Research and Links

Childhood Adversity and Resilience (see data for this topic)

Websites with Related Information

• ACEs Aware. UCLA-UCSF ACEs Aware Family Resilience Network.
• California Dept. of Social Services: Office of Child Abuse Prevention
• California Essentials for Childhood (EfC) Initiative. California Dept. of Public Health & California Dept. of Social Services.
• Center for Youth Wellness
• Center on the Developing Child. Harvard University.
• Centers for Disease Control and Prevention: Adverse Childhood Experiences (ACEs)
• Changing Minds. Futures Without Violence.
• Child and Adolescent Health Measurement Initiative: Flourishing in Action
• Child Welfare Information Gateway. U.S. Dept. of Health and Human Services, Children’s Bureau.
• National Child Traumatic Stress Network. UCLA & Duke University.
• PACEs Connection
• Robert Wood Johnson Foundation: Adverse Childhood Experiences

Key Reports and Research

• ACE Screening Implementation How-To Guide. ACEs Aware.
• Adult Health Burden and Costs in California During 2013 Associated with Prior Adverse Childhood Experiences. (2020). PLoS One. Miller, T. R., et al.
• Adverse Childhood Experiences Data Report: Behavorial Risk Factor Surveillance System (BRFSS), 2011-2017. (2020). California Essentials for Childhood (EfC) Initiative.
• Beyond Screening: Achieving California's Bold Goal of Reducing Exposure to Childhood Trauma. (2020). California Funders Workgroup on Prevention and Equity. Sims, J., & Aboelata, M. J.
• Building Community Resilience Toolkit. Strategies 2.0.
• California Essentials for Childhood Case Study: Collective Impact Through Strategic Opportunities. (2019). International Journal on Child Maltreatment: Research, Policy and Practice. Abbott, M., & Wirtz, S.
• Child Well-Being and Adverse Childhood Experiences in the U.S. (2017). Academic Pediatrics. Solloway, M. R., et al. (Eds.)
• Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention — 25 States, 2015–2017. (2019). Morbidity and Mortality Weekly Report. Merrick, M. T., et al.
• Evaluating Community-Based Family Support Networks to Reduce Adverse Childhood Experiences. Mathematica Policy Research.
• Home Visiting Is a Valuable Investment in California’s Families. (2018). California Budget and Policy Center. Hutchful, E.
• How to Implement Trauma-Informed Care to Build Resilience to Childhood Trauma. (2019). Child Trends. Dym Bartlett, J., & Steber, K.
• Preventing Adverse Childhood Experiences: Leveraging the Best Available Evidence. (2019). Centers for Disease Control and Prevention.
• Receipt of Behavioral Health Services Among U.S. Children and Youth with Adverse Childhood Experiences or Mental Health Symptoms. (2021). JAMA Network Open. Finkelhor, D., et al.
• Resources to Support Children’s Emotional Well-Being amid Anti-Black Racism, Racial Violence, and Trauma. (2020). Child Trends. Parris, D., et al.
• Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. (2020). Office of the California Surgeon General. Bhushan, D., et al.
• Screening Kids from Birth to Age 5 for Trauma. (2019). Children Now. Francis, L.
• The Promise of Adolescence: Realizing Opportunity for All Youth. (2019). National Academies Press. National Academies of Sciences, Engineering, and Medicine.
• Transforming Practice with HOPE (Healthy Outcomes from Positive Experiences). (2021). Maternal and Child Health Journal. Burstein, D., et al.
• Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity. (2019). National Academies Press. National Academies of Sciences, Engineering, and Medicine.

County/Regional Reports

• Data Briefs on Adverse Childhood Events Among California’s Children. (2014). Child and Adolescent Health Measurement Initiative.

More Data Sources For Childhood Adversity and Resilience

• California Behavioral Risk Factor Surveillance System. California State University Sacramento.
• Maternal and Infant Health Assessment (MIHA). California Dept. of Public Health & University of California San Francisco.
• National Survey of Children's Health. Child and Adolescent Health Measurement Initiative.

