Skip to main content

Verified by Psychology Today

Adverse Childhood Experiences

The Building Blocks of Hope

A paradigm shift from adverse to positive childhood experiences.

Key points

  • ACEs (adverse childhood experiences) may contribute to a range of health and mental health problems in adulthood.
  • PCEs (positive childhood experiences) promote improved health, well-being, and relationships.
  • There is great power in the presence of supportive relationships, safe environments, and social connectedness.

The Traces of ACEs

The presence of adversity, especially early on, can significantly affect the human brain and development. Since the late 1990s, we've learned about ACEs, or adverse childhood experiences, and the traces they leave behind.

ACEs may be defined as potentially traumatic events that occur between the ages of 0-17, including any of the following:

  • The experience of abuse, neglect, or violence
  • Witnessing violence in the home or community
  • Having a family member attempt or die by suicide
  • Growing up in a household with substance use or mental health problems
  • Experiencing instability due to parental separation

According to the CDC, ACEs may contribute to chronic health problems, mental illness, and substance abuse problems in adulthood, and may negatively influence education, job opportunities, and earning potential. From diabetes, cancer, and heart disease, to depression, anxiety, and suicide, ACEs are associated with a range of adult health and mental health problems.

ACEs are common, with about 61% of adults reporting at least one ACE. Nearly 1 in 6 reported experiencing four or more ACES in a previous survey across 25 states.

As a result, we’ve become quite familiar with the experiences to avoid and factors to minimize in the context of child development. But how familiar are we with the protective factors to embrace? Can we pinpoint the positive experiences in a child’s life that may buffer the effects of abuse, neglect, or harm? There are steps one can take to promote resiliency and well-being in children who experience adversity. Yet in a scarcity-ridden culture swarmed with deficit-minded policies and programs, this strengths-based approach resembles a journey less trekked.

Despite the waves of life’s doom and gloom, children are incredibly resilient. There is always hope. And this is what emerging research seeks to promote.

Positive Childhood Experiences

Dr. Christine Bethell and her colleagues with Johns Hopkins Bloomberg School of Public Health have identified “positive childhood experiences” associated with improved health and well-being in adulthood. While decades of research illustrate the many benefits of positive experiences, the HOPE project (Health Outcomes from Positive Experiences) further reinforces children’s ability to withstand or recover from adverse experiences when the appropriate supports are in place.

There are four categories of PCEs, which include:

1. Nurturing and supportive relationships

These relationships include the presence of caregivers who are attuned and responsive to a child’s needs, adults outside of the family that show genuine care and interest in the child, and positive relationships with peers.

2. Safe, stable, protective, and equitable environments in which children can develop, play, and learn

These environments refer to homes where children feel safe and secure, and consistently have their basic care needs met. This also includes spaces where children have various opportunities to learn and play.

3. Constructive social engagement and connectedness

This connectedness may stem from participation in sports, music groups, and other extracurricular activities. It may also involve a child’s engagement in different community projects, service opportunities, or participation in cultural or spiritual traditions with one’s family.

4. Social and emotional competencies

The fourth building block refers to a child’s ability to understand emotions, practice self-regulation, and move past challenges in a productive manner. This also includes learning socially and culturally appropriate interpersonal skills. Children need trusted adults to teach and reinforce such skills in the home.

There is HOPE

According to Bethell et al. (2019), positive childhood experiences, including those listed above, are associated with reductions in depression and poor mental health, and help enhance one’s ability to build healthy relationships in adulthood. This is true even for those who have experienced multiple ACEs.

“This study offers the hopeful possibility that children and adults can thrive despite their accumulation of negative childhood experiences,” says Bethell. “People assume eliminating adversity automatically results in good health outcomes, but many people reporting lower adversity in childhood still had poorer mental and relational health outcomes if they did not also report having had positive childhood experiences.”

In other words, the avoidance of ACEs does not automatically foster healthy childhood development. Simply avoiding the negative does not inherently produce the positive. Children require the presence of safe and nurturing environments to grow into strong and resilient adults.

Further work is needed to reduce the gaps between research and practice and to generate policies aimed at promoting the positive experiences for all children. Imagine a society where negative experiences are not just grieved, but more fully nurtured and mended by positive interactions and supports? What would it look like to facilitate and promote this perspective of hope?


Bethell C, Jones J, Gombojav N, Linkenbach J, Sege R. Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels. JAMA Pediatr. 2019 Sep 9;173(11):e193007. doi: 10.1001/jamapediatrics.2019.3007. Epub ahead of print. Erratum in: JAMA Pediatr. 2019 Sep 30;: PMID: 31498386; PMCID: PMC6735495.

About. HOPE - Healthy Outcomes from Positive Experiences. (2021, March 4).