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ACEs Education & The 4 Types of Child Abuse

Updated: Jul 2

A child hides their hands and face in their legs after one of the four types of child abuse.


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What is ACEs education?

ACEs education programs teach the public how adverse childhood experiences, or ACEs, negatively impact a person’s health, as well as mental, relational, and economic stability. Adverse childhood experiences include any events that threaten or undermine a child’s sense of safety, stability, and ability to appropriately bond with caregivers. Examples include:

  • Being a victim of violence, abuse, or neglect.

  • Witnessing violence in the home or community.

  • Grieving a family member who attempted or died by suicide.

  • Experiencing substance use problems by adults in the home.

  • Managing mental health challenges of adults in the home.

  • Suffering after parental separation and/or incarceration.

The purpose of ACEs education programs is to help others understand the importance of preventing childhood violence in order to improve individual health outcomes and wellbeing into adulthood. The benefits of childhood safety will also relieve the medical system, criminal legal system, and social services system from being overburdened by the treatment, prosecution, and resources distribution necessary after violence.

ACEs education research: The Kaiser ACE Study

ACE’s education utilizes evidence-based research from the Adverse Childhood Experiences (ACE) Study. Between 1995-1997, the Center for Disease Control (CDC) partnered with Kaiser Permanente, a major healthcare provider in the United States, to understand how childhood abuse and other challenges within the home can impact individual health and well-being across a lifetime. Over 17,000 participants completed confidential surveys about their childhood experiences between 0-17 years old, as well as current health status and behaviors. 

The CDC and Kaiser ACE study was published in 1998. The report showed that adverse childhood experiences, as well as other challenging events during a person’s developmental years, were directly connected to chronic health problems, mental illness, and substance use challenges both in adolescence and adulthood. Additionally, the results proved that adverse childhood experiences can limit educational, career, and earning potential. 

Nadine Burke Harris, the first and former California Surgeon General, gave a TED Talk on how childhood trauma affects health across a lifetime to disseminate the findings of the Kaiser ACE study. She advocates for ACEs education programs to prevent adverse childhood experiences and protect the health and wellbeing of individuals throughout their lifetimes.

What are the four types of abuse against children?

Today, the CDC defines child maltreatment as abuse or exploitation by an adult in a caretaking role (like a parent, stepparent, caregiver, coach, teacher, etc.) to a child under the age of 18. However, child-on-child abuse is also common. In the case of child sexual abuse, the age of consent is determined by each state and is usually between 16-18. 

Child maltreatment is organized into 4 types of abuse: physical abuse, emotional abuse, sexual abuse, and neglect. Any of these 4 types of abuse can result in death or serious physical, psychological, and emotional harm that may have lifelong impacts on a child’s health, relational and financial wellness.

Physical Abuse

Physical abuse includes the use of force like hitting, punching, kicking, shaking, or burning a child’s body. Often the signs of physical abuse appear on the child like wounds, bruises, cuts, burns, bone fractures, or sore muscles.

Emotional Abuse

Emotional abuse diminishes a child’s sense of self-worth or mental or emotional health through harsh words, threats, shaming, isolation, and silencing patterns. It keeps the child trapped in a system of control by their caregiver often causing the child to question their confidence and reality. This form of abuse can be one of the most difficult to recognize.

Sexual Abuse

Sexual abuse is the use of a child to meet the sexual demands of the caregiver through fondling, rape, sodomy, exposition of private parts, or watching pornography. Sexual exploitation and trafficking — or the solicitation of a person under the age of 18 for a sex act in exchange for something of value — is also included. 


A caregiver is neglectful when they are unable or refuse to meet their child’s basic needs like safe housing, healthy food, suitable clothing, age-appropriate education, and necessary medical care. Although abuse is a behavioral issue that can be avoided, childhood neglect can be caused by social, economic, or health challenges that redirect parental attention to advocacy, financial, and medical needs as opposed to adequate childcare.

Unfortunately, these four types of abuse are far too common. According to reported cases, 1 in 7 children have experienced abuse or neglect in the past year in the United States. In 2020, 1,750 children died from one of the four forms of abuse in the United States. Additionally, these four types of abuse are not singular in application, meaning two or more may be present at the same time. In 2017, the lifetime economic cost of child abuse and neglect was $592 billion, which includes the costs of childhood and adult healthcare, welfare, criminal justice, education, and productivity losses. This number is just as high as other public health issues like heart disease and diabetes. Violence impacts the individual as well as the community. 

ACE’s education expanded: The Pair of ACEs

Over a decade later in 2014, ACE’s education programs expanded to include adverse community experiences in a report entitled, “Adverse Community Experiences and Resilience: A Framework for Addressing and Preventing Community Trauma,” by Howard Pinderhughes, Rachel Davis, and Myesha Williams. The authors noted that adverse childhood experiences occur within the context of family as well as the greater community. Children can also be harmed within:

  • A Social-Cultural Environment: The people and culture children engage with. 

