Adverse childhood experiences (ACES)

What are adverse childhood experiences (ACEs)?

The term Adverse Childhood Experiences (ACEs) is used to describe a wide range of stressful or traumatic experiences that children can be exposed to whilst growing up.  ACEs range from experiences that directly harm a child (such as suffering physical, verbal or sexual abuse, and physical or emotional neglect) to those that affect the environment in which a child grows up (including parental separation, domestic violence, mental illness, alcohol abuse, drug use or incarceration).

A Blackburn with Darwen study found that almost half (47%) of adults across the Borough have suffered at least one ACE, with 12% of adults in Blackburn with Darwen having suffered four or more ACEs. The study has shown that the more ACEs individuals experience in childhood, the greater their risk of a wide range of health-harming behaviours and diseases as an adult.

The ACE animation below tells the story of a young boy growing up, and how his experience with ACEs could affect his life experience. We hope that you find this animation informative and useful, whether it is being used as part of a training programme, or as a local resident watching with interest.  If you have been affected by any of the issues raised in the ACE reports or the animation please contact your GP for advice.  Alternatively, we have suggested a number of organisations that you may want to seek support from below.

What must be remembered is that ACEs can be prevented. The work that we are doing across Blackburn with Darwen aims to both prevent ACEs occurring in the first place wherever possible, and to prevent the consequences of ACEs in those that have already experienced them.

How common are ACEs?

ACEs are unfortunately all too common.  Our Blackburn with Darwen study found that almost half (47%) of our adult population (aged 18-69 years) had at least 1 ACE, with many people having higher ACE scores.  The following was found for our population:

  • 53% Had experienced 0 ACEs
  • 19% Had experienced 1 ACE
  • 16% Had experienced 2-3 ACEs
  • 12% Had experienced 4+ ACEs

This is similar to the English ACE population study which found the following across England:

  • 53% Had experienced 0 ACEs
  • 23% Had experienced 1 ACE
  • 15% Had experienced 2-3 ACEs
  • 9% Had experienced 4+ ACEs

The original ACEs study, which was conducted in the USA, found that around two thirds (64%) of the 17,000 individuals included in the study reported at least one ACE, with over a quarter (26%) suffering  physical abuse and a fifth experiencing some form of sexual abuse.  Around one in eight individuals (13%) had experienced four or more ACEs.

What impact can ACEs have?

When exposed to stressful situations, the “fight, flight or freeze” response floods our brain with corticotrophin-releasing hormones (CRH), which usually forms part of a normal and protective response that subsides once the stressful situation passes.  However, when repeatedly exposed to ACEs, CRH is continually produced by the brain, which results in the child remaining permanently  in this heightened state of alert and unable to return to their natural relaxed and recovered state. Children and young people who are exposed to ACEs therefore have increased – and sustained - levels of stress. In this heightened neurological state a young person is unable to think rationally and it is physiologically impossible for them to learn. 

ACEs can therefore have a negative impact on development in childhood and this can in turn give rise to harmful behaviours, social issues and health problems in adulthood. There is now a great deal of research demonstrating that ACEs can negatively affect lifelong mental and physical health by disrupting brain and organ development and by damaging the body's system for defending against diseases. The more ACEs a child experiences, the greater the chance of health and/or social problems in later life.

ACEs research shows that there is a strong dose-response relationship between ACEs and poor physical and mental health, chronic disease (such as type II diabetes, chronic obstructive pulmonary disease; heart disease; cancer), increased levels of violence, and lower academic success both in childhood and adulthood.

Epidemiological evidence from Blackburn with Darwen (2012) showed that there was increased risk (adjusted odds ratio) of having health and social problems in adulthood for those individuals who had experienced 4+ ACEs, compared to those with no ACEs.  Individuals with 4 or more ACEs were:

  • 4.5 times more likely to have become pregnant or got somebody pregnant under 18 years of age
  • 30.6 times more likely to have had a sexually transmitted infection (STI)
  • 1.8 times more likely to be morbidly obese
  • 2.3 times more likely to have liver or digestive disease
  • 1.5 times more likely to have stayed overnight in hospital in the last 12 months
  • 3.7 times more likely to a regular heavy drinker
  • 3.9 times more likely to be a current smoker
  • 9.7 times more likely to be a heroin or crack user
  • 5.2 times more likely to have been hit in the last 12 months
  • 7.9 times more likely to have hit someone in the last 12 months
  • 8.8 times more likely to have been in prison or cells

Can ACEs be prevented? 

Whether you are an adult looking to reverse the impact of your own ACEs, or a parent or caregiver keen to make sure that your children do not grow up with ACEs themselves, the simple answer is - yes! Stable, nurturing adult-child relationships and environments help children develop strong cognitive and emotional skills and the resilience required to flourish as adults.  By encouraging such relationships ACEs can be prevented, even in difficult circumstances, and it is crucial to support and nurture children and young people as they develop and grow.  For adults who experienced ACEs in their childhood, it is also very possible to minimise the impact of ACEs on their health, relationships and lives in general (see the support section below).

