What are adverse childhood experiences (ACEs)?

You may have heard of adverse childhood experiences (ACEs) and wondered what they are and whether your teenager is being affected by them. Learn what causes ACEs, how to spot signs of them in your teen, and strategies to support and guide a young person with ACEs towards healing.

What are ACEs?

Adverse childhood experiences (ACEs) are stresses, traumas and disruptions experienced during childhood that can have lasting impacts on a person’s health and wellbeing. Researchers initially identified 10 common ACEs:

1. physical abuse

2. psychological abuse

3. sexual abuse 

4. physical neglect (inadequate food, shelter, health care)

5. emotional neglect

6. witnessing domestic violence

7. substance abuse in the family

8. having a close family member with untreated mental health issues

9. parental divorce or separation

10. having a close family member in prison.

Experts have since identified more ACEs, including:

• experiencing natural disasters like bushfires or floods 

• being a refugee from war or repression

• loss of a parent/carer through deportation

• death of a loved one or close friend (learn more about grief)

• witnessing a death

• having a life-threatening illness

• being in or witnessing a serious accident

• feeling unsafe from racism or bullying

• negative experiences with foster or kinship care

• housing instability.

Psychologist Cherry Kura explains that ACEs have many layers:

Are ACEs common?

Many children and young people are exposed to and experience ACEs. Two-thirds of young people worldwide have at least one ACE. In Australia, about 20 per cent of children are likely to experience three or more ACEs, and the rate is higher in communities such as Aboriginal and Torres Strait Islanders.

Exposure to adversity can happen at any point in childhood, as Cherry explains. ‘Some people might have a period of stability, but through either forced displacement, a migration experience or something like moving schools, they might go from a protective, psychologically supportive environment to one that’s really challenging.’

How ACEs impact a teen’s brain

It’s not entirely clear exactly why ACEs affect brain development, but research shows a link between childhood trauma and a constant state of ‘fight, flight or freeze’, which is when the body sends more of the stress hormones cortisol and adrenaline into the bloodstream. While this bodily response is helpful for emergency situations, if it happens too often in everyday life, it becomes ‘toxic stress’. 

Cherry explains: ‘When a young person is in a state of toxic stress, the brain is forced to prioritise immediate survival over something like long-term development.’ Constantly being in survival mode is thought to disrupt brain development from a young age by affecting the parts that control, memory, language, logic and emotion processing.

Cherry compares the effects to having ‘an overactive smoke detector’ that can cause people to ‘see threat or judgement or a lack of safety even in safe or normal situations’.

If you’re looking to understand more about how childhood trauma affects the brain and body, Nadine Burke Harris’s TED talk is a great place to start.

How ACEs show up in adulthood

ACEs can impact a person’s health and wellbeing into adulthood. They might show up in the way we react to stress and setbacks, as a hidden driver of behavioural issues and mental health challenges. Sometimes the trauma can be reactivated by a positive event – for example, when a person enters a new relationship and feels emotionally vulnerable.

While some adults can describe a distressing aspect of their childhood that’s had a big effect on them, others might have pushed that experience out of their mind long ago as a way of coping with it, or they might not even realise that what they experienced was distressing. ‘Even just acknowledging it as an adverse experience is still quite a vulnerable and emotionally activating thing,’ Cherry says.

The physical effects of ACEs

Unfortunately, ACEs put adults at higher risk of physical conditions like heart disease, stroke, cancer and respiratory diseases. For people with more than six ACEs, their life expectancy is nearly 20 years lower than average. 

While ACEs don’t always lead to bad outcomes, adults with four or more ACEs have been found to be up to 12 times more likely to develop problems with alcohol and drugs. ACEs affect all types of families, and their effects can repeat through generations.

‘There’s so much variability in how ACEs impact someone,’ Cherry says. While ACEs do increase the risk of experiencing physical or mental health related challenges, she emphasises that they don't define your future. 'With the right support, we know change is possible,’ she adds.

What’s an ‘ACE score’?

An ACE score is the number of different types of adverse childhood experiences a person faced while growing up. A person can get their score by doing a questionnaire originally created by the US Centers for Disease Control and Prevention. Keep in mind that this quiz is based on the original framework, so it might not include all types of ACEs. An ACE score isn’t supposed to be a label or a diagnosis; rather, it’s a framework for getting people the right support. 

