NHS Information on Adverse Childhood Experiences

Adverse Childhood Experiences (ACEs) are stressful events occurring in childhood including

• domestic violence
• parental abandonment through separation or divorce
• a parent with a mental health condition
• being the victim of abuse (physical, sexual and/or emotional)
• being the victim of neglect (physical and emotional)
• a member of the household being in prison
• growing up in a household in which there are adults experiencing alcohol and drug use problems.

The term was originally developed in the US for the Adverse Childhood Experiences Study which found that as the number of ACEs increased, so did the risk of experiencing a range of health conditions in adulthood. There have been numerous other studies which have found similar findings including in Wales and England.

ACEs and health inequalities

Preventing ACEs should be seen within the wider context of tackling societal inequalities. While ACEs are found across the population, there is more risk of experiencing ACEs in areas of higher deprivation.

ACEs have been found to have lifelong impacts on health and behaviour and they are relevant to all sectors and involve all of us in society. We all have a part to play in preventing adversity and raising awareness of ACEs. Resilient communities have an important role in action on ACEs.

An ACE survey with adults in Wales found that compared to people with no ACEs, those with 4 or more ACEs are more likely to

• have been in prison
• develop heart disease
• frequently visit the GP
• develop type 2 diabetes
• have committed violence in the last 12 months
• have health-harming behaviours (high-risk drinking, smoking, drug use).

When children are exposed to adverse and stressful experiences, it can have long-lasting impact on their ability to think, interact with others and on their learning.

ACEs should not be seen as someone’s destiny. There is much that can be done to offer hope and build resilience in children, young people and adults who have experienced adversity in early life.

National action

The Scottish Public Health Network produced a report ‘Polishing the Diamonds – Addressing Adverse Childhood Experiences’ in 2016 which summarised the research and set out a number of areas for action in Scotland. You can read more about ACEs in the report.

The Scottish Government has set out its commitment to preventing and mitigating ACEs. You can read about their commitment in the 2017/18 Programme for Government (external site).

We co-ordinate a Scottish ACEs Hub to progress national action on ACEs.

The ACE Hub, working with Scottish Government and other partners is involved in action on

• raising awareness and understanding about ACEs
• contributing to developing the evidence base on ACEs
• policy and practice approaches to prevent ACEs and mitigate their negative impacts.

You can help reduce ACEs by

• preventing household adversity
• supporting parents and families
• building resilience in children and wider communities
• enquiring about ACEs routinely in your services to respond appropriately
• encouraging wider awareness and understanding about ACEs and their impact on health and behaviour
• using encounters with adults in services such as homelessness services, addiction, prison or maternity services, to also consider the impacts on their children or future children.

You can find out more about tackling ACEs in our evidence report ‘Tackling the Attainment Gap’.

We will be doing more work in this area soon. Stand by for an upcoming announcement.