Introduction

The original conception of Adverse Childhood Experiences, or ACEs, provides important context for understanding how early traumatic life events have long-term health impacts. The original conception of ACEs focused on exposure to physical, emotional, and sexual abuse and neglect along with household dysfunctions, such as substance abuse, mental illness, parental separation/divorce, incarceration of family, and domestic violence. However, this original ACEs conception leaves out many detrimental experiences, particularly for marginalized communities. This is problematic, particularly given the unequal distribution of multiple ACEs between communities. 

According to the CDC, “While all children are at risk of ACEs, numerous studies show inequities in such experiences. These inequalities are linked to the historical, social, and economic environments in which some families live.” (CDC, 2025) Marginalized communities are more likely to experience the originally listed ACES. At the same time, systemic factors, such as racism, sexism and poverty create additional Adverse Childhood Experiences. Additional research on ACEs led to the expansion of the original ACEs framework to include broader social and environmental factors that disproportionately impact marginalized youth. 

Research clearly showed how systemic issues, such as racism, sexism, and economic systems that entrench poverty, play a critical role in contributing to childhood trauma and adverse impacts. These include community-level factors (e.g. Cronholm et al., 2015; Finkelhor et al., 2013), such as community violence, and the compounding role of systemic inequities, like racism and other forms of discrimination, on youth (e.g. Camacho et al., 2022). It is important to understand how intersecting forms of oppression increase a youth’s exposure to experiencing multiple ACEs. These expanded ACEs are listed below:  

1. Community Violence: Exposure to or witnessing violence in the neighborhood or community to include crime and violence, witnessing assault, household theft, a loved one murdered, witnessing murder, experiencing a riot, or being in a war zone.
2. Racism and Other Forms of Discrimination: Experiences of systemic racism or discrimination based on race, ethnicity, gender identity or other identities.
3. Living in an Unsafe Neighborhood/Property Victimization: Communities that experience higher rates of violent and non-violent crimes against persons and property.
4. Bullying: Peer victimization and social exclusion.
5. Family Separation/Foster Care Experience: A child experiences foster care or a child forcibly removed from a family, any youth sent or taken away from their family for any reason – family separation and deportation.
6. Poverty and Socioeconomic Hardship/Status: Chronic financial instability affecting basic living conditions. Includes parental job loss, unability to find work, unemployment.
7. Peer Rejection/Peer Victimization:  Social rejection by peers, isolation, No “really good friends” at school or in community.
8. Parental Fighting: Parents always arguing.
9. Major Illness or Bad Accident/Injury: The youth having experienced or witnessed someone they loved experience a bad accident or major illness.
10. School Performance: Below average grades.
11. Major Loss: Someone close died due to accident, illness, or other cause.
12. Parental or family deployment into a war zone: Parent gone to fight in a war and is gone for several months.
13. Not meeting identity social norms: Overweight, physical or other disabilities, not meeting masculine/feminine gender norms. Including, facing family or community rejection due to one's sexual orientation or gender identity, or cultural identity.
14. Homelessness or Housing Instability: Lack of stable, safe housing.
15. Natural Disasters and Climate Change: Experiencing trauma related to environmental catastrophes and disasters. 

Image

(Figure 1. Cronholm et al., 2015)

In summary, the expanded model of ACEs accounts for the ways in which environmental, systemic, and socio-cultural factors may lead to childhood trauma that has lasting impacts on the physical and mental health of adults. These ACEs are not evenly distributed in communities, with marginalized youth facing increased exposure to adverse childhood experiences. Action is needed to prevent, interrupt, and address the impact of adverse childhood experiences in our communities. 

Stay connected to the Youth Development Insights Blog for ongoing research highlights on ACEs and their role in youth development.

Applying the expanded ACEs to our ordinary lives

Please reflect on these questions:

1. Have youth in your community and/or yourself experienced any environmental, systemic, and/or socio-cultural ACEs that have proven challenging to one’s healthy development?
2. This week, what can we do to help others who are exposed to these challenging situations?
3. What can we do to prevent these environmental, systemic, and socio-cultural ACEs from happening in the first place?
4. What can you do this month to continue your learning and understanding about ACEs?
5. What actions will you take to prevent youth from experiencing ACEs in our community?

Resources

Camacho S, Henderson SC. The Social Determinants of Adverse Childhood Experiences: An Intersectional Analysis of Place, Access to Resources, and Compounding Effects. Int J Environ Res Public Health. 2022 Aug 27;19(17):10670. https://doi.org/10.3390/ijerph191710670. PMID: 36078386; PMCID: PMC9518506.

CDC. About Adverse Childhood Experiences. Retrieved on 2/11/2025 from: https://www.cdc.gov/aces/about/index.html#cdcreference_6.

Cronholm PF, Forke CM, Wade R, Bair-Merritt MH, Davis M, Harkins-Schwarz M, Pachter LM, Fein JA. Adverse Childhood Experiences: Expanding the Concept of Adversity. Am J Prev Med. 2015 Sep;49(3):354-61. https://doi.org/10.1016/j.amepre.2015.02.001. PMID: 26296440.

Finkelhor D, Shattuck A, Turner H, Hamby S. A revised inventory of Adverse Childhood Experiences. Child Abuse Negl. 2015 Oct;48:13-21. https://doi.org/10.1016/j.chiabu.2015.07.011. Epub 2015 Aug 7. PMID: 26259971.

Finkelhor D, Shattuck A, Turner H, Hamby S. Improving the adverse childhood experiences study scale. JAMA Pediatr. 2013 Jan;167(1):70-5. https://doi.org/10.1001/jamapediatrics.2013.420. PMID: 23403625.

Folk JB, Ramaiya M, Holloway E, Ramos L, Marshall BDL, Kemp K, Li Y, Bath E, Mitchell DK, Tolou-Shams M. The Association Between Expanded ACEs and Behavioral Health Outcomes Among Youth at First Time Legal System Contact. Res Child Adolesc Psychopathol. 2023 Dec;51(12):1857-1870. https://doi.org/10.1007/s10802-022-01009-w. Epub 2022 Dec 24. PMID: 36565372; PMCID: PMC10290175.

Hawes DJ, Allen JL. A Developmental Psychopathology Perspective on Adverse Childhood Experiences (ACEs): Introduction to the Special Issue. Res Child Adolesc Psychopathol. 2023 Dec;51(12):1715-1723. https://doi.org/10.1007/s10802-023-01100-w. Epub 2023 Jul 8. PMID: 37421507; PMCID: PMC10661772.

Kysar-Moon, A. (2022). Adverse childhood experiences, family social capital, and externalizing behavior problems: An analysis across multiple ecological levels. Journal of family issues, 43(12), 3168-3193.

PACEs Connection. (n.d.). 3 realms of ACEs. Retrieved from https://www.pacesconnection.com/ws/Handouts_3RealmsACEs_EN.pdf

Pachter, Lee M. DO*; Coll, Cynthia García PhD†. Racism and Child Health: A Review of the Literature and Future Directions. Journal of Developmental & Behavioral Pediatrics 30(3):p 255-263, June 2009. | https://doi.org/10.1097/DBP.0b013e3181a7ed5a 

Wu, S., Lindstrom Johnson, S., Wolfersteig, W., & others. (2022). The power of local research to inform adverse childhood experiences in substance use prevention in adolescents and adults. BMC Public Health, 22, 1197. https://doi.org/10.1186/s12889-022-13503-3