Navigating ACEs - Ruth McGuire


At first glance, the term ACEs sounds like it might refer to something great or ‘outstanding.’ However, it actually refers to Adverse Childhood Experiences. Most children will experience some sort of adverse experience.


However, when these experiences are sustained or are multiples of individual adverse experiences that cause trauma and exceptional levels of stress, then they are classified as ‘Adverse Childhood Experiences’ or ACEs. These experiences have a damaging effect on a child’s life during childhood but often filter through to their lives as adolescents and later on as adults. 


The Centre for Disease Control (CDC) in the US is well known for undertaking major research into ACEs. It defines them as ‘potentially traumatic events that occur in childhood (0-17 years)’ and lists as examples ‘experiencing violence, abuse, or neglect, witnessing violence in the home or community, having a family member attempt or die by suicide.’  


ACE types

These can be direct or indirect. Direct ACEs often occur in the home. For example, different types of abuse such as emotional, physical, sexual and also neglect could be included in this category. Indirect ACEs could also involve homelife but affect a child in a different way. For example, a parent may be a substance misuser of drugs or alcohol, may be incarcerated in prison or may live outside the family home. Other examples include a child living with a parent (s) who have mental illnesses or disabilities. In other cases, some children almost become ‘surrogate’ parents as they care for sick parents. Children who themselves live with disabilities or serious illnesses may also be living with an ACE.  


Social disadvantage, poverty and deprivation are also classified as ACEs and can have a negative impact on a child’s well-being and health. Children who for example live in deprived areas or in poverty may live in poor quality homes that are damp or overcrowded and in addition may have limited access to good healthy food.  Living with parents or a parent who is struggling to make ends meet may lead to a child’s emotional needs being unmet as the priority for the parent(s) is on meeting their child’s physical needs.  


Children living outside the UK may experience other types of ACEs. For example, children who live in countries where war and conflict are norms, may experience trauma and fear as a direct result of living in an environment where explosions, deaths of friends/relatives and loss of their homes as a result of war or conflict, are ‘norms.’ Understanding that ACEs go beyond the Eurocentric version is important. This is because some children may leave their countries of birth and migrate to other countries elsewhere. In the UK, these children may belong to families categorised as refugees or asylum seekers. A 2020 report “Adverse Childhood Experiences in child refugee and asylum-seeking populations” published by Public Health Wales highlights the problems children who migrate from countries of conflict to live elsewhere. It stated as follows: 

“By the time a displaced child arrives in a host country, he or she is likely to have experienced a multitude of ACEs due to their reasons for migrating and on their journeys to host countries, which can often be lengthy and fraught with danger.. Subsequent ACEs can occur post-migration, as children wait for asylum decisions, enter the care system, or begin settling into a new community.”


Impact of ACEs

Research has found that children who live through numerous ACEs, often develop physical and mental health problems. These include problems such as stress, anxiety and post-traumatic stress disorder. Later on in life, these problems may escalate into serious physical health problems such as heart disease, cancer and other problems that are related to the immune system. Research has also found that the brains of children who live with various ACEs are affected by toxic stress – a level of stress that is beyond the ‘fight or flight’ normal levels of stress. Toxic stress is believed to affect a child’s capacity to learn and also their memory. As a result, a child’s long-term prospects may be affected by an inability to make the most of their educational opportunities. Low aspirations are often found in deprived communities. These can also affect a child’s attitude towards education, careers and their future prospects. 


Mitigations and support


Economic support. 

 This is not necessarily about practitioners providing money direct to families, but they could signpost families to sources of financial support or ensure they maximise opportunities to save money or to access benefits and access statutory help they are entitled to claim.  Support could also be about signposting parents to adult learning/training opportunities so that they can ‘upskill’ and gain qualifications that will increase their earning power and therefore improve their financial circumstances. In other cases, the onus could be on employers to provide family friendly work policies that allow parents to work flexibly to fit in with their caring responsibilities. 


Emotional support and interventions. 

Local authorities will usually provide ‘early help/early support’ to families whose children need support and intervention to overcome adverse experiences. Practitioners should contact local authorities to identify sources of local support and help. This could include interventions such as parenting support/training or home visits from health or other specialists to support a child. It may also include therapeutic services from Child and Adolescence Mental Health Services (CAHMS). GPs may also be able to signpost families to specialist counsellors or therapists who can provide intervention to minimise the impact of ACEs. 


Safeguarding Children Partnerships 

These partnerships work with health, children’s services and other statutory agencies to provide support to children. They are a useful avenue of support and guidance. Although they may not list ACEs as a specific category, they will often provide guidance to parents/carers of children who have been affected by bereavement, suicide or some other ‘adverse’ experience that is affecting or has affected the safety and well-being of a child. 


Resilience skills 

Teaching children/young people the skill of resilience will help them to cope more effectively with past and potential adverse experiences. It is a life skill that enables children (and adults) to bounce back after disappointments, tragedies or adversities. 


Key tips when building resilience in children: 


  • Provide a supportive environment for children which includes setting routines to promote stability and security 

  • Promote self-care so that children know how to look after themselves e.g., healthy eating, physical exercise, emotional well-being 

  • Ensure children can access a ‘go to’ adult outside the home when/if needed 

  • Create an environment that allows children to be themselves and to have safe spaces to express their concerns and feelings without being judged or feeling judged 

  • Involve children in making decisions that affect them  

More details advice on strategies to use to build resilience can be found in the Resilience Framework at or in the Samaritans DEAL programme. Links below. 



There is an increasing recognition that ACEs are a public health and national problem.  However, there is not yet a national and overall strategy to respond to ACEs. Until such time, practitioners must use available resources and training to ensure they can in their own local settings implement strategies to counteract the deleterious impact of ACEs. 


Further information and resources

Animated video on impact of ACEs

Paediatrician presentation on impact of trauma on children

The Early Action Together ACEs learning network provides helpful information about the Early Action Together programme and its work in relation to Adverse Childhood Experiences (ACEs).  


Useful websites