Adverse childhood experiences (ACEs) are traumatic events or chronic stressors that can negatively impact a child's health and are outside of their control. It is estimated that 64% of Americans have experienced at least one ACE and 13% have experienced four or more. ACEs incorporate a variety of events and stressors including, but not limited to child abuse and neglect, sexual abuse, domestic violence, substance abuse, mental illness, crime, extreme economic adversity, bullying and school or community violence, sudden loss of a loved one, sudden and frequent relocation, serious accidents or life-threatening childhood illness, natural disasters, kidnapping, and war. Experiencing ACEs without supportive adults can lead to toxic stress, or an extensive activation of the stress response system. This can lead to an increased allostatic load, or “wear and tear” on the body and brain. ACEs have been linked with maladaptive health behaviors including, but not limited to physical inactivity, alcohol, substance and tobacco misuse and negative health outcomes, including but not limited to heart disease, cancer, chronic lung disease, skeletal fractures, liver disease, suicide, depression, obesity and poor self-rated health throughout the lifespan.
Due to the dramatic impact ACEs have on behavior and health outcomes, the American Academy of Family Physicians (AAFP) encourages physicians to learn about ACEs and to recognize the impact ACEs may have on their patients' health. In addition, the AAFP supports programs that aim to: (1) prevent the occurrence of ACEs; (2) reduce the severity of the acute consequences of ACEs; and (3) treat long-term consequences of ACEs. Examples of these types of programs include but are not limited to (1) parental education, (2) parent-child interaction and psychotherapy, (3) dual substance abuse treatment and parenting interventions, and (4) trauma-informed care. Additionally, the AAFP supports research on the effectiveness of ACEs screening and mitigation strategies to improve health outcomes, and advocates for public policies and legislation to support these initiatives.
Acknowledging the nature of ACEs as outside of a child’s control and the potential for negative impact on a child’s health, the AAFP affirms that ACEs, when used as a screening tool, not be diagnostic of the implied risk and that collection of information from ACEs screening be subject to pre-existing conditions protections for health insurance. (2019 COD) (October 2023 COD)