The Long-Term Impact of Adverse Childhood Experiences (ACEs)

ACE Questionnaire

Content updated from previous publish date.

Our childhood experiences have a powerful influence on the rest of our lives. When those early years are marked by abuse, neglect, or trauma, it can have a negative lasting impact with serious consequences. In fact, adverse childhood experiences, or ACEs, can set the stage for long-term physical and mental health problems.


For decades, researchers have been looking into the many possible consequences of adverse childhood experiences. Experts have been studying how the effects of childhood trauma impact people not only during their early years but also in adulthood.

Research shows that ACEs are very stressful and traumatic and can interfere with normal developmental processes. They also increase the risk for health problems and psychiatric disorders.

In 1995, the Centers for Disease Control (CDC) and Kaiser Permanente undertook a large-scale study to identify the extent of ACEs in a group of 17,337 adult participants. This study also looked at the long-term effects of ACEs.

Adverse childhood experiences were surveyed using 8 specific questions that covered neglect, abuse, and household dysfunction, such as witnessing domestic violence.

The results of this research found that nearly 25% of those in the study had been exposed to 3 or more of the 8 ACEs that were being studied at that time. The fact that the participants were primarily middle-class Caucasian adults was a clear indication that ACEs can happen in almost any household.

However, it is now well-known that chronic poverty, community violence, and racism can also negatively impact a child’s physical and mental health and development.

When your childhood years are marked by abuse, neglect, or trauma, it can have a negative lasting impact with serious consequences. Adverse childhood experiences can set the stage for long-term physical and mental health problems. Click To Tweet


Since the time of that groundbreaking study, the ACE questionnaire has had some minor modifications. The latest version is comprised of 10 questions that cover adverse and traumatic experiences a child could be subjected to or witness while growing up. The categories include:

The scores on the ACE questionnaire range from 0 to 10, with zero meaning no exposure and 10 indicating a person was subjected to significant—if not profound—levels of trauma before age 18. The higher the score, the higher the long-term health consequences a person can be at risk for.

Of note, the ACE questionnaire is not a stand-alone diagnostic assessment. It specifically addresses only negative experiences, not positive ones. It’s not necessarily predictive of future problems, although those correlations exist.

Rather, it’s intended to be used as a guide for clinicians and community health workers to identify services that can benefit the child and family.


The development of a child’s brain is very sensitive to the environment in which they are raised. A loving, supportive, and predictable home environment bodes well for the brain to organize and function in developmentally appropriate ways as the child grows up.

However, for children who are repeatedly subjected to trauma, chaos, abuse, and/or neglect, healthy brain development is often obstructed. When a child is chronically exposed to adverse and traumatic experiences, the brain’s stress activation system—which impacts immune, metabolic, and cardiovascular functioning—is constantly in overdrive.

As the brain develops, the delicate balance of neurotransmitters (brain chemicals) that are necessary for healthy brain function can be disrupted due to the constant flood of stress hormones. This process can also stunt the development of certain areas of the brain, such as the hippocampus, which is important for memory formation.

When enduring toxic levels of stress, it’s as though the child’s brain is stuck in fight-or-flight mode. This can lead to problems with self-regulation, learning, and social interactions, as well as trouble controlling emotions, aggression, and nightmares. Another long-term consequence involves difficulty forming and maintaining healthy attachments later in life.

The negative effects of the adverse experiences can even alter a child’s genes and be passed along to the next generation.


Not everyone with a high ACE score will develop health problems later in life. Some children have natural strengths that can help them navigate the turmoil that surrounds them in a way that other children may not be able to.

In addition, having a close relationship with one or more caring adults can help buffer the adversity at home. For example, a teacher may provide extra support for the child. In other instances, a loving relative who cares for the child may provide a temporary refuge from the trauma. These adults can promote a sense of safety that helps the child become more resilient.

However, adults who had multiple ACEs and did not have healthy connections to people around them—nor strengths that were nurtured—can be at an increased risk for physical and mental health problems in adulthood, including:

The connection between high ACE scores and substance abuse is especially strong. In fact, more than 25% of people with addictions report childhood trauma, according to a 2022 study in General Psychiatry. This study also found that higher levels of ACEs were associated with greater severity of mental health disorders.


