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Adverse Childhood Experiences | ACES

Child Abuse and Trauma Associated with Long Term Mental and Physical Health Consequences

ACE Study Overview (14:45) 



Child maltreatment includes all types of abuse and neglect of a child under the age of 18 by a parent, caregiver, or another person in a custodial role (e.g., clergy, coach, teacher). There are four common types of abuse:

The total lifetime cost of child maltreatment is $124 billion each year.

More than 3 million referrals of child maltreatment are received by state and local agencies each year—that's nearly 6 referrals every minute.

Alcohol and other Drug Abuse

Research consistently reflects an increased likelihood that children who have experienced abuse or neglect will smoke cigarettes, abuse alcohol, or take illicit drugs during their lifetime. In fact, male children with an ACE Score of 6 or more (having six or more adverse childhood experiences) had an increased likelihood—of more than 4,000 percent—to use intravenous drugs later in life (Felitti & Anda, 2009).


The Adverse Childhood Experiences (ACE) Study is the largest and most influential study of the relationship between childhood adversity and long term health. The AVA ACE Study DVD contains the most comprehensive description of the ACE Study findings and replications of those findings among a general population sample in Washington State and other similar findings from large nationally representative samples. The DVD features plenary addresses by the ACE Study Co-Investigators, Drs. Vincent Felitti and Rob Anda along with discussion by Dr. Frank Putnam, an internationally renowned childhood trauma researcher and child psychiatrist. The DVD also includes individual interviews with Drs. Felitti and Anda along with an interview with Dr. David Williamson, the obesity researcher and CDC epidemiologist who, after hearing Dr. Felitti speak in 1990 about his clinical observations of increased rates of child sexual abuse among obese women in his San Diego Kaiser Permanente Preventive Medicine Program, introduced Dr. Felitti to Dr. Anda who then developed the methodology, oversaw the research and supervised the scientific publications from the ACE study. To date, there have been more than 60 scientific publications from the ACE Study. Dr. Putnam describes how the ACE Study "changed the landscape" regarding how researchers and clinicians look at childhood trauma.

Dr. Richard Krugman, the first Vice Chancellor for Health Affairs and, since 1990, Dean of the Medical School at the University of Colorado recently reviewed the AVA ACE Study DVD for the Journal of the American Medical Association (August 15, 2012 - Vol. 308, No.7, pages 718-719). Dr. Krugman writes, "This DVD should be viewed by students, residents, all primary care health professionals, and all specialists working with adult patients who are the downstream casualties of adverse childhood experiences. He also suggests, "Watching the entire DVD, which takes around 4 hours and is well worth the effort and time, but to obtain maximum benefit, it may need to be watched in multiple short sessions.” Dr. Krugman, an international authority on child maltreatment, is the longest serving dean of any American medical school, a former Editor-In-Chief of the journal Child Abuse and Neglect and once directed the Kempe Center at the University of Colorado.


Definitions of Adverse Childhood Experiences

The following categories all occurred in the participant's first 18 years of life.

Types of Abuse

Emotional Abuse
  • Often or very often a parent or other adult in the household swore at you, insulted you, or put you down and sometimes, often or very often acted in a way that made you think that you might be physically hurt.
Physical Abuse
  • Sometimes, often, or very often pushed, grabbed, slapped, or had something thrown at you or ever hit you so hard that you had marks or were injured.
Sexual Abuse
  • An adult or person at least 5 years older ever touched or fondled you in a sexual way, or had you touch their body in a sexual way, or attempted oral, anal, or vaginal intercourse with you or actually had oral, anal, or vaginal intercourse with you.

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Emotional Neglect
  • Respondents were asked whether their family made them feel special, loved, and if their family was a source of strength, support, and protection. Emotional neglect was defined using scale scores that represent moderate to extreme exposure on the Emotional Neglect subscale of the Childhood Trauma Questionnaire (CTQ) short form.
Physical Neglect
  • Respondents were asked whether there was enough to eat, if their parents drinking interfered with their care, if they ever wore dirty clothes, and if there was someone to take them to the doctor. Physical neglect was defined using scale scores that represent moderate to extreme exposure on the Physical Neglect subscale of the Childhood Trauma Questionnaire (CTQ) short form constituted physical neglect.
    1Collected during the second survey wave only (N=8,667).

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Household Dysfunction

Mother Treated Violently
  • Your mother or stepmother was sometimes, often, or very often pushed, grabbed, slapped, or had something thrown at her and/or sometimes often, or very often kicked, bitten, hit with a fist, or hit with something hard, or ever repeatedly hit over at least a few minutes or ever threatened or hurt by a knife or gun.
Household Substance Abuse
  • Lived with anyone who was a problem drinker or alcoholic or lived with anyone who used street drugs.
Household Mental Illness
  • A household member was depressed or mentally ill or a household member attempted suicide.
Parental Separation or Divorce
  • Parents were ever separated or divorced.
Incarcerated Household Member
  • A household member went to prison.
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