Adverse Childhood Experiences: Everything You Need to Know About The ACE Study and Test

by Shea Brogren, MOT, OTR/L February 08, 2020

Adverse Childhood Experiences: Everything You Need to Know About The ACE Study and Test

In 1998, the CDC released significant results from their Adverse Childhood Experiences (ACEs) study. This study was groundbreaking, as it outlined the impact that adverse childhood experiences and childhood trauma can have on an individual’s development and health.

An adverse childhood experience is a traumatic event or circumstance a child experiences that directly impacts brain functioning and can have life-long effects. The preliminary study, as well as subsequent studies, found that most people in the U.S. have experienced at least one ACE. This places them at a higher risk for chronic diseases, such as diabetes, heart conditions, cancer, depression, immune system disorders, thyroid problems, and alcoholism. 

In this article, we will briefly review the impact of childhood trauma on the brain and body, review the significance of the ACEs study, and discuss important implications of the study. 

How does trauma affect the body and brain? 

A traumatic event can be described as an event (one-time or recurring) that impacts a child’s stress system to the point where they cannot access appropriate coping mechanisms. Examples of trauma may include loss of a parent or loved one, a prolonged or serious childhood illness, parental separation or divorce, witnessing violence or abuse, or any type of child abuse.

Childhood traumaThese types of events have a direct impact on a child’s developing brain. When a child is experiencing a traumatic event, the part of the brain involved with alerting the body’s alarm or stress system is activated. When this part of the brain is activated, stress chemicals are released throughout the body, signaling a fight or flight response.

Physical manifestations such as a racing heart, sweating, feeling numb or dissociating, a feeling of panic, etc take over the body when trauma is occurring.  When trauma is experienced frequently or repeatedly, this can have a direct negative impact on the brain and the immune system’s functioning.

In addition to immune system functioning, childhood trauma can impact behavior, ability to regulate emotions, social skills, and important cognitive skills such as planning, judgment, attention, and memory. These effects can impact a person years after the trauma was experienced. 

The ACE Study and Test 

The CDC ACEs study was conducted from 1995 to 1997, with the results being released in 1998. Over 17,000 individuals completed a questionnaire asking about their childhood experiences and their current health status and behavioral functioning. The results were impactful, with ⅔ of the participants indicating they had experienced at least one ACE. One in five participants had experienced three or more ACEs. The study included ACEs in the following categories: 

  • Experiencing violence or any type of neglect or abuse (physical, verbal, emotional, sexual) 
  • Witnessing violence at home or in the community
  • Having a family member attempt or commit suicide 
  • A parent with substance abuse or misuse 
  • A parent with mental health problems 
  • Having an unstable living environment due to parents being in jail or prison 

When scoring the questionnaire, each positive response was given one ACE point. Each individual’s “ACE score” was calculated by adding the number of positive responses, with a range from 0 (no positive responses) to 10 (all positive responses). The results showed that as the number of ACEs increased, the number of health and well-being issues also increased.

The researchers concluded that the more adverse childhood experiences a person has, the higher their risk is for developing health problems and chronic diseases. If interested, you can take the ACEs study test to determine your own ACE score. 

 Other important findings from the study included: 

  • The more types of trauma a person experienced, the greater their risk for health, social, and emotional problems
  • Individuals generally experience more than one type of trauma
  • Childhood trauma is an extremely common occurrence, regardless of race, socioeconomic status, and gender. Participants in the study were generally white, middle-class, males and the rates of trauma were impactful.

Implications of the ACE study 

The ACEs study results helped bring greater awareness to the reality of adverse childhood experiences and childhood trauma. How can we use this information in our daily lives? Below, we have highlighted three major implications of the ACEs study. 

Childhood trauma affects children of all ages, races, genders, and socioeconomic statuses.

It is important to recognize that adverse childhood experiences are happening to children of very diverse backgrounds and the prevalence of childhood trauma is more common than once thought. One recent study found that 61% of adults across 25 states indicated they had experienced at least one type of ACE, and 1 in 6 indicated they had experienced four or more types of ACEs.

Women and several ethnic minority groups were at a greater risk of experiencing four or more types of ACEs. 

The effects of childhood trauma can be experienced for years to come, often well into adulthood.

Childhood trauma effects

The ACEs study highlighted how adverse experiences as a child continue to impact children into their adulthood, with varying effects including diabetes, mental illness, and even cancer. The effects of childhood trauma on the brain are significant and need to be recognized. 

The focus must be on preventing childhood trauma and adverse childhood experiences.

With the knowledge we have regarding ACEs and their detrimental impact on physical and mental health, it is crucial that necessary actions are taken to prevent ACEs whenever possible.

The CDC has developed an initiative aimed at preventing adverse childhood experiences. These initiatives include strengthening economic supports to families, teaching adults and children important skills (social-emotional, parenting skills, etc), supporting social norms that protect against violence and adversity (public campaigns, legislative action, etc), connecting youth with caring adults, mentors, and activities, intervening early to lessen the immediate and long-lasting effects of trauma. 

Closing Thoughts 

The findings from the ACEs study are important, as they help bring more awareness to adverse childhood experiences in the United States. As discussed, the effects of childhood trauma are significant and life-changing.

The difficult part to acknowledge is that ACEs are more common than most realize. However, this knowledge can help bring about prevention. Prevention is the key moving forward to minimize ACEs and in turn, help prevent chronic physical and mental disorders. 




Centers for Disease Control. (2018). Adverse childhood experiences study (ACES). Accessed from 

Chang, X., Jiang, X., Mikandarwire, T., & Shen, M. (2019). Associations between adverse childhood experiences and health outcomes in adults aged 18-59 years. PLoS ONE, 14 (2). 

Shea Brogren, MOT, OTR/L
Shea Brogren, MOT, OTR/L

Shea Brogren, MOT, OTR/L, is an occupational therapist with over three years of experience in pediatrics and child/adolescent mental health and has also worked as an adjunct lecturer at the University of North Dakota. Shea has a special interest in program development and developed and implemented occupational therapy programming at a residential treatment center for children. She now practices in an outpatient setting.

Her primary area of interest involves working with children who have experienced developmental trauma. Shea has advanced training in SMART treatment (Sensorimotor Arousal Regulation Treatment), the Zones of Regulation, using sensory-based interventions to address trauma, infant mental health, attachment, and arousal regulation related to trauma disorders.

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