Neuropsychological testing also shows that individuals who have experienced high levels of childhood trauma have difficulty with emotional awareness and emotional bias.

Emotional awareness and emotional bias tests involve having a person look at images of facial expressions and categorize them as happy, neutral, angry, or disgusted. On these tests, people with high scores on the ACE Questionnaire typically respond slower to happy faces and more quickly to disgusted faces. They also identify fewer neutral faces correctly while recognizing more angry faces correctly.

This contributes to an emotional bias known as a conscious negativity bias. Ultimately, this means people with higher levels of adverse childhood experiences are more likely to have a negative view of the world.


Fortunately, certain mental health therapies and lifestyle changes can help mitigate the onset or reduce the severity of ACEs consequences, such as:

  • Address the adverse childhood experiences with a trained psychotherapist to help work through the emotional trauma.
  • Consider Eye Movement Desensitization and Reprocessing (EMDR), which is a powerful treatment for trauma survivors.
  • Seek treatment for alcohol, drug, and/or food addiction
  • Switch to a healthier diet with lots of fresh produce and omit fried foods, sugar products (including soda), and ultra-processed foods.
  • Exercise regularly and spend less time on the couch.
  • Volunteer in your community to build positive social connections.

If you’re an adult who endured the trauma of adverse childhood experiences, start taking good care of yourself now. Incorporating healthier habits and seeking treatment for your physical and mental health issues can open up greater possibilities for your life as you go forward.

Emotional trauma, substance abuse, depression, and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.


  1. I was thrilled to discover the ACES study in 2016, and am grateful for the peace of mind I found in that knowledge. My ACES score is an #8, so I can fully attest to the truths you have stated in this article. The turmoil of trying to navigate life without the solid foundation that should be afforded in childhood is truly horrendous.

    However, the knowledge of ACES, brain health, mindful eating and living, and finding new emotional support systems for myself have been the good medicine that is accelerating my path to wholeness. I have come to know for myself that mental health care is NOT “anti-Jesus,” and that my Christian witness is NOT tainted by the fact that I am engaging in health care for my brain and emotions!!!

    Stigma has been one of my greatest challenges since I grew up in a very strict religious environment, so your voice brings great comfort, relief, and hope to my journey. I am so grateful for the validation I find in the volumes of your work, and my progress is gaining momentum exponentially since I have been able to combine the knowledge of ACES with the mind/brain knowledge you also bring to my hurting heart.

    Yes, I’m still a work in progress, but I am making tremendous progress! It is information in articles like this one that helps me hold on to my hope for a brighter future. Thank you for sharing this information so beautifully. I find it to be fresh wind beneath my wings again today, and that is the reason I am an avid fan of the Amen Clinics. God bless you, and THANK YOU for sharing!!!

    Comment by Connie Spurlock — May 28, 2021 @ 5:43 AM

  2. I am now a mother, grandmother and an RN (recently retired , but may return to some sort of healthcare). My ACE scored 6. I believe I have dealt with my childhood traumas, but every once in awhile something reminds me of my past traumas and I just explode all over. My husband is very supportive, but I protected my children from my side of the family and they don’t understand. I know this isn’t “ normal “ behavior, but I don’t know how to control it.

    Comment by Lori — May 28, 2021 @ 6:38 AM

  3. I suffered from severe sexual abuse as s child and as a teen
    I have tried to take care of my self but the pain never goes away

    Comment by Monica — May 28, 2021 @ 7:38 AM

  4. Excellent topic to take into account

    Comment by Marlene — May 28, 2021 @ 8:29 AM

  5. My ace score was 8. My childhood was crazy, and unpredictable. I very rarely felt safe or protected.

    Comment by Amie Klingler — May 28, 2021 @ 8:36 AM

  6. in the entire 35 years that I worked as a mental health therapist and then addictions was added ,never once did I meet a person who struggled with a myriad of difficulties and/or struggles with serious legal difficulties or addiction, affects of narcissistic personality disorder, who did not endure trauma violence inconsistent parenting witnessing violence sexual abuse verbal abuse mental abuse and of course then came to children who endured all of this through bullying at school. The response was always to medicate everything and everybody.I have never understood how we couldn’t correlate violence and child hood to struggles in functioning In adult hood. To me one goes with the other. You put your hand in the fire, you will burn. I am now retired but it has been a hard 35 years fighting against a system that still continues to victim blame and medicate people who are struggling

