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The Science
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Research has shown that the higher the combination of Adverse Childhood Experiences (ACEs), the higher the risk of detrimental future health conditions and individual and interpersonal problems. The costly consequences could be prevented by truly investing in all children and nurturing relationships.

ACEs and Toxic Stress

ACE Pyramid -throughout lifespan .png

ACE PyramidMechanism by which Adverse Childhood Experiences influence health and wellbeing throughout the lifespan

Explore the science of ACEs and toxic stress in these insightful links:

The original ACE Study
What are ACEs & how do they related to toxic stress?
National household survey of adverse childhood experiences and their relationship with resilience to
The Relation Between Adverse Childhood Experiences and Adult Health
Effects of positive and negative childhood experiences on adult family health
Cumulative risk of compromised physical, mental and social health in adulthood due to family conflic
Adverse Childhood Experiences (ACE) Study
Adversity in childhood is linked to mental and physical health throughout life
Evaluating Community Approaches to Preventing or Mitigating Toxic Stress
Breaking the cycle of intergenerational abuse
Traumatic childhood could increase heart disease risk in adulthood
Adverse Childhood Experiences: Addressing Health Disparities through Prevention, Early Detection, an
Adverse Childhood Experiences as Predictors of Perceived Health
Connecting the Brain to the Rest of the Body
The ACEs Index
A Critical Assessment of the Adverse Childhood Experiences Study at 20 Years
Intergenerational transmission of trauma effects: putative role of epigenetic mechanisms
The effect of multiple adverse childhood experiences on health
Life course health consequences and associated annual costs of adverse childhood experiences across
Adverse childhood experiences and health-risk behaviors among adults in a developing country setting
Racism is an Adverse Childhood Experience (ACE)
Discrimination: A Social Determinant Of Health Inequities
Tackling the attainment gap by preventing and responding to ACEs
ACEs in Hertfordshire, Luton and Northamptonshire
ACEs and their association with Mental Wellbeing in the Welsh adult population
ACEs and their association with chronic disease and health service use in the Welsh adult population
ACEs and their impact on health-harming behaviours in the Welsh adult population

London Facts

A report for the GLA estimated that 10 per cent of Londoners are likely to have experienced four or more different types of adversity, including abuse or neglect.

A similar evaluation is addressed in the ACE Index, a national study that produced a ranking of ACEs prevalence across England using official data such as child protection plans. The study concluded that London was among the most affected areas. 

The London Assembly Health Committee has also released official data in 2020 on the intersections among children having experienced up to three specific ACEs: domestic abuse, substance misuse and parental mental ill-health. Children having experienced all three were reported to total 3097. The Committee pointed to difficulties in assessing the true numbers, which are probably much higher across Greater London.

While methods of measurement may differ, it is clear that much more should be done to assess the true level of need in London and to translate the results into policy.

UK Facts

The evidence from surveys and studies carried out in the UK since 2014 has been reported by the Commons Select Committee as follows:

47% of English adults had experienced at least one ACE and 9% experienced 4 or more.
Scottish Public Health estimated that prevalence in Scotland would be at least as high.
50% of Welsh adults had experienced at least one ACE and 14% experienced 4 or more.

The Children’s Commissioner’s Office estimated at least 690,000 children aged

0–5 in England live in a household with an adult that experienced domestic violence and abuse, substance misuse or mental health difficulties.


As big as the challenges associated with ACEs are the initiatives from communities, survivors, practitioners and researchers who are committed to understanding, promoting and building resilience.


The Welsh Adverse Childhood Experience and Resilience Study interviewed approximately 2,500 adults aged 18-69 years in various parts of Wales in 2017.

The data showed a direct association between childhood resilience and mental health across the lifespan. It also demonstrated that having some resilience resources more than halved risks of current mental illness in those with four ACEs or more. 

The science demonstrates that resilience is built from interactions with others. Nurturing relationships play a significant role in this process, especially when we face multiple challenges growing up.

Discover more about the science of resilience through these stimulating resources: 

The Building Community Resilience Collaborative
Roadmap for Resilience
How to Use the ‘Pair of ACEs’ to Build Community Resilience
Fostering Equity: Creating Shared Understanding for Building Community Resilience
Resilience: An overview
Building children and young people’s resilience in schools
Resilience in African American Children and Adolescents
Resilience Against Traumatic Stress
Putting resilience and resilience surveys under the microscope
Trauma Resilience in UK Policing
Stress and Resilience
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