Research & Science
Jul 1
· Written By
Ted Handler, MD

Adverse Childhood Experiences (ACEs) 100

So, what’s considered an ACE? ACEs range from abuse, psychological and sexual, to simply living with family members that suffer from mental illness. Find your ACE score and learn more about health correlations.

In our last post, we laid the groundwork for understanding the effects of toxic stress by describing the foundational Adverse Childhood Experiences (ACEs) study. That study was one of the first to establish a connection between stressful childhood events and adult physical medical conditions such as high blood pressure and obesity. 

This week, we wanted to get a little more granular about ACEs. What actually are these events that doctors are caring more about each year? Do they apply to you?

What Are ACEs?

In one sense, ACEs are exactly what they sound like: experiences in childhood that are... adverse. They range from abuse, psychological and sexual, to simply living with family members that suffer from mental illness. They also include events that don’t technically happen to you. For example, if you remember seeing a parent threatened, or if a family member went to prison, those are considered ACEs. We will get more into each ACE at the end of this post.

How are ACEs Correlated with Health Effects

The original study was done in 17,000 Kaiser Permanente members in the 1990s. Kaiser asked its members, largely white, upper middle class, and well-employed, to answer the below questions about their childhood experiences. When compared to Kaiser members that answered “no” to the above questions, people with a greater number of “yes” answers were more likely to have the previously described mental and physical health conditions, such as liver disease, lung disease like COPD, and high blood pressure. The risk of mental and biological disease increases with each ACE, but the statistical cutoff for real significant risk is at 4 or more ACEs.










Source: American Journal of Preventative Medicine


A note about this correlation: it’s real. With statistics, we tend to look for groups in studies to have at least 20 members before we can comment on the significance of the results. With 17,000 participants, we can be certain that this connection is pretty darn real. Additionally, Kaiser, as an organization, is in an incredible position to comment on population health. Other institutions need to do a significant amount of legwork to find out about the health of their study participants, usually recruiting the help of doctors that are paid to carry out studies. Kaiser is both the study coordinator and doctor in this story: the health effects are already part of the system. 

What’s Your ACE Score?

At Oath, we want to help our members to understand the complex interplay between stress physiology, resilience, community and health. That starts with the health baseline of our birthing parents, part of which is an understanding of the stress they faced as a child. An ACEs score is one tiny piece of that puzzle, but it’s an important one (see above). 

An “ACE Score” is a fairly simple number: it is the total number of “yes” answers to the original ACEs survey. This is the total number of adverse experiences from your childhood, which can, on a population scale, correlate with risk for future health problems. There’s a lot of nuance here; other factors such as individual differences in the stress response might differentiate whether or not your ACEs score actually predicts health outcomes. But for now, the score is simply a helpful indicator to guide decisions around population health.

Get your ACEs score with the quiz below. Don’t worry, we won’t leave you high and dry if your score worries you. Future posts will dive deeper into ongoing studies of interventions for victims of stressful events, and those with maladaptive stress responses.

Ted Handler, MD
Ted Handler, MD

Founding Pediatrician at Oath Care and general pediatrician in the San Francisco Bay Area.