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The ACE Score: Understanding Your Past, Building Your Future
Have you ever wondered why you react to stress in a certain way, or why certain emotional or physical challenges seem to follow you? The Adverse Childhood Experiences or ACE Score is a tool that can help answer these questions, shifting the clinical focus from “What is wrong with you?” to “What happened to you, and how can we support your growth?”.
The RISE program acknowledges that trauma is widespread and uses the ACE score as one tool—used cautiously—to understand a client’s context, not as a final diagnosis.
What is the ACE Score?
The ACE Score is a measure of the total amount of toxic stress a person experienced before the age of 18. It is a simple count of 10 different types of childhood trauma, with one point given for each type of adversity experienced.
The original ACE study looked at two primary categories of Adverse Childhood Experiences:
- Abuse:
- Physical Abuse
- Emotional Abuse (Verbal Abuse)
- Sexual Abuse
- Household Dysfunction/Neglect:
- Physical Neglect
- Emotional Neglect
- Growing up with a household member who was substance-dependent (alcohol or drugs)
- Growing up with a household member with a mental illness
- Parental separation or divorce
- Experiencing domestic violence (violence against the mother or stepmother)
- Having a household member who was incarcerated (in jail or prison)
Your ACE score is simply the sum of how many of these 10 categories you experienced. For example, if your parents divorced and a household member struggled with substance abuse, your score would be 2.
What Does an ACE Score Mean?
It’s important to remember that your ACE score is not destiny; it is a risk factor and a statistical guideline. It acts as a proxy for the level of adversity you faced in childhood.
The significance of the score is based on the groundbreaking findings of the CDC-Kaiser Permanente ACE Study, which found a strong, dose-response relationship between the number of ACEs and negative health and social outcomes later in life:
- The Higher the Score, the Higher the Risk: As your ACE score increases, so does your statistical risk for chronic diseases, social problems, and emotional problems.
- Physical Health Risks: A high score is linked to a significantly increased risk for conditions like heart disease, lung disease, liver disease, chronic depression, and even a shorter life expectancy.
- Behavioral/Mental Health Risks: Individuals with higher scores are more likely to face challenges such as depression, anxiety, PTSD, and substance use disorder. For example, those with an ACE score of 4 or more were found to have a 4- to 12-fold increased risk for alcohol and substance use disorder, depression, and suicide attempts.
The underlying reason for this connection is toxic stress. Prolonged activation of the body’s “fight-or-flight” response during childhood disrupts brain development and the immune system, affecting how a person’s stress-response system functions well into adulthood.
What Should I Do About It?
Understanding your score is the first step toward healing and growth. The goal is to move beyond viewing yourself through the lens of symptoms and instead focus on functional resilience.
Here are the key steps, as supported by the principles of trauma-informed care:
1. Prioritize Safety and Regulation
Trauma-informed care recognizes that before any deep healing can occur, you must feel physically and psychologically safe.
- Grounding: Learn somatic tools, like breathing exercises or the 5-4-3-2-1 technique (identifying 5 things you see, 4 things you feel, etc.), to bring yourself back to the present moment when you feel overwhelmed.
- Window of Tolerance: Learn to identify when you are hyper-aroused (panicked, anxious) or hypo-aroused (numb, checked out). The goal is to return to the optimal zone—your Window of Tolerance—before attempting to process difficult memories.
2. Seek Trauma-Informed Support
The core principle is that healing happens with the client, not to them. Look for programs that utilize a “Bottom-Up” approach, which addresses the body and nervous system before moving to the mind.
- Somatic Therapies: Modalities like Somatic Experiencing (SE) and Trauma-Informed Yoga focus on releasing the physical tension that trauma leaves in the body.
- Cognitive Therapies: Once stabilized, you can engage in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) to reframe negative cognitive distortions (like feeling “It was my fault”) or EMDR for processing specific traumatic memories.
3. Focus on Resilience Building
The journey is about building resilience, not just reducing symptoms. The RISE program tracks progress using a tool called the Connor-Davidson Resilience Scale (CD-RISC) to measure improvements in your ability to cope and adapt.
- Healthy Boundaries & Connection: Trauma-informed care emphasizes restoring your sense of Empowerment & Choice. This includes learning about healthy boundaries, asking for help, and building trust with supportive people.
- Meaning Making: The final step involves rewriting your personal narrative and finding Post-traumatic Growth, acknowledging your past without letting it define your future.
Understanding your ACE score is simply an opportunity to address the root causes of distress and begin the journey of healing, evolving, and resilience building.
