ACEs & PCEs Explained: Supporting Children's Long-term Health

In 1995, the CDC and Kaiser Permanente healthcare organization conducted a study to look at the impacts of Adverse Childhood Experiences (ACEs) on various long term life outcomes. ACEs include experiences such as abuse, neglect, household substance use, caregiver mental illness, domestic violence, incarceration of a family member, and chronic instability.

The results were sobering: not only did the study reveal that most people experience at least one ACE, but it also showed that the more ACEs a person experienced, the greater their risk for challenges in adulthood. These challenges included increased rates of chronic health conditions, mental health concerns, substance use, relationship difficulties, and reduced overall well-being – even decades after their ACEs. This study’s findings highlighted the ways in which early stress can shape brain development, the nervous system, and stress-response patterns over time; illuminating the fact that our experiences as children have a long-term impact on not only our mental health, but also our physical health.

But ACEs do not determine destiny.

As this research has evolved, researchers have asked an equally important question: What helps protect children, even when adversity is present? That question led to a growing understanding of the powerful impacts of Positive Childhood Experiences (PCEs).

PCEs are the relationships, environments, and experiences that help children feel safe. They act as protective factors, reducing the potential long-term impact of adversity and supporting healthy brain and emotional development. PCEs don’t erase hardship, but they can help the brain learn that stress can be met with care, safety, and repair. They help children develop the necessary skills to overcome adversity in childhood, and then into adulthood, too. 

There are 7 PCEs that have been identified in the research:

1. Being able to talk to family about feelings
2. Having family stand by you during difficult times
3. Participating in community traditions
4. Having a sense of belonging in high school
5. Feeling support from friends
6. Having two non-parent adults that take an interest in you
7. Feeling safe and protected by an adult in the home

When children experience these positive supports, they help mitigate the effects of ACEs. In other words, even when a child has been dealt a difficult hand, consistent positive experiences can strengthen resilience, support nervous system regulation, and promote healthier outcomes over time.

This is a powerful message for both educators and caregivers: you do not need to (and likely cannot) eliminate all adversity for the children you care about. In fact, doing so could be harmful for children in the long run. Instead, building PCEs into everyday moments, by listening, showing up consistently, offering reassurance, creating belonging, and responding with care during hard moments is the work that best supports children.

If you are an adult in the life of a child under 18, you have tremendous potential to be part of their positive childhood experiences. Your presence, predictability, and connection matter more than you might realize; and strung together, those small moments add up to lasting protection for their mental, emotional, and physical health.

References

Bethell C, Jones J, Gombojav N, Linkenbach J, Sege R. Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels. JAMA Pediatr. 2019:e193007.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8.