The term A.C.E.S has been in the news lately with regard to two seemingly unrelated points: multiple recent mass shootings and an NBC News article titled “Kicking Kids Out of Preschool is Damaging… Why is it Still Happening?” Events such as these are not isolated and they can have a cascading effect on society. Families and children who have not suffered a recent loss or tragic event may still be traumatized and the effects can manifest in unlikely ways.

 A.C.E.S. is an acronym for Adverse Childhood Experiences Study.  A collaborative study between Kaiser Permanente and the C.D.C. examined the effects of childhood trauma; such as loss, abuse, or neglect, and their effect on later-life health and well-being. The study, which included over 26,000 people, showed how childhood events can have profound life-long negative effects. These events are not limited to a particular segment of society, as people from all walks of life can experience trauma. The study provided an assessment linking the relationship between adverse childhood experiences and future health risks; evidence that children are affected by the environment in which they live.  Nature and nurture affect how each of us develops: however, one’s home environment is an integral part of development, in part by the level of socio-emotional support available, on a spectrum ranging from healthy and supportive at one end to extreme neglect and family dysfunction on the other. Young children are not immune to the stress and emotional turmoil brought on by mass shootings, the loss of a close relative or other household challenges. Supportive environments give children the tools needed to provide clarity, to better understand and comprehend the change. Unfortunately, for some children, the home environment does not support healthy development.

In the A.C.E.S. study, the participants were given a score based on how many adverse experiences existed in their lives before the age of 18; each experience is one point.  The “experiences” were varied and included the following: the loss of a parent (or other close relationship), divorce, growing up with an alcoholic or drug addict in the household, living with a family member suffering from mental illness, having a family member in jail, physical or emotional neglect, loss of adult job and the potential effect on the household, physical, emotional or sexual abuse, and “other” not listed. Any of these adverse childhood experiences could influence the healthy social, emotional and/or cognitive development of a child. 

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Each adverse experience, or life “event” in a child’s world is awarded one point, the more points a child has, the more likely the risk for future health issues. Studies have shown those who have experienced four or more adverse experiences (4+ points) are at an increased risk for heart disease, liver disease, lung disease, and multiple types of cancer up to 20 years later. Additionally, these same people are at risk for increased alcoholism, smoking, depression, obesity, and early death. Fortunately, there are ways to minimize these health risks. 

It is important to provide the tools for a healthy future in the early years of a child’s life. While a child cannot be protected from all situations, such as their family or home environment, there are “protective” factors which can help a child towards a brighter future. Children fare better when raised in a supportive environment with engaged caregivers, one in which they can feel safe and secure, especially during turbulent times, to be able to grow and thrive. Part of this requires a greater awareness of what promotes healthy child development, and especially the role adults, teachers, and caregivers play in a child’s emotional development. Children are not born with “emotional regulation” skills, such as the ability to effectively manage their emotions of sadness, anger, and frustration, or with the ability to verbalize some thoughts or feelings, nor are children born with executive function skills such as self-control.  In a supportive environment these skills are nurtured and developed; unfortunately, sometimes the home is the toxic environment where a child “earns points”. Without an outlet or a responsive caregiver to help make sense of a difficult situation, a developing young child’s stress, fear, or anxiety might be expressed by “acting out”. 

According to the article “Kicking Kids Out of Preschool”, (National Survey of Children’s Health, 2016) an estimated 50,000 preschoolers had been suspended in 2015, with 17,000 expelled.  Fifty thousand young children, ages two, three, and four-year-old, suspended or kicked out of preschool. Young children are often suspended or expelled when the behavior interferes or becomes too challenging to the classroom or preschool environment.  For those children living in an environment which is considered a point on the A.C.E.S. scale, a stable environment away from home is even more important. Preschool is crucial for young children to build social-emotional skills, such as sharing and taking turns, building a range of emotional coping skills and play. Play supports all forms of child development from physical to cognitive to socio-emotional. Although most teachers have not had specialized training in how to support the social and emotional needs of children or in working with children who have experienced trauma, teachers can provide an outlet for children. Expelling children for acting out without  investigation of the reason is harmful to the child, their family, and our communities.

Events in our world are not isolated, they have a cascading effect on society as a whole. The unseen effects of those living in adverse childhood environments, as seen in the A.C.E. study,  as well as today’s news headlines can be a threat to society today and tomorrow. While not always visible, long term emotional effects can take their toll via health issues tomorrow. Families and children who have been spared from loss in the latest tragedy on a personal level may still be traumatized. Parents, caregivers, teachers… anyone in a child’s socio-emotional orbit needs to be aware a child’s outward behavior is not always as it appears. A child who acts out might be unable to verbalize the real issue (fear, stress, uncertainty), as his or her communication skills are still developing. Disruptive behavior may be the tip of the iceberg, with the larger problem still unseen. What is A.C.E.S. and why does it matter? Future generations of healthy adults depend upon our understanding of a child’s healthy socio-emotional development. 

Lisa Smith, M.A. DEVM, Teachers College Columbia University, is an Educational Consultant specializing in customized workshops supporting child development through play. Ms. Smith is also an Adjunct Professor of Psychology at U.C.C. She can be reached at or her website