  • A Physical/Built Environment: The structural place children are raised in.

  • An Economic Environment: The economic opportunities available or restricted to children and their families.

Previously, the medical approach to treat trauma addressed individual symptoms from adverse childhood experiences. However, it neglected the root causes of negative health outcomes caused by social injustices like institutional betrayal, community violence, gang violence, and sexual violence that trapped children in cycles of fear, grief, and abuse management throughout development. These forms of abuse are often caused by social structures that children are supposed to depend on for support. Instead, structural violence escalates harm. Examples include:

  • Racism, sexism, sizeism, ableism, speciesism, homophobia, transphobia, and xenophobia.

  • Poverty and limited economic opportunities.

  • Segregation and racial redlining that restrict residency opportunities based on race or ethnicity.

  • Gentrification and displacement due to economic disparities.

  • Toxic exposure due to environmental injustice.

  • Lack of adequate public transportation.

  • Poor food quality and access.

  • Failing educational systems.

  • Over and under policing.

  • High rates of incarceration.

  • Stigmatization and criminalization of mental illness and substance use.

Adverse childhood experiences compound with adverse community experiences to create poly-victimizations or complex trauma for children. Multiple forms of harm sustained throughout childhood can cause a range of debilitating symptoms like anxiety, panic attacks, insomnia, irritability, aggression, mental illness, and inattentiveness that can lead to autoimmune diseases and other chronic health problems. According to ACEs education programs, when violence is rooted both in the family and community, it can be difficult for children to secure safety into adulthood and receive the necessary resources to recover. 

The study has influenced the Campaign for Trauma-Informed Policy and Practice which provides trauma-informed training within the legal system, foster care system, and other systemic organizations that support survivors and can prevent abuse.

Incest abuse as an ACE

Incest abuse is an adverse childhood experience and an adverse community experience. Sexual violence in the home occurs more frequently, expands over a longer duration, and begins younger than childhood sexual violence outside of the home due to the accessibility that the person who harms has to the child. If homes remain an abusive environment throughout development, children lack an understanding of safety. Their bodies become trapped in the navigation and management of external violence creating an unsafe and unstable sense of self internally as well. Incest survivors often experience chronic health, relationship, and economic challenges throughout their lifetimes. Although incest happens within the family system, the community also contributes to the harm of the child.

In cases of intrafamilial abuse of all kinds, especially sexual abuse, community intervention can break the cycle of violence. However, the abuse continues when the community refuses to see the problem or neglects to act. Due to the stigmatized and taboo nature of incest, many community members remain unaware of the patterns that cause perpetration or safe strategies to prevent sexual violence in the home. This leaves the responsibility of disclosure on the victimized child. Children suffering from incest rarely disclose due the normalization of abuse in their family systems, threats from the people harming them, or economic dependency on the person or people harming them. 

When children do disclose, the intervention models enacted often cause them more harm. Children are removed from their homes and placed in foster care, where they are four times more likely to be sexually abused. The criminal legal system frequently fails to side with the child and hold the person who harmed accountable. Those convicted and incarcerated often serve short sentences in a violent carceral system only to be released and often reoffend. 

Adult childhood sexual abuse survivors often delay disclosure until an average age of 52 years old. Sometimes the severity of the abuse causes Dissociative Amnesia, a condition that makes the victim forget that the violence occurred. Memories resurface much later through emotional and visual triggers and flashbacks. Other times, survivors wait to disclose to protect their safety. Instead, they choose to disclose only after they have established a solid sense of economic, physical, psychological, and relational safety. For many, this process can take decades. Others never find or recreate a safe foundation due to continued intrafamilial and structural violence, as well as the lack of access to support resources. 

For those who do disclose, it's not always a conscious choice. However, to the extent possible, deciding when and to whom to disclose can be a means of empowerment for a survivor. Taking that choice away can add to the trauma.

ACEs education: How to heal

If you are a victim or survivor of adverse childhood experiences or adverse community experiences, there is hope for healing. ACEs education information can help you to better understand yourself so that you can comprehend the consequences of violence on your health, as well as teach you to manage your symptoms and recovery with compassion, competency, and care. 

ACEs education programs guided by the Kaiser ACE Study encourage trauma-informed training for medical practitioners, therapists, dentists, social workers, educators, and others working with people like physical trainers and yoga teachers. As you explore healing techniques and modalities, research practitioners in advance to ensure that they received trauma-informed training so that you experience the best treatment available. 

Community resilience models promoted by ACEs education programs seek to address adverse community experiences. Many individuals and organizations work together tirelessly to rebuild safe family systems, revitalize damaged social networks, and recreate community care models that prevent structural violence and offer healing. Connect with those who share your vision and values for safety and justice to collaborate in the great work to secure peace and safety for everyone. 

ACEs Education: Resources

For further information, please, review the following resources:



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