially and economically diverse urban population.

The findings added important nuance. Rates of adversity were higher than those found in the original study, and many individuals reported significant community-level stressors despite having an ACE score of zero. In other words, the original ACE framework did not fully capture the lived experiences of many people, particularly those in under-resourced or marginalized communities.

This matters, especially in schools and caregiving environments, because it challenges us to think beyond a checklist.

ACEs are not a diagnostic tool.
An ACE score does not predict a child’s future, nor does it define their capacity for growth, healing, or success. Instead, it offers a lens through which to understand how early experiences can shape development.

Adversity is broader than we originally measured.
Experiences like chronic stress, systemic inequities, community violence, and exclusion can have profound impacts on a child’s nervous system and sense of safety, even if they are not captured in a traditional ACE score.

Context and relationships matter.
Two children with the same ACE score can have vastly different outcomes depending on the presence of protective factors: safe relationships, supportive adults, and environments that promote regulation and connection.

So where does this leave us?

For educators, caregivers, and professionals, the takeaway is not to tally scores, but to deepen our understanding. We can use an ACEs score as a piece of information that provides context for the types of supports a child may need or benefit from, and also as a backdrop for challenging behaviors, which could otherwise seem confusing.

When we view behavior through a developmental and brain-based lens, we begin to ask different questions. We can ask, “What might this child have experienced?” and just as importantly, “What does this child need right now to feel safe, supported, and able to engage?”

ACEs research opened the door to understanding the long reach of early adversity. Our job now is to walk through that door with nuance, recognizing both the weight of early experiences and the incredible capacity for resilience when the right supports are in place.

https://sparqtools.org/mobility-measure/philadelphia-adverse-childhood-experiences-phl-ace/