Adverse Childhood Experiences

Epidemiology of ACEs

The first large-scale population study to link Adverse Childhood Experiences, commonly called ACEs, to poor adult health outcomes was completed by a partnership between the CDC and Kaiser Permanente in the mid-1990s. This study identified 10 specific childhood experiences linked to a long list of chronic health conditions including heart disease, cancer diabetes, and even depression. The 10 ACEs originally studied do not account for all possible types of childhood adversity.

10 ACEs


  1. Physical
  2. Emotional
  3. Sexual


  1. Physical
  2. Emotional

Household dysfunction

  1. Parental divorce or separation
  2. Witnessing household violence
  3. Incarcerated household member
  4. Household substance abuse
  5. Household mental illness


From a sample size of approximately 17,000 insured adults living in Southern California, the study revealed that ACEs are incredibly common, with 64% of the population having experienced at least 1 ACE. The study also discovered that the more ACEs a person had the higher their risk for severe obesity, alcoholism, or depression

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How toxic stress harms developing brains

How does childhood adversity lead to poor adult health outcomes? The evidence points to toxic stress. Toxic stress occurs when a child experiences strong, frequent, and/or prolonged adversity, such as:

  • Accumulated burdens of family economic hardship-without adequate adult support
  • Caregiver substance abuse or mental illness
  • Chronic neglect
  • Exposure to violence
  • Physical or emotional abuse

Coping Strategies

During a child’s sensitive developmental years, exposure to toxic stress leads to structural changes in the brain. Due to these changes in the brain, the child over-develops physiological and behavioral coping strategies meant for survival in dangerous environments. The child perceives danger and instability in everyday circumstances and responds with a toxic stress coping strategy, such as hyper-vigilance or aggression.

Adults who witness these coping behaviors often misinterpret them as behavioral problems or learning difficulties exclusively. As a result, children exhibiting toxic stress coping behaviors are often considered disruptive in common social environments, such as school.

Helpful Videos

Seeking additional support

If you have Medicaid, try calling the Washington Mental Health Access Line at 888-693-7200.

For any other insurance carrier try calling the number on the back of the insurance card or log onto their website and search for provider coverage.

Public Documentary Screenings

Email S. Nelson if you are interested in organizing a community or professional screening of the documentary Resilience: The Biology of Stress and the Science of Hope. 

We have scheduled public screenings of the documentary Resilience: The Biology of Stress and the Science of Hope:

  • Date:
    • Thursday, September 13, 2018
    • 6:30 to 8 p.m.
  • Location:
    • Snohomish Health District
      3020 Rucker Avenue
      Everett, WA 98201
  • Register Online
  • STARS Credits will be offered for Child Care Providers