What ACE scores don’t show are the positive factors that can help young people build the resilience to cope with ACEs. A really important factor is the presence of emotionally supportive relationships. This can be with parents or other family members, family friends, colleagues or managers at work, or community leaders and teachers.

‘People might grow up in, let’s say, a strained parental climate, but there’s a grandparent, an aunt, a cousin who might be able to provide a physically safe home for them to go to’, Cherry says as an example. 

Just one emotionally supportive relationship can make all the difference, no matter the types of ACEs a teen might have. Safe relationships provide emotional support during tough times and nurture a teenager’s ambitions by seeing their value and potential.

Recognising that your teen may have ACEs

As a parent or carer, you can’t always be aware of the existence and type of ACEs that might be impacting your teen, as the stress, trauma or disruption could have happened outside the home or without your knowledge. 

All families go through their own tough times, and some circumstances identified as ACEs, like being in an accident or experiencing a war, may be unavoidable events and not any family member’s choice or fault. Whether the ACEs were out of parental control or it’s more complicated than that, the subject can be pretty confronting for everyone. It’s completely normal for parents and carers to feel guilt or shame if they suspect their teen might have ACEs and feel they could have done more to protect them. 

While connecting the dots can be a hard thing to sit with, what matters is taking steps to learn what’s behind your teen’s feelings and behaviour and getting them the help they need.

What to look out for

If your teen is showing some of the following signs, ACEs might be a part of the picture:

• problems regulating emotions

• severe social struggles

• school refusal

• trouble concentrating

• bedwetting or insomnia

• strong avoidance of certain situations

• eating disorders

• phobias

• anxiety

• depression

• symptoms of post-traumatic stress disorder

• trouble showing affection

• withdrawing from others

• suicidal ideation

• self-harming.

If ACEs are involved, their effects can show up in ways you might not expect. As Cherry says, ‘Every person will respond in a unique way, depending on a range of things like their temperament, or their developmental age and stage, but also their prior life experiences.’ Other factors include your child’s access to support at the time of the adversity and how they dealt with it. 

Try not to panic if your teen exhibits some of these signs, as a couple of them can be typical, temporary responses to school stress or a period of big change. Others are also common with neurodivergence. ‘The symptoms only capture so much,’ Cherry says. The best way to find out what’s happening for your teen is to get them assessed by a professional, starting with your GP, who might refer them to a psychologist. 

How to support a young person with ACEs

It can be upsetting to think your child might be suffering from past trauma; however, healing is possible. Here’s how you can support them:

• Keep them safe, psychologically and physically.

• Identify what triggers their trauma.

• Find trauma-informed services like Blue Knot.

• Connect your child with a mental health professional to help them build emotional regulation skills.

• Work on developing trust through calm, consistent parenting.

• Support the positive, stable relationships in their life.

• Stick to routines at home whenever you can.

• Try to do something fun with your child regularly.

• Encourage their hobbies or cultural connections.

• Practise self-care to manage your own stress.

• Consider whether you have ACEs that might affect your choices.

People can and do recover from the effects of ACEs. A good first step is to support your teen in learning to work through the overactive stress response they’re experiencing. This includes helping them to:

• prioritise good sleep

• avoid alcohol

• eat healthily

• get lots of exercise

• spend time in nature

• practise deep breathing/mindfulness

• see supportive friends, family or community Elders.

Help your child make a list of what works for them. You’re not expected to have all the answers. What your young person with ACEs needs most from you is love, understanding and patience.

Get extra support

It’s understandable if you're reluctant to share with professionals that your child has or may have experienced ACEs. However, you don't need to report specific details to get support. Simply letting them know helps them to provide the best care.

A good first contact is your family GP, who will be able to assess your teen and can arrange a mental health treatment plan if needed. The plan allows you to claim up to 10 sessions a year through Medicare. As well as connecting you with the right specialist, your GP can tell you about community, parenting or peer support groups. These groups don’t have to be ACE-related to be helpful.

Here are a few expert services:

• Blue Knot (1300 657 380), offers helpline support for adult carers of ACE-affected young people and a directory of trauma-informed therapists.

• Phoenix Australia, the national centre for post-traumatic mental health, has resources in Arabic, Mandarin, Vietnamese and other languages.

• 1800RESPECT offers free, confidential counselling to people impacted by domestic, family or sexual violence.

• Kids Helpline is a safe online space for parents and children, with web and phone counselling.

• 13YARN has trained Aboriginal or Torres Strait Islander crisis supporters.

Frequently asked questions about ACEs