ACEs and counter-ACEs: How positive and negative childhood experiences influence adult health

Child Abuse Negl. 2019 Oct;96:104089. doi: 10.1016/j.chiabu.2019.104089. Epub 2019 Jul 27.


Background: Numerous studies over the past two decades have found a link between adverse childhood experiences (ACEs) and worse adult health outcomes. Less well understood is how advantageous childhood experiences (counter-ACEs) may lead to better adult health, especially in the presence of adversity.

Objective: To examine how counter-ACEs and ACEs affect adult physical and mental health using Resiliency Theory as the theoretical framework.

Participants and setting: Participants were Amazon mTurk users ages 19-57 years (N = 246; 42% female) who completed an online survey.

Methods: We conducted a series of regression analyses to examine how counter-ACEs and ACEs predicted adult health.

Results: Corresponding to the Compensatory Model of Resiliency Theory, higher counter-ACEs scores were associated with improved adult health and that counter-ACEs neutralized the negative impact of ACEs on adult health. Contrary to the Protective Factors Model, there was a stronger relationship between ACEs and worse adult health among those with above average counter-ACEs scores compared to those with below average counter-ACEs scores. Consistent with the Challenge Model, counter-ACEs had a reduced positive effect on adult health among those with four or more ACEs compared to those with fewer than four ACEs.

Conclusions: Overall, the findings suggest that counter-ACEs protect against poor adult health and lead to better adult wellness. When ACEs scores are moderate, counter-ACEs largely neutralize the negative effects of ACEs on adult health. Ultimately, the results demonstrate that a public health approach to promoting positive childhood experiences may promote better lifelong health.

Keywords: Adversity; Childhood; Mental health; Physical health; Resilience.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Adverse Childhood Experiences*
  • Female
  • Health Status*
  • Humans
  • Male
  • Mental Health*
  • Middle Aged
  • Protective Factors
  • Surveys and Questionnaires
  • Young Adult