Learn More About This Topic

Why This Topic Is Important

Childhood adversity—such as child abuse, exposure to violence, family alcohol or drug abuse, and poverty—can have negative, long-term impacts on health and well being (1, 2). Nearly half of U.S. children have experienced at least one adverse childhood event (3, 4). Early experiences affect brain structure and function, which provide the foundation for learning, emotional development, behavior, and health (5). The toxic stress associated with traumatic, and often cumulative, early adverse experiences can disrupt healthy development and lead to behavioral, emotional, school, and health problems during childhood and adolescence (2, 3, 4, 6). It also can lead to serious behavioral, emotional, and health issues in adulthood, such as chronic diseases, obesity, alcohol and other substance abuse, and depression (1, 2, 4). The more traumatic and toxic events experienced by a child, the more likely the impact will be substantial and long-lasting (7).

Resilience, an adaptive response to hardship, can mitigate the effects of adverse childhood experiences (3, 6, 8). It is a process of adapting well in the face of adversity, trauma, threats, or other significant sources of stress. Resilience involves a combination of internal and external factors. Internally, it involves behaviors, thoughts, and actions that anyone can learn and develop. Resilience is also strengthened by having safe, stable, nurturing relationships and environments within and outside the family (6, 8, 9).

For more information on childhood adversity and resilience, see kidsdata.org’s Research & Links section.

Sources for this narrative:

1.  Centers for Disease Control and Prevention. (2020). Preventing adverse childhood experiences. Retrieved from: https://www.cdc.gov/violenceprevention/childabuseandneglect/aces/fastfact.html

2.  Shonkoff, J. P., et al. (2016). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232-e246. Retrieved from: https://pediatrics.aappublications.org/content/129/1/e232

3.  Bethell, C. D., et al. (2017). A national and across-state profile on adverse childhood experiences among U.S. children and possibilities to heal and thrive. Child and Adolescent Health Measurement Initiative. Retrieved from: https://www.cahmi.org/wp-content/uploads/2018/05/aces_brief_final.pdf

4.  Sacks, V., & Murphey, D. (2018). The prevalence of adverse childhood experiences, nationally, by state, and by race or ethnicity. Child Trends. Retrieved from: https://www.childtrends.org/publications/prevalence-adverse-childhood-experiences-nationally-state-race-ethnicity

5.  Center on the Developing Child. (n.d.). Brain architecture. Retrieved from: https://developingchild.harvard.edu/science/key-concepts/brain-architecture

6.  Bethell, C. D., et al. (2014). Adverse childhood experiences: Assessing the impact on health and school engagement and the mitigating role of resilience. Health Affairs, 33(12), 2106-2115. Retrieved from: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2014.0914

7.  Center for Youth Wellness. (2014). A hidden crisis: Findings on adverse childhood experiences in California. Retrieved from: https://centerforyouthwellness.org/wp-content/themes/cyw/build/img/building-a-movement/hidden-crisis.pdf

8.  Center on the Developing Child. (2015). The science of resilience. Retrieved from: https://developingchild.harvard.edu/resources/inbrief-the-science-of-resilience

9.  Pinderhughes, H., et al. (2015). Adverse community experiences and resilience: A framework for addressing and preventing community trauma. Prevention Institute. Retrieved from: https://www.preventioninstitute.org/publications/adverse-community-experiences-and-resilience-framework-addressing-and-preventing

Policy Implications

In recent years, policymakers, researchers, and advocates increasingly have focused on childhood adversity (e.g., physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and/or the accumulated burdens of family economic hardship), recognizing that such experiences can have harmful, lifelong consequences (1, 2). For example, children exposed to multiple adverse childhood experiences (ACEs) are more likely to develop negative health behaviors and chronic diseases in adulthood (1). Unaddressed ACEs place strain on public systems, including child welfare, education, health care, and juvenile justice (1). Policymakers have a role in helping to prevent ACEs, as well as in ensuring early identification and intervention for parents and children affected by trauma. While California has made strides in these areas, continued efforts are needed to ensure that all families have the opportunity to help their children thrive and reach their full potential (1, 3).

