ACEs and PCEs

Adverse Childhood Experiences (ACEs) are potentially traumatic events occurring before age 18. The 10 ACE factors are divided into two categories: child maltreatment and household dysfunction.

Child maltreatment includes direct action against a child (abuse and neglect). Household dysfunction consists of factors in the child's living environment which contribute longterm risk (such as household adults experiencing mental illness, drug abuse, or incarceration).

An individual's ACE score is determined through a simple survey which measures how many types of ACEs they experienced up to age 18. This gives a score between 0 and 10.

Research indicates that higher ACE scores correlate with increased risks of cancer, cardiovascular disease, mental illnesses like depression, and lower perceived quality of life (Felitti et al., 1998; Kerker et al., 2015, as cited in Rariden et al., 2021). An ACE score of four or more is considered high risk, with a score six or more potentially leading to premature death within twenty years without intervention (Alhowaumel et al., 2023; Brown et al., 2009).

Positive Childhood Experiences (PCEs) serve as protective factors against the negative impact on adult wellness associated with a high ACE Score.

Research by Dr. Bethell and her team focused on individuals who, despite ACE scores of four or higher, thrived in adulthood. They looked for the protective factors that helped them do well, and found the seven/eight PCEs. Their 2019 research shows that the presence of six/seven PCEs leads to a 72% decrease in adulthood mental illness among this high risk population.

PCEs promote healthy development and resilience in children. These experiences nurture physical, cognitive, social, and emotional competencies through stable relationships, secure environments, social engagement, and opportunities to develop positive skills. PCEs are measured similarly to ACEs on a yes-or-no scale from zero to eight.

At TCK Training, we regularly share how the eight Positive Childhood Experiences can be implemented to protect Third Culture Kids to improve long-term thriving and buffer against the long-term effect of ACEs.

Watch our free PCEs Miniseries to learn more. We also have a family PCEs inventory worksheet which is included in our Family Curriculum C or can be purchased separately for $5.

How to Implement PCEs for Third Culture Kids

In 2021 we conducted a survey of ACEs in 1,904 globally mobile Third Culture Kids (TCKs) to understand how ACEs impact this community. In 2022 we released two separate white papers exploring data we collected and analyzed during this survey. Both white papers are available on our website. In “Caution and Hope” we include a discussion of ACEs and their history; in “TCKs at Risk” we discuss individual ACE factors in detail. Both papers discuss negative outcomes in adulthood associated with childhood ACEs, with extensive references.

Alhowaymel, F. M., Kalmakis, K, A., Chiodo, L. M., Kent, N. M, & Almuneef, M. (2023). Adverse childhood experiences and chronic diseases: Identifying a cut-point for ACE scores. International Journal of Environmental Research and Public Health, 20(2). doi: 10.3390/ijerph20021651.

Bethell, C., Jones, J., Gombojav, N., Linkenbach, J., & Sege, R. (2019). Positive childhood experiences and adult mental and relational health in a statewide sample. JAMA Pediatrics, 173(1), 1-10. doi: 10.1001/jamapediatrics.2019.3007.

Brown, D. W., Anda, R. F., Tiemeier, H., Edwards, V. J., Croft, J. B., & Giles, W. H. (2009). Adverse childhood experiences and the risk of premarture mortality. American Journal of Preventative Medicine, 37(5), 389-396. doi:https://doi.org/10.1016/j.amepre.2009.06.021.

Rariden, C., SmithBattle, L., Yoo, J. H., Cibulka, N, & Loman, D. (2021). Screening for adverse childhood experiences: Literature review and practice implications. The Journal for Nurse Practitioners, 17(1), 98-104. doi: 10.1016/j.nurpra.2020.08.002.