ACEs in Spades​​

Life isn’t about the cards you’re dealt—it’s about how you play them.

In the 1990s, Kaiser Permanente and the Centers for Disease Control and Prevention (CDC) conducted the Adverse Childhood Experiences (ACEs) Study, fundamentally changing how we understand the long-term impact of childhood trauma. The research revealed a powerful connection between early adversity and struggles later in life, including mental health challenges, addiction, and chronic medical conditions.

The original ACEs Study identified 10 categories of childhood adversity, grouped into three main areas:

Abuse

• Emotional abuse by a parent or adult in the household

• Physical abuse by a parent or adult in the household

• Sexual abuse

Neglect

• Emotional neglect

• Physical neglect

Household Challenges

• Witnessing intimate partner violence toward one’s mother or caregiver

• Growing up with substance use in the household

• Living with a household member who experienced mental illness or attempted suicide

• Experiencing parental separation or divorce

• Having an incarcerated household member

  
  

The study revealed a clear dose–response relationship: the more ACEs a person experienced, the higher their risk for long-term effects such as toxic stress, depression, anxiety, substance use, heart disease, autoimmune conditions, and other chronic health issues. While the research emphasizes risk, I’ll offer my hot take. One thing I've noticed in my own life—and in many of my clients, though certainly not everyone—is that humor often becomes a survival skill. Some of the funniest people I know endured incredibly difficult childhoods. Laughter doesn't erase pain, but sometimes it helps us carry it.

I first encountered the ACEs Study during my social work training, but its significance quickly became deeply personal. These were not abstract statistics—they mirrored the lived experiences of people I knew well, including myself. Seeing how accurately this research reflected the lives of adults around me was both sobering and illuminating. And yet, even in the midst of grief and heartbreak, the research also pointed toward something essential: hope.

Healing is possible. Through awareness, therapy, supportive relationships, and intentional personal growth, we can begin to repair what early adversity disrupted. While we cannot change the past, we can shape the future—rewrite our stories and support meaningful changes in our brains through neuroplasticity.

Growing up with multiple ACEs does not have to define who we become, nor does it mean we are destined to pass pain on to the next generation. It is also critical to acknowledge that systemic factors—such as racism, sexism, poverty, and community violence—can compound childhood adversity. Understanding these broader contexts helps foster compassion, both for ourselves and for others, on the path toward healing.

If your childhood included a high number of ACEs—if you were dealt a heavy hand early in life—know this: it is not a life sentence. There is real and lasting hope. Through therapy and the courage to share your story, you can build the safety, connection, and stability that may have been missing in childhood, improving both your health and overall well-being.

ACEs increase risk—they do not determine our future. Many people with high ACE scores go on to build healthy, meaningful, connected lives.

Maybe we don't get to choose the cards we're dealt. But we do get to decide what we do with the hand we're holding.

I am living proof of this, and you have the opportunity to become living proof, too. Healing is possible. Growth is possible. Change is possible. I would bet my life on it.

All in,

Mandy

Curious about your own ACE score? You can take the ACEs questionnaire as a starting point for reflection.

Remember, your score is not a diagnosis or a prediction—it is simply one tool for understanding how early experiences may have shaped your health and relationships.

Take the Ace Study