Understanding ACEs

In an ideal world, every child would navigate their formative years without encountering any form of trauma or difficulty. However, for many children and young people, this is not the case, with many experiencing more than one adverse childhood experience (ACE). These experiences can continue to affect individuals well into later life.

As practitioners in education and health and social care, what do we understand by the term ‘ACE’, and how can we best support individuals who have experienced adversity in childhood?

What are ACEs?

Adverse childhood experiences (ACEs) can refer to a single event, or a prolonged series of experiences. According to the Early Intervention Foundation (now known as Foundations), they are best understood as, ‘…a set of 10 traumatic events or circumstances occurring before the age of 18 that have been shown through research to increase the risk of adult mental health problems and debilitating diseases.’

Half of these ACE categories relate to child abuse and neglect, and half represent types of family dysfunction that could result in exposure to trauma:

1. 1. physical abuse

1. 1. sexual abuse

1. 1. psychological abuse

1. 1. physical neglect

1. 1. emotional neglect

1. 1. witnessing domestic abuse

1. 1. having a close family member who misuses drugs or alcohol

1. 1. having a close family member with mental health problems

1. 1. having a close family member who served time in prison

1. 1. parental separation or divorce on account of relationship breakdown

It’s important to note that there are many other types of adversity that can affect children in both the short and longer term, including bereavement, bullying, racism, disability and poverty. Therefore, rather than being confined by the ten ACE categories, we can broaden our perspective to include all types of childhood adversity to better understand an individual’s experiences and offer the most effective support to them.

How prevalent are ACEs?

A systematic review and meta-analysis of global ACE-related data carried out by World Psychology, and referenced in Psychiatry Advisor in December 2023, estimates that 60% of the world’s population has been exposed to at least one ACE. The study spanned 22 countries and involved a sample size of over half a million participants.

This statistic is a reminder of how common ACEs may be in our services, not only among the individuals we care for, but also among staff members. When reflecting on effective trauma-informed practice, therefore, it’s essential that our approach encompasses the whole community in which we work.