aces, toxic stress & resilience

Research tells us that exposure to Toxic Stress during childhood can lead to negative health outcomes in adulthood. We understand that great variation exists between individuals and their experiences, and that not all experiences influence outcomes in the same way. We also know that building the foundation of resilience, beginning in early life is critical to preventing and buffering toxic stress


What are ACEs?

Adverse Childhood Experiences (ACEs) are negative, stressful, traumatizing events that occur before the age of 18 and confer health risk across the lifespan. The 10 best studied ACEs are divided into the umbrellas of abuse, neglect, and household dysfunction. These experiences create toxic stress. Children with ongoing, unmitigated toxic stress develop patterns of maladaptive behaviours and physiological disruptions that compromise health over the lifespan.

The term ACE has been in use since 1998, when U.S. not-for-profit healthcare consortium Kaiser Permanente published the results of its Adverse Childhood Experiences (ACE) Study, a joint research project with the Centers for Disease Control. This population-based study of more than 17,000 adults examined the connection between negative early experiences and adult health outcomes; it found that a higher level of exposure to intense childhood stress, triggered by ACEs, had a clear, dose-response relationship to an individual’s likelihood of developing physical, behavioural, and social problems in adulthood.

After the original ACE Study was completed, related research continues
across the U.S., Canada and in several other countries too, contributing to a growing
body of knowledge about the effects of childhood stress, as well as how to integrate this knowledge into policy and practice. Two of the researchers instrumental in pioneering the ACE Study are members of the Alberta Family Wellness Initiative (AFWI) faculty.
Watch them describe the origins of ACEs below.


The ACE Questionnaire was developed to assess an individual’s exposure to toxic stress during the first 18 years of life. The questionnaire asks participants about negative experiences related to abuse, neglect, and household dysfunction, and assigns participants an ACE score based on how many of these types of experiences they encountered. 

The ACE Questionnaire should not be thought of as a diagnostic tool; some people with high ACE scores are nevertheless resilient, meaning they avoid negative outcomes, while some people with low ACE scores struggle with a range of health challenges in adulthood. The questionnaire isn’t designed to measure factors like genetic makeup, nor does it account for the presence of positive mitigating factors. However, research suggests that the higher the ACE score, the greater the risk for that individual to develop physical, social and behavioural problems. 

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