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What is an ACE score?

ACE is an acronym that standards for Adverse Childhood Experiences. The original study was published in 1998 by the federal agency The Centers for Disease Control and Prevention (CDC) with the help of the large HMO Kaiser-Permanente in Southern California. The original study found that "seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life." Health risks included alcoholism, drug abuse, depression, and suicide attempt, sexually transmitted disease, physical inactivity, severe obesity, heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease.

Major takeaways from the study:

  • More than half surveyed reported having at least one category of childhood exposure.

  • More than one in five reported three or more categories of childhood exposure.

  • Those reporting four or more categories (compared to those with none) had 4 to 12 fold increased health risks.

The seven categories studied included:

  • psychological abuse,

  • physical abuse,

  • sexual abuse,

  • violence against mother,

  • living with household members who were substance abusers,

  • living with household members who were mentally ill or suicidal,

  • living with household members who were ever imprisoned.

The following image shows the potential influence high ACE scores may have on the relative physical and mental impairment in adulthood (source):

The original CDC-Kaiser ACE study is based on more than 13,000 responses to their questionnaire requiring more than 60 responses accounting for a variety of variables across different topics.

It has since become common for a short list of statements to encompass the findings of that study for which a person's response to these statements result in an "ACE Score" that is intended to mirror the original study's findings. Groups today are asked to consider their own histories using these short lists of statements from which the impact and value of the original ACE study can then be discussed. Those that respond honestly to such lists of statements can then reflect on their own "ACE Score" and consider not only the impact those experiences may have had on their own adult lives but also how such experiences may be currently impacting students in schools today.

The following is one sample of a brief survey for people to consider their own "ACE Score" (source). Directions: answer "Yes" or "No" to the following ten questions.

Prior to your 18th birthday:

  • Did a parent or other adult in the household often or very often… Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt?

  • Did a parent or other adult in the household often or very often… Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured?

  • Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way? or Attempt or actually have oral, anal, or vaginal intercourse with you?

  • Did you often or very often feel that … No one in your family loved you or thought you were important or special? or Your family didn’t look out for each other, feel close to each other, or support each other?

  • Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

  • Were your parents ever separated or divorced?

  • Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her? or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?

  • Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?

  • Was a household member depressed or mentally ill, or did a household member attempt suicide?                       

  • Did a household member go to prison?

Now add up your “Yes” answers. This is your ACE Score.


Impact of ACEs on the classroom

It is difficult for teachers to determine an accurate ACE score for students because the categories include aspects of a student's home life that may not be comfortable for families to discuss openly and honestly (or legally in some cases). This difficulty in determining an ACE score does not mean students with a high ACE score will not still impact a classroom. Instead, behaviors that negatively impact a classroom might flag a need to consider a high ACE score as an underlying cause. This does not mean students that do not do what teachers tell them to do have high ACE scores. This means students that exhibit behaviors related to trauma may not benefit from typical classroom consequences and behavior-modifying deterrents. Students that do not respond to time-outs, absence of rewards, loss of privileges, detention, and other such typical consequences may have trauma-related beliefs toward school, teachers, their peers, and especially toward themselves.

According to 'A Practitioner’s Guide to Educating Traumatized Children' by Basha Krasnoff of Education Northwest, fear, anxiety, and constant interpreting of teachers and peers can offset a student's focus on learning. It is this awareness on which this article looks to shine a light.

When I speak informally with teachers (and parents!) about student challenges, I like to ask how often they feel they raise their voice or "yell" when students are particularly challenging. The general consensus is most, if not all, want to raise their voice or yell and many admit it occasionally feels necessary to get students to listen. There are many memes in recent years that pokes fun at teachers politely asking their students to line up only to show a need to roar the same command moments later.

Teachers know that they need to be good role models for their students. Teachers know they themselves hate being yelled at for things they do (or don't do). Yet, in a single moment, a teacher can easily react to what they may see as disrespectful levels of disobedience. Whether its one student, a small group, or more than half of a class, the teacher's reaction is a human reaction that can be understood (even in disagreement) by an outside observer. How teachers manage classrooms and cultivate an environment that limits these reactions is a different conversation to be discussed in a separate post. Here, what is most important is that those students with the highest potential for a high ACE score may be more affected by such teacher reactions.

