Adverse Childhood Experiences & Development | C&F
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How to protect children from the negative impacts of adverse childhood experiences – a comprehensive approach

By Child & Family Blog Editor and , | November 2021 

At the heart of supporting children with ACEs is mobilizing the actual and potential protective factors around the child.


A team of researchers has created a framework for comprehensively addressing the cascade of problems that emerge from adverse experiences of children from birth to age 18. These patterns of harm are consistent across continents and cultures. The more adverse experiences a child has, the greater the damage. When first researched in the early 2000s, adverse childhood experiences (ACEs) were surprisingly widespread, with two thirds of 17,000 mainly middle-class people in the United States reporting at least one. ACEs are more prevalent in disadvantaged communities where there is less income, less education, and greater social marginalization.

Based on years of research, the framework – called the Intergenerational and Cumulative Adverse and Resilient Experiences (ICARE) model – identifies 10 types of ACEs, as well as 10 protective and compensatory experiences (PACEs) that build resilience.

10 Adverse Experiences 10 Protective Experiences
Physical abuse

Emotional abuse

Sexual abuse

Physical neglect

Emotional neglect


Domestic violence

Mental illness in the household

Criminality in the household

Substance abuse in the household

Unconditional love from caregivers *Having a best friend

Being part of a social group

Having a mentor


Living in a safe and clean home with enough food

Getting a good education

Having a hobby

Engaging in regular physical activity

Having family routines and consistent rules


*This is the most important protection.


The ICARE model also recommends a wide set of interventions that address the many ways ACEs can harm children’s development. At the heart of the approach is supporting the protective factors that are already in place in families and helping families become stronger.

The ICARE model shows the pathway by which ACEs can disadvantage children’s future and harm the next generation.

Flowchart showing how ACEs and PACEs (Adverse Childhood Experiences and Protective and Compensatory Experiences) affects children. This is a complex image. Supplementary information is below: Poverty and Other Environmental Stressors negatively affect neurobiological adaptations, developmental systems, and lead to health and social problems Prevention and Treatment Programs reduce ACEs, Increase PACEs, assist neurobiological and stress regulation interventions, and support interventions targeting developmental consequences for parent and child.

Neurobiological and epigenetic impacts of ACEs

Prolonged activation of stress responses that are typically used in brief crisis-response situations results in biological and neurobiological changes that can become embedded in a child. The body’s immune system can be harmed, as well as the development of brain structures and functions. Epigenetic changes to DNA as a result of adversity – the methylation of certain genes that change how they function – embed the impact of ACEs, influencing how the child responds to stress later in life. Epigenetic changes are heritable, passed from mothers and fathers to their biological children.

The ICARE model shows the pathway by which ACEs can disadvantage children’s future and harm the next generation.

Developmental impacts of ACEs

The most significant developmental system in early childhood is attachment. Secure attachment evolves when an infant’s needs are consistently met, creating a safe and predictable place where caregivers can be trusted. Attachment also has a biological/neurobiological dimension, for example, with the action of the hormones dopamine and oxytocin. ACEs can disrupt attachment, which is associated with a wide range of behavioral, social, and emotional problems later in life.

ACEs can also damage cognitive development. Skills associated with executive function, such as working memory, inhibitory control, and focused attention, can be harmed in children who have experienced adversity. This can lead to problems with learning during education and training.

Intergenerational transmission

ACEs can disadvantage the next generation in two ways: Parents who have been adversely affected by ACEs in their own lives are more likely to struggle with parenting. And parents may pass to their children epigenetic changes that affect the child’s biological response to stress.

Strategies to mitigate the negative impacts of ACEs

The foundation of the strategic approach proposed by the ICARE model starts with assessing and mobilizing protective factors that already exist or could exist around the child. Researchers point to successful support programs in five categories:

  1. Supporting parents and caregivers with their own psychological and emotional well-being
  2. Supporting parents and caregivers with attachment and parenting skills
  3. Supporting children directly, for example, by encouraging their participation in sports, hobbies, and friendships
  4. Psychological therapies for children that address the past traumas
  5. Play-based therapeutic activities for children and parents together

The authors of the framework explain that the ICARE model “suggests new opportunities to design and implement multilevel prevention and intervention programs across the various pathways by which adverse and protective experiences influence outcomes.”

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