Adverse childhood experiences (ACEs) are potentially traumatic events that occur before a person turns 18. They include abuse (physical, emotional, and sexual), neglect (physical and emotional), and household dysfunction such as domestic violence, substance misuse, parental separation, mental illness in a caregiver, and incarceration of a household member. Expanded definitions also include community-level adversities like neighborhood violence, bullying, discrimination, and economic hardship.

People who have experienced ACEs may not always recognize the connection between childhood events and current difficulties. Common signs in adulthood include:

• Persistent anxiety, depression, or emotional numbness
• Difficulty trusting others or maintaining stable relationships
• Heightened startle responses, hypervigilance, or trouble sleeping
• Chronic pain, headaches, or unexplained physical symptoms
• Difficulty regulating emotions, including intense anger or prolonged sadness
• Patterns of self-blame, shame, or low self-worth
• Use of alcohol, food, or other substances to cope with distress

These signs can appear in childhood or may not surface until adolescence or adulthood, often triggered by new stressors or life transitions.

ACEs are identified through structured screening interviews and validated questionnaires, the most well-known being the original 10-item ACE questionnaire developed by Felitti and colleagues for the CDC-Kaiser Permanente ACE Study (1998). Expanded versions now capture additional adversities such as peer victimization, community violence, and economic hardship. Screening is typically conducted by a trained clinician as part of a broader psychosocial assessment.

Support for people affected by ACEs usually involves trauma-informed therapy. Common evidence-based approaches include:

• Cognitive behavioral therapy (CBT), which helps identify and change unhelpful thought patterns linked to past experiences
• Eye movement desensitization and reprocessing (EMDR), which helps the brain reprocess traumatic memories so they become less distressing
• Somatic and body-based therapies, which address the physical ways the body stores and responds to stress
• Attachment-focused therapies, which help repair relational patterns disrupted by early adversity

Building protective factors is equally important. Strong, stable relationships with caring adults, community connectedness, social-emotional skill building, and physical wellness practices all reduce the long-term impact of ACEs. Early intervention in childhood can prevent many negative outcomes, but meaningful recovery is possible at any age.

Consider reaching out to a mental health professional if memories of childhood experiences continue to intrude on your daily life, if you notice patterns in your relationships or coping behaviors that cause you distress, or if you feel emotionally overwhelmed without a clear present-day cause. You do not need to be in crisis to benefit from professional support. Many people seek help simply because they want to understand themselves better and break cycles they may be repeating.

If you are in immediate distress or having thoughts of self-harm, contact the 988 Suicide and Crisis Lifeline (call or text 988 in the U.S.) or go to your nearest emergency department. Crisis counselors are available 24 hours a day, 7 days a week.

The following resources offer reliable information about ACEs, their health effects, and available support:

• CDC: About Adverse Childhood Experiences
• American Psychological Association: Adverse Childhood Experiences
• SAMHSA: Understanding Child Trauma