Summary: New research shows close to six out of ten people worldwide report having adverse childhood experiences (ACEs).
Key Points:
- ACEs are negative experiences that occur during childhood, including but not limited to physical and emotional neglect and/or abuse, experiencing/witnessing violence, and living through a natural disaster
- ACEs are associated with negative physical, emotional, and psychological outcomes throughout the lifespan
- Each additional ACE increases risk of negative outcomes
Adverse Childhood Experiences and Long-Term Health
In the early 1990s, a research team from Kaiser Health made a startling discovery: patients who reported a specific type of experience in their early years – later defined as adverse childhood experiences (ACEs) – showed higher rates of various physical, mental, and emotional disorders than people who didn’t report those experiences, which leads to an ongoing question among mental health practitioners and providers: how many kids worldwide have adverse childhood experiences?
A study published recently in the Journal of the American Medical Association – Pediatrics called “Prevalence of Adverse Childhood Experiences in Child Population Samples: A Systematic Review and Meta-Analysis” answers that question. Here’s how the researchers phrase their inquiry:
“What is the prevalence of adverse childhood experiences (ACEs) among samples of children aged 0 to 18 years in English language–published literature?”
To arrive at a reliable conclusion valuable to the mental health treatment community and any interested parents, teachers, or public policymakers, the research team assessed all publications on the topic of adverse childhood experiences published between 1998 and 2024. The final sample set included data on 490,423 children from 65 studies conducted in 18 countries.
Half a million people is more than adequate for making population-level generalizations, which makes this study unique. To date, very few studies assessed the prevalence of ACEs around the world, and instead focused primarily on prevalence in the U.S. and Western Europe.
Before we review the results of this study, we’ll take a moment to define ACEs and discuss negative outcomes associated with ACEs.
What are Adverse Childhood Experiences (ACEs)?
ACEs are negative experiences that occur before age 18 and have negative effects on long-term health. ACEs have a negative impact on social, emotional, mental, and physical health. Examples of ACEs include, but are not limited to, the following:
- Emotional, physical, or sexual abuse
- Emotional or physical neglect
- Witnessing or experiencing domestic violence
- Witnessing or experiencing violence in home neighborhood
- Living with a family member with a mental health disorder
- Living with an family member with alcohol/substance use disorder (AUD/SUD)
- Having a family member sentenced to incarceration or currently incarcerated
- Experiencing racism/bullying
- Living in foster homes/home
- Experiencing economic hardship
The Centers for Disease Control (CDC) identify elevated risk for a significant number of negative outcomes associated with ACEs:
Physical Injury:
- Fractures
- Burns
- Traumatic brain injury
Mental health:
- Depression
- Anxiety
- Suicidality
Maternal health:
- Unplanned pregnancy
- High-risk pregnancy
- Fetal death/miscarriage
Infectious disease:
- HIV
- STDs
Chronic conditions:
- Cancer
- Diabetes
Risky behavior:
- Unsafe sex
- Alcohol and drug use
- Misuse of opioids
Work and School:
- Impaired educational attainment
- Decreased work performance
- Problems finding and keeping work
- Reduced lifetime earning/income
The increased risk of those negative outcomes for people with ACEs is the reason we publish articles like this one. It’s also one of the reasons we pay more attention to youth and adolescent wellness than in previous generations. We now understand that protecting children from harm during childhood is one of the best ways to promote lifelong health and wellness.
Recognizing ACEs also led to the development of trauma-informed care, which is a related topic for another article, like this one:
Adverse Childhood Experiences (ACEs) and Long-Term Mental Health
That article explores ACEs and trauma in-depth, whereas this article is about the worldwide prevalence of ACEs. Let’s take a look at what the researchers found.
The Prevalence of Adverse Childhood Experiences: New Data Expands Our Awareness
After a thorough statistical analysis of close to half a million health records covering a 25-year period, the research team identified the following rates of ACEs worldwide:
Prevalence of ACEs
- No ACEs: 42.3%
- One ACE: 22.0%
- Two ACEs: 12.7%
- Three ACEs: 8.1%
- Four ACEs: 14.8%
Let’s correlated that data with the figures we report in the article on ACEs on long-term mental health we link to above. That research – on a large cohort of twins in Sweden – showed the following:
Presence of:
- (1) ACE increases risk of developing a mental health disorder by 65%
- (2) ACEs increases risk of developing a mental health disorder by 147%
- (3) or more ACEs increases risk of developing a mental health disorder by 357%
The research team identified various demographic variables associated with increased incidence of ACEs:
Prevalence of 4 or More ACEs
- Indigenous peoples: 63% higher incidence
- History of juvenile offending: 29% higher incidence
- Children in residential care: 26% higher incidence
- Adolescents 12-17 vs. children 0-11: 16% higher incidence
In addition, researchers found that the incidence of No ACEs was higher in studies that used questionnaires answered by children, compared to questionnaires answered by parents. We’ll editorialize on that, because it’s hard not to arrive at a sad conclusion. It’s possible the percentage of children reporting No ACEs skews higher in child answers than adult answers is that the children don’t understand what they’ve experienced, and are unable to categorize their experiences according to metrics that evaluate the presence of ACEs.
With that said, here’s how the authors of the study summarize these results:
“As principal antecedent threats to child and adolescent well-being that can affect later life prospects, ACEs represent a pressing global social issue. Early identification and prevention strategies, can reduce prevalence of ACEs and mitigate their severe effects.”
We’ll discuss their conclusions below.
How Data on ACEs Helps Us Help Our Patients and Families
The position the study authors take echoes the position of child mental health advocates in the U.S. and around the world. The way we mitigate the long-term effect of ACEs revolves around three things:
- Protecting children from adversity as a worldwide priority
- Detecting problems early, possible by expanding awareness and promoting mental health screening in primary care/general pediatric settings
- Increasing access to trauma-informed care, recognized as the most effective treatment modality for people with a history of ACEs
The data shows us that the worldwide prevalence of ACEs is lower than the prevalence of ACEs in the U.S. The most recent data shows that among adults surveyed about their childhood experiences, 61 percent reported at least one ACE, compared to 22 percent worldwide, and 17 percent reported four or more ACEs, compared to 15 percent worldwide.
That’s more evidence to support the assertion of the Surgeon General of the U.S. – along with countless other mental health professionals and advocates – that we’re currently in a youth mental health crisis, exacerbated by increasing levels of loneliness and isolation.
The combination of those factors – ACEs, loneliness, and isolation – increases risk for our youngest and most vulnerable citizens. However, with the help of active and engaged adults/parents/caregivers and evidence-based treatment delivered by mental health professionals, we can support our children adolescents and give them the tools they need to maintain positive mental health and overall wellbeing as they navigate the transition from adolescence to adulthood.