    Comment by heide toner — May 28, 2021 @ 9:02 AM

  7. I am so pleased to read such a concise article on the subject. I am a high school teacher in a low income area and this gives so much insight into what my students are dealing with and how I can help them. I am currently starting EMDR for my own mental health, and I want to help raise a generation of emotionally healthy young people. Thank you!

    Comment by Kat Galvan — May 28, 2021 @ 9:29 AM

  8. Had all of them. Have had a good life for the last 46 years with a wonderful man who understands. Was able to raise wonderful children. Before then was really having issues. A bad marriage with the same treatment as my childhood. Couldn’t wait to get out of my childhood home that I ended up in the same situation.

    Comment by Rita — May 28, 2021 @ 10:21 AM

  9. I wish that I would have known this when I was younger, I had all of the symptoms I was sexually molested as a child by a close relative and felt that I was a magnate to other abusive men. I always wondered why I didn’t do well in school . Plus I have had some head injuries hit by a hammer and slammed against the wall. Would like to know how I can heal to move forward at age 66. Never too old

    Comment by R. Valeria Cruz — May 28, 2021 @ 12:18 PM

  10. As another victim of childhood abuse I understand only too well Dr. Amen’s article. Others who did have love as children who grow up in a totally dysfunctional family still have major health issues in later life. Someday it will be considered a legal and human right to grow up in a nurturing environment whether with one’s biological parents or not. All the people who cannot find their chosen jobs due to machines and new technologies can be trained as family health counselors.

    Comment by MICHAEL JANKO — May 28, 2021 @ 4:21 PM

  11. 9/10 on the ACEs test, finally passed a test, lol. I teach Horse Facilitated Learning to at risk youth and Veterans. I find that one of the best ways to heal ACEs is through Horse Wisdom. Horse Wisdom is taught both in the classroom and in the paddock, it fosters oxytocin and teaches trust and self worth. We find that participants who have trauma involving human relationships often struggle to connect and open up to another human. This immediately presents challenges and roadblocks. Partner them with a horse however and the process is greatly expedited.

    Comment by Alane Millions — May 28, 2021 @ 7:10 PM

  12. Very interesting and encouraging article about the ACEs questionnaire. Please tell me how I can get access to it so I can see how I score. Thank you.

    Comment by Martha Escalante — May 28, 2021 @ 8:31 PM

  13. Please tell me how I can get access to the questionnaire so I can see how I score. Thank you.

    Comment by Martha Escalante — May 28, 2021 @ 8:34 PM

  14. I am 64.

    Comment by George Schuler — May 29, 2021 @ 7:53 AM

  15. Very compassionate and helpful article. I witnessed my mother being addicted to barbiturates all through my childhood until I went to boarding school at the age of eleven. My Gran provided the one source of security and comfort , but she was not there for ever.

    Comment by Jenny Eckersley — May 29, 2021 @ 11:55 AM

  16. Highly useful article. You should recomend Havening Techniques to conquer past traumas. It is really efficient predrrred by Ca based traumatherapist as preferred therapy.

    Comment by Marianne Sandberg — May 30, 2021 @ 12:06 AM

  17. While I was reading the comments from otheroffer people, I noticed there was A CEs T est back in 2016.
    Is that test still available for todays readers?
    Can I take it on my laptop?


    Comment by JIm Wencel — May 30, 2021 @ 1:16 PM

  18. Thank you so much for these great emails! The info in these articles is a wealth of whakaaro nui and help to my self, my Whanua and people I spend time with. Living across the Pacific in Aotearoa (New Zealand), it is so great to get this info.

