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The ACE Study (Adverse Childhood Experiences) is an ongoing collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente. Led by Co-principal Investigators Robert F. Anda, MD, MS, and Vincent J. Felitti, MD (


The ACE Study is perhaps the largest scientific research study of its kind, analyzing the relationship between multiple categories of childhood trauma (ACEs), and health and behavioral outcomes later in life.


● Requested participation of 26,000 consecutive patients seeking medical treatment at Kaiser Permenente in San Diego; 70% agreed.

● Initiated in 1995 and 1997- enrollees are being tracked

● 17,000 middle-class American adults undergoing comprehensive, biopsychosocial medical evaluation” with Kaiser Permanente: Lead Researcher Vincent J. Felitti, MD

● Cohort population was 80% white including Hispanic, 10% black, and 10% Asian. Their average age was 57 years; 74% had been to college, 44% had graduated college; 49.5% were men

● In any four years 81% of all adult Kaiser Permanente health care members seek medical evaluation; there is no reason to suspect study selection bias.

● Looked at eight general categories:

- Recurrent and severe physical abuse (11%)

- Recurrent and severe emotional abuse (11%)

- Contact sexual abuse (22%)

- Growing up in a household with:

- An alcoholic or drug-user (25%)

- A member being imprisoned (3%)

- A mentally ill, chronically depressed, or institutionalized member (19%)

- The mother being treated violently (12%)

- Both biological parents not being present (22%)


● They used a simple scoring system: “exposure during childhood or adolescence to any category of ACE was scored as one point. Multiple exposures within a category were not scored: one alcoholic within a household counted the same as an alcoholic and a drug user; if anything, this tends to understate our findings.” (


● The ACE Score therefore can range from 0 to 10.


● Less than half of this middle-class population had an ACE Score of 0; one in fourteen had an ACE Score of 4 or more. Almost two-thirds of the study participants reported at least one ACE, and more than one in five reported three or more ACE.


Why is it important?

Dr. Felitti states, “Adverse childhood experiences are the main determinant of the health and social well-being of the nation” (2004).


“Children with toxic stress live much of their lives in fight, flight or fright (freeze) mode. They respond to the world as a place of constant danger. With their brains overloaded with stress hormones and unable to function appropriately, they can’t focus on learning. They fall behind in school or fail to develop healthy relationships with peers or create problems with teachers and principals because they are unable to trust adults. Some kids do all three. With despair, guilt and frustration pecking away at their psyches, they often find solace in food, alcohol, tobacco, methamphetamines, inappropriate sex, high-risk sports, and/or work and over-achievement. They don’t regard these coping methods as problems. Consciously or unconsciously, they use them as solutions to escape from depression, anxiety, anger, fear and shame.”  (Jane Ellen Stevens, Oct. 3, 2012)

Findings of the ACE Study

As the number of ACE increase, the risk for the following health problems increases in a strong and graded fashion:

  •  alcoholism and alcohol abuse

  •  chronic obstructive pulmonary disease (COPD)

  •  depression

  •  fetal death

  •  health-related quality of life

  •  illicit drug use

  •  ischemic heart disease (IHD)

  •  liver disease

  •  risk for intimate partner violence (Continued)

  •  multiple sexual partners

  •  sexually transmitted diseases (STDs)

  •  smoking

  •  suicide attempts

  •  unintended pregnancies


"Dr. Putnam is right -- ACEs changed the landscape," Anda says. "Or perhaps the many publications from the ACE Study opened our eyes to see the truth of the landscape. ACEs create a "chronic public health disaster "that until recently has been hidden by our limited vision. Now we see that the biologic impacts of ACEs transcend the traditional boundaries of our siloed health and human service systems. Children affected by ACEs appear in all human service systems throughout the lifespan -- childhood, adolescence, and adulthood -- as clients with behavioral, learning, social, criminal, and chronic health problems." (Jane Ellen Stevens, Oct. 3, 2012)

Why Intervention?

  1. Because people matter.

  2. We live as part of systems; what effects one part of the system affects the other parts, too, whether they are aware of it or not.

  3. Cost: According to a CDC study released earlier this year, just one year of confirmed cases of child maltreatment costs $124 billion over the lifetime of the traumatized children. The researchers based their calculations on only confirmed cases of physical, sexual and verbal abuse and neglect, which child maltreatment experts say is a small percentage of what actually occurs.


• $32,648 in childhood health care costs

• $10,530 in adult medical costs

• $144,360 in productivity losses

• $7,728 in child welfare costs

• $6,747 in criminal justice costs

• $7,999 in special education costs


Points of Intervention

Education • Prevention • Treatment

Develop curriculum to inform and educate on the history, research outcomes, and implications. Inform key leaders, principle distributors of the outcomes of the ACE study. Inform adults, caregivers, young parents.

Inform pastors, ministers, and other community leaders.


Purchase or develop and implement ACE informed parenting classes for parenting infants, toddlers, elementary, ‘tweens, and teens. Include major focus on substance abuse as a major contribution to ACE.)


Educate adults about ACE impact in their own lives; implement individual and group counseling to address ACE in a healing and productive manner. Substance abuse treatment is a major focus.

Person. Sunset. Trauma. Deliverance. Counseling.

"A hard look at the public health disaster calls for the both the prevention and treatment ACEs," he continues. "This will require integration of educational, criminal justice, healthcare, mental health, public health, and corporate systems that involves sharing of knowledge and resources that will replace traditional fragmented approaches to burden of adverse childhood experiences in our society" (Anda from the article by Jane Elen Stevens, 2012).

Join TECS, ELCCC and the GA ACE Project by donating funds toward the purchase of educational materials and outreach in Georgia.

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