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Improving health
Previously NHS Health Scotland

Overview of ACEs

Adverse Childhood Experiences (ACEs) are stressful events occurring in childhood including

  • domestic violence
  • parental abandonment through separation or divorce
  • a parent with a mental health condition
  • being the victim of abuse (physical, sexual and/or emotional)
  • being the victim of neglect (physical and emotional)
  • a member of the household being in prison
  • growing up in a household in which there are adults experiencing alcohol and drug use problems.
  • ACEs are common. The original study found almost two thirds of participants experienced 1 or more ACE and more than 1 in 5 experienced 3 or more ACEs.
  • While we do not have a Scottish ACE survey, it has been proposed that we could assume similar prevalence of ACEs in the Scottish population as has been found in
    • Wales - almost 50% experienced 1 ACE and 14% experienced 4 or more
    • England – almost 50% experienced 1 ACE and over 8% 4 or more.
  • Research has found that a relationship with one trusted adult during childhood can mitigate the impacts of ACEs on mental and physical wellbeing.

The term was originally developed in the US for the Adverse Childhood Experiences survey which found that as the number of ACEs increased in the population studied, so did the risk of experiencing a range of health conditions in adulthood. There have been numerous other studies which have found similar findings including in Wales and England.

ACEs and health inequalities

Preventing ACEs should be seen within the wider context of tackling societal inequalities. While ACEs are found across the population, there is more risk of experiencing ACEs in areas of higher deprivation.

ACEs have been found to have lifelong impacts on health and behaviour and they are relevant to all sectors and involve all of us in society. We all have a part to play in preventing adversity and raising awareness of ACEs. Resilient communities have an important role in action on ACEs.

An ACE survey with adults in Wales found that compared to people with no ACEs, those with 4 or more ACEs are more likely to

  • have been in prison
  • develop heart disease
  • frequently visit the GP
  • develop type 2 diabetes
  • have committed violence in the last 12 months
  • have health-harming behaviours (high-risk drinking, smoking, drug use).

When children are exposed to adverse and stressful experiences, it can have a long-lasting impact on their ability to think, interact with others and on their learning.

ACEs should not be seen as someone’s destiny. There is much that can be done to offer hope and build resilience in children, young people and adults who have experienced adversity in early life.

You can find out more about principles that could underpin work on ACEs by reading the ‘Adverse childhood experiences in context' produced by the Scottish Adverse Childhood Experiences Hub. 

Overcoming childhood adversity – inspiring stories

With Public Health Wales, we have published a collection of stories from individuals sharing how they have used their knowledge about childhood adversity in their work and lives. We hope these stories will be inspiring, showing the difference that we can all have in the lives of those around us.

National action

In collaboration with many individuals and organisations across the UK, including the Scottish Childhood Adversity Hub, we have produced a report called 'Ending Childhood Adversity'. This new report builds on the previous Scottish Public Health Network 'Polishing the Diamonds' report and sets out a strong case for preventative action on childhood adversity.

The Scottish Government has set out its commitment to preventing and mitigating ACEs. You can read about their commitment in the 2017/18 Programme for Government (external site).

We co-ordinate a Scottish ACEs Hub to progress national action on ACEs.

The ACE Hub, working with Scottish Government and other partners is involved in action on

  • raising awareness and understanding about ACEs
  • contributing to developing the evidence base on ACEs
  • policy and practice approaches to prevent ACEs and mitigate their negative impacts.

You can help reduce ACEs by

  • preventing household adversity
  • supporting parents and families
  • building resilience in children and wider communities
  • encouraging wider awareness and understanding about ACEs and their impact on health and behaviour
  • using encounters with adults in services such as homelessness services, addiction, prison or maternity services, to also consider the impacts on their children or future children.

 You can find out more about tackling ACEs in our evidence report 'Tackling the Attainment Gap'.

We have produced this short animation to contribute to raising awareness about the impact of childhood adversity. We hope it can stimulate discussion about what action can be taken to both prevent and respond to early adversity.

Please share and use the clip and let us know what you think

You can find further information to support dealing with trauma and traumatic events on the NHS Inform website (external website).

Contact us

You can contact the Childhood Adversity team for more information about our work.