Students with a higher ACE score may be experiencing trauma that is impairing their basic sense of trust in those around them. According to this article from, impaired trust can result in a lack in self-regulation, decreased ability to delay gratification, misperceive threats, and are withdrawn or aggressive. The impact of trauma on academic skills detailed in this 2015 presentation by Kacey Rodenbush can affect concepts of predictability in their environment, appreciate another's point of view, and bring linear order to narrative story-telling or organizing a summary of informational text. A higher ACE score does not guarantee the prediction of specific academic gaps but can give reason to behaviors that may require a learning environment to be adapted to meet specific developmental needs.

With nearly 40% of students in the U.S. with some form of trauma (i.e. sexual assault, physical assault, witnessing domestic violence), you may look for behaviors in students related to difficulty managing relationships (sharing parts of your life, getting to know someone as an individual, being reliable, etc) and even inconsistent or negative self-efficacy or self-image.

Teachers must acknowledge that trauma is entering classrooms unseen. Parents must acknowledge that trauma might be impacting their children. Students must acknowledge that trauma exists and there are things they can do about it. However, it will take an initial effort on the part of teachers and parents to recognize their impact on students before we can expect students to take ownership of their own social and emotional well-being.

My goal to develop self-directed learners is in part to develop healthy social and emotional awareness and management. Self-directed learners are self-aware of their feelings and learn to cope with overwhelming emotions in ways that are relevant to the wants and needs of both themselves and those around them. Self-directed learners are socially aware, exercising interpersonal skills with empathy and strategies for resolving conflicts (internal and external). Self-directed learners are socially aware and learn to recognize the relationship of their personal surroundings to their home, their community, state, and world. Expanding this world view takes time and the higher potential for a high ACE score makes this development more challenging but equally important for all people within a shared community.


Impact of Teacher Behavior on Students with high ACEs

For teachers to understand the impact a student with a high ACE score may have on their classroom, it is important to develop an awareness of how their behavior is perceived by their students. Students with a high ACE score can be affected by teacher behaviors more than the majority of students that may find teacher behaviors generally acceptable and are not deeply affected by loss of composure (e.g. frustration, fear, sadness, disgust, extreme joy).

The 2016 article, "Teacher Behavior Unwanted According to Student’s Perceptions", published in International Education Studies; Vol. 9, No. 11; 2016, by Canadian Center of Science and Education (source), details how teacher behavior can impact student learning as much as it can impact student social and emotional development. It highlights four themes: fairness, violence (physical and psychological), communication barriers, and characteristics, quoting student responses and a list of coded behaviors. The most important takeaway for the context of this article is how teachers "develop external control instead of developing internal control which requires patient, consistent and reassuring teacher behavior and they choose to threaten and scare the students by emphasizing the difficulty of the courses, reporting to the parents, and with grades to motivate them to study." This is meant to highlight the impact on the general student population that teacher behavior can have on students. However, it is even more important to consider the impact teacher behavior has on the percentage of students with higher ACE scores.

Students with higher potential for a high ACE score will be more greatly affected by teacher misbehaviors. This is due to the fact that the human brain develops first the emotional control center (limbic system) before it begins developing processing skills for rational decision-making (prefrontal cortex). Students with higher ACE scores may likely react to behavior correctional practices (discipline) in schools differently than students with a zero ACE score because their limbic system may not have developed in contexts that allow them to react to discipline in ways teachers expect.

Students with high ACES may be prone to developing an Oppositional Defiant Disorder possibly due to experiences of abuse or neglect, harsh or inconsistent discipline, a lack of parental supervision, living with parent or family discord or has a parent with a mental health or substance use disorder. According to the Mayo Clinic, "oppositional and defiant behaviors can be strengthened and reinforced through attention from peers and inconsistent discipline from other authority figures, such as teachers."

When a classroom has a majority of students that are relatively well-developed academically, socially, and emotionally, it may be difficult for a teacher unaware of ACEs to recognize that a student not conforming to such relative ranges of student expectations may need something different from them. The typical rules, rewards, and punishments may not be affecting this small percentage of students as teachers expect. Asking teachers to veer away from typical classroom management practices that seem to work for the majority of students will be difficult. However, it is going to be necessary to make such shifts as a means for acknowledging that what has worked for the majority of students is not working for the percentage of students with higher ACE scores.

Self-Directed Learning is an approach that allows teacher to adjust their classroom to account for *all* students according to their development academically, social-emotionally, as well as cognitively and psychosocially.

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