Understanding Adverse Childhood Experiences: Long-Term Effects on How You Work and Lead
Photo by Tomasz Sroka on Unsplash
Review any trauma-informed literature and you are likely to come across the term ACEs, or Adverse Childhood Experiences. ACEs describe potentially traumatic or highly stressful events that happen before the age of 18. Research has shown that they can affect our health, relationships, and the way we function under pressure long after childhood has ended.
For driven and high-achieving professionals, understanding ACEs may help explain some of the patterns that continue to show up in the present, such as over-functioning, working harder than seems necessary, finding it difficult to switch off, taking too much responsibility, or struggling to ask for help.
Childhood adversity is more common in adult life than many people realize. CDC data suggests that roughly 64% of adults report at least one ACE.1 Researcher Vincent Felitti wrote that these experiences are often kept hidden by shame, silence, and stigma, which is part of why their impact can be easy to miss.² Many people learn to function, achieve, and keep moving without ever connecting present-day patterns to earlier experiences. From the outside, someone may look capable and composed while internally carrying chronic stress, self-doubt, over-responsibility, or a nervous system that has learned to stay on alert.
The Original ACE Study
The term comes from the CDC-Kaiser Permanente ACE Study, conducted between 1995 and 1997. The research began in a Kaiser Permanente obesity clinic and grew into one of the largest studies to examine the relationship between childhood adversity and adult health. More than 17,000 Kaiser Permanente patients took part.3
The original ACE framework identified ten types of adversity across three categories: abuse, neglect, and household dysfunction; 3
Five relate to direct experiences of abuse or neglect: emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect.
Five relate to the household environment: living with a parent or household member who struggled with substance use or mental illness; witnessing domestic violence toward a mother or stepmother; parental separation or divorce; or having a household member who was incarcerated.3
An ACE score is a simple count of the categories someone experienced. One point is assigned for each category, regardless of how often it happened or how severe it was.3 You can find an example of an ACE test here.
It’s important to note that the score cannot capture the full complexity of a person's experience. But the study did help to establish a clear connection between childhood adversity and later impacts on health and wellbeing.
Why It Matters
Researchers identified what is known as a dose-response relationship: meaning the higher a person’s ACE score, the greater their risk for a range of physical, emotional, and wellbeing challenges later in life.3
A few specific findings stand out:
Physical Health: Higher ACE exposure is associated with increased risk of depression, substance use, and a range of longer-term health conditions, including heart disease and cancer.³ Cumulative stress also takes a physical toll. Harvard’s Center on the Developing Child describes what can happen when a child experiences repeated adversity without enough buffering support: the stress response can remain activated, producing wear and tear similar to running an engine at full throttle for days or weeks without rest.4
Researchers describe this as allostatic load: the price the body pays for staying in a constantly mobilized, dysregulated state. Over time, that strain can show up as burnout, chronic illness, and reduced capacity for focus.
Mental Health: People with an ACE score of four or more face a four to twelve-fold increase in risk for alcoholism, drug use, depression, and suicide attempts, compared with people with no ACEs.3 The effects can also reach into work and career. ACEs have been associated with work-related challenges, including employment instability and financial strain.⁵
Executive Functioning: For some people, the effects of chronic stress and early adversity can show up in day-to-day functioning: difficulty planning and prioritizing, sustaining focus, or staying clear-headed under pressure. A harsh inner critic, imposter feelings, overthinking, perfectionism, self-doubt, or difficulty trusting your own judgment can also quietly shape how you relate to yourself and others. If you have ever wondered why you cannot simply relax into your own success, this may be part of the answer.
Under stress, familiar nervous system responses such as fight, flight, freeze, or fawn can surface too. At work, this may look like becoming defensive or irritable, avoiding difficult conversations, going blank under pressure, withdrawing from connection, overworking, or adapting so closely to others' needs that your own disappear.
Why Knowing Your ACE Score Can Be Helpful
Knowing your ACE score can be helpful because it gives you a starting point for understanding the connection between early experience and present-day patterns.
It may help explain why certain things feel harder than they "should," such as switching off, trusting others, asking for help, managing stress, feeling confident, or staying regulated under pressure.
The score can also help reduce shame. When you understand that early adversity can affect the body, the nervous system, your sense of self, and emotional regulation, some patterns stop feeling like personal flaws and start making more sense as adaptations.
The value is not in reducing yourself to a number. The value is in the questions the number can open up: What did I have to adapt to? What did I learn to do to stay safe, connected, or valued? And how might those adaptations still be affecting me now?
What ACE Scores Don't Tell You
At the same time, it is important to treat the ACE score as a reference point, not the whole picture. The original ACE framework has limitations. It does not capture every form of adversity. Later research, including the Philadelphia Expanded ACE Study, has broadened the framework to include community-level and systemic stressors such as witnessing violence, racism, unsafe neighborhoods, bullying, and involvement in the foster care system.⁶
The score also does not account for protective support, relational repair, community, or the resilience a person developed along the way.⁷ Two people with the same ACE score can have very different outcomes.⁷
What matters most is not the number, but the recognition of how early experiences may still be shaping you in the present day.
If you’re ready to understand and shift the deeper patterns that limit your confidence, voice, and presence, I'd welcome the chance to work with you. Learn more about coaching with me.
I am a certified professional coach (CPCC) with specialist training in trauma-informed modalities including the NeuroAffective Relational Model® (NARM®), Compassionate Inquiry, Internal Family Systems, Voice Dialogue, and somatic coaching. I am not a licensed therapist. If you are experiencing symptoms that require clinical support, I encourage you to seek guidance from a licensed mental health professional. You can find additional resources and support [here].
References
Swedo, E. A., et al. (2023). Prevalence of Adverse Childhood Experiences Among U.S. Adults: Behavioral Risk Factor Surveillance System, 2011–2020. Morbidity and Mortality Weekly Report, 72(26), 707–715. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/72/wr/mm7226a2.htm
Felitti, V. J. (2002). The relationship of adverse childhood experiences to adult health: Turning gold into lead. Zeitschrift für Psychosomatische Medizin und Psychotherapie, 48(4), 359–369. English translation available online. https://www.memoiretraumatique.org/assets/files/v1/Documents-pdf/2002-ACE-Gold_into_Lead-%20felitti.pdf
Felitti, V. J., Anda, R. F., Nordenberg, D., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext
Center on the Developing Child at Harvard University. ACEs and Toxic Stress: Frequently Asked Questions. https://developingchild.harvard.edu/resources/infographics/aces-and-toxic-stress-frequently-asked-questions/
Corporation for a Skilled Workforce. What Are ACEs and Why Do They Matter in the Workplace? https://skilledwork.org/what-are-aces-and-why-do-they-matter-in-the-workplace/
Philadelphia ACE Task Force. Philadelphia Expanded ACE Study. https://www.philadelphiaaces.org/philadelphia-ace-survey
Center on the Developing Child at Harvard University. Take the ACE Quiz, and Learn What It Does and Doesn’t Mean. https://developingchild.harvard.edu/in-the-news/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean/