The List of ACEs Should Be Longer

By Wendy B Smith, Ph.D. LCSW – PsychologyToday.com – December 3, 2025

KEY POINTS

• The traditional ACEs list is useful, but it does not go far enough.
• Interviews with former youth offenders offer insight into nature of additional ACEs.
• ACEs rarely occur in isolation.
• Every kind of adverse experience can negatively impact development.
  
  

The list of Adverse Childhood Experiences (ACEs), developed by V. J. Felitti and a group of other researchers in 1998, comprised seven categories of adverse experience, organized into two groups: abuse (physical, psychological, or sexual) and household dysfunction (substance abuse or mental illness of a parent, domestic violence, and imprisonment of a family member). In the nearly three decades since, the list expanded to include parental separation or divorce, and physical and emotional neglect.

ACE Screenings in Health Settings

ACE screenings are now widely used in health and mental health settings, providing short cuts to a sketch of events in an individual’s childhood that might have implications for current health or mental health problems. However, family circumstances and events are not the only sources of severe stress in the lives of children. A broader conceptual framework of situations and occurrences that can have traumatic impact offers a more dimensional and therefore more useful understanding of the early experiences of people we seek to help. It may also point the way to potential policy solutions when societal structures or conditions are creating trauma.

Expanding the List of Adverse Experiences

I interviewed 29 formerly incarcerated youth offenders about their childhoods for my recently published book, Before Their Crimes: What We’re Misunderstanding About Childhood Trauma, Youth Crime, and the Path to Healing. I asked many questions about home life, parents, school, and never asked specifically about problematic experiences, yet the open-ended recounting of childhood memories revealed the ACE scores of the people I spoke with as clearly as if they had checked the boxes on an ACE screen.

Their descriptions of childhood convinced me that the ten ACEs did not capture the difficulties that impinged powerfully on their developing selves. The memories they shared led me to create another list, first among which was the death of a parent. In my small sample, nearly 30% had lost a parent when they were under the age of 15, and in every case, a cascade of other risks and ACEs followed.

I added ten more, each of which can and often does put children at increased risk of negative outcomes. I included having parents who were teenagers themselves; experiencing foster care; multiple home moves; school moves during elementary, middle, and high school; being bullied; school suspensions and expulsions; having a relative who is a gang member; being introduced to crime by a family member; and witnessing gun violence. Even this list does not exhaust derailing experiences that can occur.

Thinking About Crime and Community-Level Experiences

All of the people I interviewed had committed crimes when they were teenagers, and most of those crimes were violent. I hoped to learn more about what had happened in their early lives that might shed light on their turn to crime. Adverse experiences in childhood were the defining feature in their lives. And never just one. ACEs did not come singly for them.

Most of the people I interviewed experienced between three and six of the “traditional” ACEs and another three to six of the eleven I added. In a few cases, there were as many as eleven to fourteen in total. Adverse experiences increase vulnerability to and risk of future negative events, especially for children who have no one to lean on or have not had the opportunity to develop coping capacities. For example, children who experience sexual abuse are often re-victimized. Children whose parents are addicted to substances frequently face both emotional and physical neglect. Children whose relatives are gang-involved are at greater risk of exposure to gun violence and of being introduced to drug use or criminal activities.