Policy and program options to help prevent, interrupt, and mitigate the effects of childhood adversity include:

• Raising public awareness about ACEs and their negative, lasting effects on children and families (1)
• Ensuring effective prevention services are in place, including strength-based parenting education, family support, and home-visiting services for families in need (4)
• Promoting policies that help reduce family stress and increase stability for children, e.g., policies to improve the social safety net for families in need, support family-friendly business practices, and ensure quality child care is affordable and accessible (4)
• Institutionalizing trauma-informed policies and practices for public and private systems and organizations (designed specifically to address the consequences of trauma and facilitate resilience and healing), including screening and intervention with reimbursement mechanisms (1, 3)
• Supporting formal workforce education about ACEs and trauma-informed approaches for professionals who work with families and children, such as administrators, doctors, nurses, educators, social workers, and juvenile justice staff (1, 3)
• Promoting increased collaboration across organizations and systems (e.g., local and state government, education, health care, juvenile justice, child welfare, and nonprofits) to address systemic barriers to preventing or treating trauma and toxic stress, including improving service coordination, sharing data, and aligning measures of success (1, 4)
• Supporting ongoing strategies to provide accessible, culturally competent, trauma informed, and resilience-building systems of mental health, substance abuse treatment, and other community services (1, 3, 5)
• Expanding data collection related to ACEs and resilience to study and advance effective interventions aimed at preventing and reducing the impacts of trauma on children, families, organizations, systems, and communities (1, 3)

For more information related to ACEs and resilience, see kidsdata.org’s Research & Links section or visit ACEs Connection, Center for Youth Wellness, and Prevention Institute. Also see Policy Implications in kidsdata.org’s Child and Youth Safety and Emotional and Behavioral Health topics.

Sources for this narrative:

1.  Center for Youth Wellness. (2015). Children can thrive: A vision for California's response to adverse childhood experiences. Retrieved from: https://centerforyouthwellness.org/wp-content/themes/cyw/build/img/building-a-movement/children-can-thrive.pdf

2.  Bethell, C. D., et al. (2017). A national and across-state profile on adverse childhood experiences among U.S. children and possibilities to heal and thrive. Child and Adolescent Health Measurement Initiative. Retrieved from: https://www.cahmi.org/wp-content/uploads/2018/05/aces_brief_final.pdf

3.  Bradshaw, J. (2015). Helping children heal: Promising community programs and policy recommendations. Children's Defense Fund - California. Retrieved from: https://rysecenter.squarespace.com/s/helping-children-heal.pdf

4.  Centers for Disease Control and Prevention. (2019). Essentials for childhood: Creating safe, stable, nurturing relationships and environments for all children. Retrieved from: https://www.cdc.gov/violenceprevention/childabuseandneglect/essentials.html

5.  California Department of Social Services, & California Department of Health Care Services. (2018). The California integrated core practice model for children, youth, and families. Retrieved from: https://cdss.ca.gov/inforesources/the-integrated-core-practice-model

How Children Are Faring

Childhood adversity is common among California children, and many children experience multiple adverse circumstances or events that can pose a lifelong threat to their well being. The most timely assessment of childhood adversity comes from the National Survey of Children's Health (NSCH), in which parents report on the current status of their children. NSCH estimates from 2016-2019 show that 36% of California children ages 0-17 had been exposed to one or more adverse childhood experiences (ACEs), and around 4% had been exposed to four or more. At the local level, the share of children with two or more adverse experiences ranged from fewer than 1 in 8 (12%) to more than 1 in 4 (29%) across regions with data. Statewide and nationally, African American/black children were more likely than their Hispanic/Latino and white peers to have two or more ACEs in 2016-2019.

According to the 2013-2014 Maternal and Infant Health Assessment, one in four California women with a recent birth (25%) experienced two or more childhood hardships before age 14. Among young mothers ages 15-19, one-third (33%) experienced two or more hardship as children, compared with fewer than one-fifth (19%) of mothers ages 35 and older. Statewide, an estimated 34% of postpartum women living at or below the federal poverty guideline were exposed to at least two childhood hardships, more than double the estimate (16%) for women with higher family incomes (above 200% of the federal poverty guideline).

The California Behavioral Risk Factor Surveillance System ACEs Module, combining data from 2011 to 2017, shows that among California adults living in households with children, an estimated 17% experienced at least four ACEs before age 18.