ACEs Awareness Day • Child Abuse Prevention Month
April is National Child Abuse Prevention Month. Across the country, states are also marking ACE (Adverse Childhood Experiences) Awareness Day — a growing observance recognizing the impact of Adverse Childhood Experiences on the health and well-being of millions of Americans. Different states observe it on different dates throughout the spring.* If you’ve spent any time on mental health social media, you’ve probably seen the quiz: Ten yes-or-no questions and a score from zero to ten, indicating how damaged you are.
But what does it actually measure — and what doesn’t it?
Origins
In the mid-1980s, Dr. Vincent Felitti ran an obesity program at Kaiser Permanente in San Diego. The program worked well and all patients lost weight — but even so, more than half of them dropped out. Felitti started interviewing the dropouts and discovered a surprising commonality: the majority had been abused as children. For many, obesity was merely a symptom of a deeper problem. One woman, who was raped at 23, told Felitti: “Overweight is overlooked… and that’s the way I need to be.” (Felitti, The Permanente Journal, 2002).
Felitti would later describe the phenomenon as “reverse alchemy.” “How does this happen,” he wrote in The Permanente Journal, “Turning the gold of a newborn infant into the lead of a depressed, diseased adult?” The ACE study was his attempt to answer that question at scale. Partnering with Dr. Robert Anda at the CDC, Felitti designed a study of over 17,000 adult members of Kaiser Permanente’s health plan, all middle-class, middle-aged, employed, and insured. They asked ten questions: about physical, emotional, and sexual abuse; about neglect; about household dysfunction and domestic violence, substance abuse, mental illness, parental separation, and incarceration. Each “yes” added a point. The total was your ACE score. The landmark findings were published in 1998 in the American Journal of Preventive Medicine (Felitti et al., 1998).
Findings
The study found that ACEs follow a dose-response curve: the higher a participant’s score was, the likelier they were to suffer from a broad range of misfortunes. Adults with an ACE score of 4 or more are 12 times more likely to have attempted suicide. Seven times more likely to be alcoholic. Ten times more likely to have injected street drugs. At a score of 6 or higher, life expectancy drops by roughly 20 years. These results held up across more than 70 peer reviewed publications and replications worldwide in the three decades since. The CDC now recognizes over 40 health conditions and behaviors linked to ACEs in this dose-response relationship, including nine of the ten leading causes of death in the United States, such as heart disease, cancer, chronic lung disease and more. The body keeps the score long after the mind has stopped counting.
As Felitti wrote: “The study makes it clear that time does not heal some of the adverse experiences we found so common in the childhoods of a large population of middle-aged, middle-class Americans. One does not ‘just get over’ some things, not even fifty years later” (The Permanente Journal, 2002).
ACEs are not rare. In the original study, 28% of participants reported physical abuse; 21% reported sexual abuse; nearly 40% reported two or more ACEs. One in eight experienced four or more. The study carefully centered on a non-pathological, mainstream population: they weren’t outliers. They were — and still are — the norm.
Repair
But here’s what the quiz doesn’t ask: Was anyone there for you?
The ACE score measures exposure to harm, but it doesn’t look at access to repair. It doesn’t ask whether anyone believed you, helped you name what was happening, or showed up after the worst of it. It doesn’t account for the teacher who noticed, the aunt who let you stay, the friend who said “that’s not normal.” And they matter, possibly as much as the ACE score does.
Research from the Harvard Center on the Developing Child has consistently identified the same protective factor against long-term trauma: the presence of at least one stable, committed relationship with someone who shows up. A 2019 study by Bethell et al. in JAMA Pediatrics confirmed a dose-response association between positive childhood experiences and adult mental and relational health — regardless of how many ACEs a person had. Positive relationships don’t just help. They change the equation entirely.
For Survivors of Toxic Relationships
Along with health conditions, high ACE scores predict relationship instability, attachment disruption, and a nervous system wired to repeat the patterns it learned in childhood. Research consistently shows that childhood maltreatment increases self-shame, lowers self-esteem, and raises the risk of intimate partner violence in adulthood. The children who learned to fawn, to appease, to erase themselves to survive — they grow up and find themselves in relationships that feel a lot like the ones they came from. Not by accident. By neurology.
This is what STAR Network exists to address. Not the ACE score itself, but what it points to: a nervous system shaped by childhood adversity that keeps choosing what it knows, even when what it knows is harm. TAR Anon, STAR’s free, peer-led fellowship, meets five days a week across time zones. It’s built on the science the ACE study uncovered — that healing is relational, that isolation compounds trauma, and that the single most powerful intervention isn’t a clinical protocol: it’s another human being who’s been where you are and came back.
If your ACE score is high, it doesn’t mean you’re broken; it means that you survived and can heal. If no one was there for you then, someone can be there for you now. ACEs Awareness Day is a reminder that understanding childhood adversity is the first step towards that healing, not the last. The last step is community.
Take the ACE quiz
Join a free TAR Anon meeting → taranon.org
Resources: Child Welfare Information Gateway toolkit | California’s ACEs Aware “Live Beyond” campaign | CTIPP advocacy resources
* ACEs Awareness Day dates vary by state. New York observes ACEs Awareness Day on April 30 (enacted 2019). California proclaimed May 11 in 2024 as part of the Children and Youth Behavioral Health Initiative. Maryland observes May 6 annually (established by executive order, 2021). Tennessee, New Jersey, Alaska, Delaware, Pennsylvania, Virginia, and Wyoming have all adopted statewide ACEs awareness frameworks, with observance dates set by gubernatorial proclamation and varying year to year. For a comprehensive list of state-level ACEs initiatives and dates, see the National Conference of State Legislatures resource page at ncsl.org/health/adverse-childhood-experiences.
