Signs of an adverse childhood experience (ACE) in a child — Adverse childhood experiences (ACEs) can affect a child’s emotions and behavior. They can also cause physical effects.

What are adverse childhood experiences?

Adverse childhood experiences (ACEs) are traumatic events that happen between birth and the age of 17. ACEs can cause childhood trauma that lingers long after the event occurred.

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ACEs can take a toll on your body and mind. You may have physical, mental or behavioral health challenges. But with time, you can heal. Treatment can help you put your childhood trauma behind you.

What are considered adverse childhood experiences?

Examples of adverse childhood experiences include:

Natural disasters
Violence
Abuse or assault
Neglect

Life-threatening illness

Loss of a friend or family member
Parental separation, divorce or deployment
Witnessing or being involved in a serious accident
Witnessing the death of another person

Social determinants of health may also cause childhood trauma. These are environmental factors that can lead to adverse childhood experiences with a lasting impact. These factors may include:

Housing instability or frequent moves
Feeling unsafe in your community
Lack of access to good healthcare
Food insecurity
Limited access to quality education
Financial issues
Discrimination

Who’s at risk of childhood trauma?

Any child can experience trauma, but certain factors raise the risk. ACEs are more common among:

Girls
Racial and ethnic minorities
Children in financially stressed homes
Children with stressed or overwhelmed caregivers
Children with family members who have mental health conditions
Children living with someone who has substance use disorder

What does an adverse childhood experience do to your body?

Childhood trauma causes extreme stress on your body. When you experience stress, your body releases certain hormones, like cortisol and adrenaline. These hormones help you adjust to the situation. This is called the “fight-or-flight” response. You may have:

Fast heart rate
High blood pressure
Changes to your breathing
Dilated pupils
Memory issues
Loss of bladder control

This response is usually temporary. But long-term stress causes your stress hormones to be in constant use. This is called toxic stress. It can target your brain and change how it grows and functions.

How do adverse childhood experiences affect development?

Adverse childhood experiences can cause developmental trauma. While traumatic events can cause harm at any age, childhood trauma is more severe. That’s because a child’s brain is still growing and developing. ACEs target a child’s:

Memory (hippocampus)
Logical thinking (prefrontal cortex)
Ability to process emotions (amygdala)

Severe or long-term stress places these parts of a child’s brain into survival mode for too long. This can weaken those parts. That, in turn, influences the way children react to certain situations as they grow older.

What are the signs of an adverse childhood experience?

After an adverse childhood experience, a child may show signs of trauma that could include:

Fear of other people
Difficulty sleeping or frequent nightmares
Bedwetting
Changes to their mood
Difficulty showing affection toward friends or family
Avoiding situations or events that relate to a traumatic experience
Difficulty learning in school

These signs might not be immediately present after a traumatic event. They usually develop after a child has had time to process the experience. In certain cases, a trigger — something that reminds a person of a specific event — can cause a child to react.

How does an adverse childhood experience affect an adult?

ACEs can affect an adult years after traumatic events occurred. It can impact your physical, mental and behavioral health. Childhood trauma can also affect your quality of life. Access to opportunities, like your career and education, may see an impact.

The effects of adverse childhood experiences in adulthood can include long-term (chronic) conditions. This happens because too much stress takes a toll on your body. It affects the way your cells divide and replicate. This can result in cancer. It also affects the way your heart functions by increasing your blood pressure. This can lead to heart disease.

ACEs can also decrease your overall life expectancy by nearly 20 years compared to someone who doesn’t have any ACEs.

Mental health impact

Mental health conditions that can develop in adulthood include:

Anxiety
Depression
Post-traumatic stress disorder (PTSD)
Phobias
Insomnia
Mood disorders
Eating disorders

Behavioral health impact

Childhood trauma makes adults more likely to participate in high-risk behaviors, including:

Using tobacco products
Misusing prescription medications
Using substances, including those with a high risk of addiction
Participating in risky sexual behaviors
Experiencing suicidal thoughts or engaging in self-harm

If you or a loved one is considering suicide, you can call the 988 Suicide & Crisis Lifeline.

What is an ACE score?

An ACE score is the total number of adverse childhood experiences you faced growing up. The ACEs test asks you 10 questions about traumatic events that may have happened during your childhood. The purpose of the ACEs test is to quickly figure out if you’re at a high risk for toxic stress. If you are, your healthcare provider will ask further questions about your specific ACEs and start childhood trauma treatment.

Research suggests that a high ACE score is directly linked to negative health and wellness in adulthood. Adults with 4 or more ACEs were 12 times more likely to develop conditions, including:

Alcohol use disorder
Substance use disorder
Depression

What are the 10 ACEs of trauma?

Healthcare providers figure out your ACEs score by asking you about 10 potential adverse childhood experiences. If you faced any of them during childhood, they’ll give you 1 point. The 10 ACEs of childhood trauma are:

Domestic violence: Witnessing violence between adults at home
Substance use: Living with someone who misused alcohol or drugs
Mental health condition: Living with someone who had a mental health condition or experienced suicidal thoughts or behaviors
Parental separation or divorce: Losing a parent through separation, divorce or abandonment
Incarceration: Living with someone who went to jail or prison
Emotional abuse: Being sworn at, humiliated or threatened
Physical abuse: Being hit, pushed or physically harmed
Sexual abuse: Being touched or harmed in a sexual way
Emotional neglect: Feeling unsupported or ignored
Physical neglect: Lacking food, clothing or medical care

How do you heal from childhood trauma?

Healing from childhood trauma takes time — but it’s possible. Self-care, support and therapy can make a big difference. Treatment for the effects of childhood trauma may start with steps to reduce your stress. Your healthcare provider may suggest:

Getting enough high-quality sleep
Developing healthy eating habits
Avoiding alcohol
Getting physically active
Exploring nature
Spending time with supportive loved ones

Your provider may recommend further mental health care, including:

Mindfulness
Meditation
Talk therapy
Substance use disorder treatment

A note from Cleveland Clinic

A child is constantly learning from the world around them. So, traumatic events may have a major effect on their growth and development. Adverse childhood experiences (ACEs) are common. With help from a healthcare provider, you can heal from your childhood trauma. Treatment may be lifelong, but you can overcome your ACEs. It’s important to take care of your mental health. Remember, you’re never alone.

Care at Cleveland Clinic

As your child grows, you need healthcare providers by your side to guide you through each step. Cleveland Clinic Children’s is there with care you can trust.