Blackburn with Darwen's approach to reducing ACEs

There is a growing recognition in Blackburn with Darwen that early intervention and collaborative working are essential to reducing the impact of ACEs.  The Specialist Public Health Team at Blackburn with Darwen Borough Council has worked closely with stakeholders to raise the awareness and understanding of ACEs amongst professionals, communities, families, children and young people.  The vision of the Borough is to reduce the number of adversities experienced by people in Blackburn with Darwen and to build resilience of those who have already experienced ACEs.

There have been a number of approaches and initiatives that have been developed across the Borough:

  • Raising awareness of ACEs is deeply embedded within our Children's Partnership Board, which is a sub-group of the Health and Wellbeing Board
  • We have written the reporting and recording of ACEs into specific public health contracts (such as those for sexual health and substance misuse)
  • We have worked with Lancashire Constabulary to bring ACEs into the Early Action Programme
  • We have worked with Lancashire Care Foundation Trust to train staff to be able to routinely enquire about ACEs, through the REACh (Routine Enquiry in Adverse Childhood Experiences) initiative
  • We have worked with a local secondary school to be ACE-Aware and ACE-informed, through the EmBRACE (Emotional and Brain Resilience in Adverse Childhood Experiences) initiative
  • We have been in discussions with various stakeholders to raise the awareness of ACEs and have presented at local, regional, national and international conferences
  • We have started to create an environment to support social movements around ACEs
  • We have developed an animation on ACES in collaboration with Public Health Wales

If you would like to know more about ACEs, the work of the Specialist Public Health Team, or be involved, please contact: publichealthadmin@blackburn.gov.uk

Available Support

Although the effects of ACEs can last a lifetime, the good news is that they don’t have to. By seeking support, you can both reduce the impact of ACEs on your own life and break the cycle to prevent ACEs occurring in the next generation. This support can come from something as simple as a chat with a friend or family member, via your GP, or through one of the wide range of local and national organisations below that will help you recognise, work through and reverse the impact of ACEs for yourself or somebody you care about.

Drugs, alcohol and crime

ADFAM gives information and support for the families of drug and alcohol users.

Alcoholics Anonymous. If your drinking is causing you problems and you wish to stop drinking. 0800 917 7650

Go2 - Blackburn with Darwen Young People’s Drug and Alcohol Service. Go2 can support you with alcohol, all drugs including cannabis, heroin and ecstasy, ‘legal highs’, prescription and over the counter medication and multiple drug and/or alcohol use. They offer free and confidential advice and information for anyone under 25, along with support for the whole family. 

Inspire - Blackburn with Darwen Integrated Prevention & Recovery Service. Inspire offer a wide range of support for anyone worried about their own or somebody else’s substance/alcohol use. They offer advice and guidance to individuals and family members through rapid, open access assessment leading to support and treatment. 

Go2 and Inspire are part of the charity Change, Grow, Live (CGL)

UK Narcotics Anonymous is a society of recovering addicts for whom drugs had become a major problem, that meets regularly to help each other stop using and stay clean. 0300 999 1212

Victim Support is a national charity giving free and confidential help to anyone affected by crime. 0808 168 9111 www.victimsupport.org.uk

Abuse and relationships

Changing Lives. The aim of Changing Lives is to provide information to help you understand abuse and why it happens.  They will support you to build self-confidence and self-esteem to prevent further abuse.  They will work with you to explore ways to communicate your needs in a positive relationship. Domestic abuse can destroy lives.  This doesn’t have to be your story.  Changing Lives can help you change the ending.


The Wish Centre. The WISH centre is often the first point of contact for people in Blackburn with Darwen who are experiencing domestic abuse. Trained staff are available to discuss choices and options in a non-judgemental way, providing emotional and practical support.

NSPCC is a major UK charity specialising in child protection and the prevention of cruelty to children. The NSPCC’s purpose is to end cruelty to children. Help for adults concerned about a child: 0808 800 5000 or text 88858 www.nspcc.org.uk. If you are an adult that experienced abuse as a child, the NSPCC can also provide help and advice

Women’s Aid is a national charity working to end domestic violence against women and children. 0808 2000 247

Relate is a counselling service working to promote health, respect and justice in couple and family relationships. 0300 100 1234

Mental health

Big White Wall. If you’re experiencing a tough time at home or work or struggling with mental health issues, you can now access free online professional and peer support. It provides safe, anonymous and free online support for over 16s 24/7 with a supportive community, information and self-help resources and trained counsellors online at all times.

Lancashire Mind - We are more than a mental health charity. We’re a passionate movement leading the mental wellbeing revolution in Lancashire. We campaign to make your mental wellbeing a local priority, and help you find the tools you need to manage, maintain and improve your mental wellbeing.

Samaritans - Talk to us any time you like, in your own way, and off the record – about whatever’s getting to you. You don’t have to be suicidal. We know a lot about what can help you through tough times. We can help you explore your options, understand your problems better, or just be there to listen.

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