    Aroha nui

    Comment by Shelley Burling — May 30, 2021 @ 3:48 PM

  19. I am hoping to learn more about this program. I suffered long term sexual abuse, and physical abuse.

    Comment by LillianDawn Brandstom — May 31, 2021 @ 10:46 AM

  20. Please visit PACEs (for positive and adverse childhood experiences) Connection at and look at the right hand side of the page, lower half, to find the ACEs questionnaire as well as the questionnaire for positive childhood experiences, to see how positive relationships and experiences may have buffered the ACEs. The site also has many resources for parenting with ACEs, connecting with one or more of the 440 geographic and interest-based communities (in the top tool bar click on “communities” to find your local initiative. If there’s not one, we can help you start one!)

    As a long-time Amen Clinic patient, I am thrilled to see this article and to see Dr. Amen and Tana Amen’s shift into taking more and more about the impact of childhood trauma on adult health and mental health. Tana’s vulnerability and transparency have no doubt made space for more people to connect the dots between childhood adversity and depression, anxiety, addiction. And both Amens opening up their home and hearts to care for Tana’s nieces during a hard time provided the girls with the SAFETY, structure, nurture, and stability they needed to help turn around their young lives. Amen’s latest book, “The End of Mental Illness” details how to make the brain-loving life changes that can help heal trauma and build resilience. The great news is that with healthier brains people are not as likely to re-enact family traumas with their own children. Knowing about ACEs science helps stop the cycle of abuse and addiction. I appreciate this article so much, and hope to see more friends and fans of the Amens join our movement to prevent and heal trauma, create community-led, culturally appropriate positive childhood experiences, and build resilience in children, families, and communities! Thanks for the opportunity to share.

    Comment by Carey Sipp — December 10, 2021 @ 4:37 PM

  21. When I was four and a half, my three-year-old brother died from drinking unlabeled oil of wintergreen while I was alone with him; my mother had "run upstairs for just a minute." I believed I had killed him until I was a 50-year-old adult.

    Comment by Ginny — August 6, 2023 @ 12:13 PM

  22. How much is a brain scan?

    Comment by Stephanie — September 13, 2023 @ 2:40 PM

  23. My late discovered single MTHFR genetic variant was true to its explanation of health and life challenges of both physical problems and emotional problems. I got that diagnosis almost 5 years ago but fatigue and brain fog and the need to improve nutrition and sleep and reduce stress got more attention than methyl-folate and methyl-B12. So it's a new year with trying those compounds and others to try to repair the invisible-to-others cellular damage. Having multiple chemical sensitivities, energy issues and mobility issues hasn't been fun. I am presently dependent on my husband's assistance with many chores but not much as far as helping with health information and supplements to get past the health obstacles. I looked too healthy to be considered sickly? I felt my chemical sensitivities get worse but had to avoid emergencies so no one has seen any MCS reactions. I don't mean to keep them a secret but have been forbidden to talk about health issues despite having them. The bunch of people in my world are catching on finally but I'm mostly housebound until I get my cells 'recharged'. Childhood MCS reactions are remembered as well as the ones since then. Avoiding them can be stressful.

    Comment by Elinor Nosker — September 13, 2023 @ 7:25 PM

  24. BP father, ADHD mother, strict Catholics yet divorced and left us when I was in early teens to raise ourselves. Younger sister committed suicide later while institutionalized. Yet until menopause hit, I masked any issues relatively well to maintain a stable family and relatively effective work life. However, I have not been able to hold a steady job as Cyclothymia hit with menopause and poor sleep, eating and exercise every 48-hour cycling has been completely debilitating. My question is it nature or nuture? Testostorone which I was low, B12, Magnesium, Tumeric and other supplements don't make any difference, the 48-hour cycling of high – low energy never ends…does trauma bake in susceptibility to stronger menopausal hormonal imbalance or early onset dimensia? I also had severe bacterial meningitis at 18 months that may have led to both attachment disorder (stuck isolated on a bed of ice for weeks) and highly sensitive person (HSP) disorder – or the accentuation of what I may have already had.

    Comment by MT Herzog — September 14, 2023 @ 8:32 PM

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