In a landmark study in the 1990’s, the Center for Disease Control (CDC) and Kaiser Permanente Health Appraisal Clinic assessed the association of childhood maltreatment and later life health and well being. 17,000 adults were asked 10 specific questions about the occurrence or absence of abuse, neglect and household dysfunction during their childhood. An ACE score was calculated based on the cumulative number of positive answers to the questions. The study found a clear association between exposure to ACEs and high-risk health behaviors (incl. smoking, substance abuse and risky sexual behavior) and negative health outcomes (incl. obesity, depression, suicide, asthma, mental illness and up to 20 year lower life expectancy).
The ACE results have since been duplicated repeatedly. The Philadelphia Urban ACE Study, conducted in 2012 by the Institute for Safe Families and the Philadelphia ACE Task Force, collected data on children from Southeastern PA. Five new indicators were identified – experiencing racism, witnessing violence, living in an unsafe neighborhood, living in foster care or experiencing bullying. In addition to identifying additional ACE components, the study corroborated the elevated risk of negative behavior and poor health outcomes with the increased ACE score.
The Center on the Developing Child at Harvard University has been doing fascinating research on resilience documenting the significance of a supportive relationship with a committed parent, caregiver or adult in the community. These relationships buffer children from developmental disruption and help them build key capacities, such as the ability to adapt, that enable them to respond to adversity and thrive. The combination of supportive relationships, adaptive skill-building, and positive experiences constitute the foundation of what is commonly called resilience. The bottom line is that kids can develop resiliency to mitigate the risks of these experiences.
 Center on the Developing Child at Harvard University. (2015). Supportive Relationships and Active Skill-Building Strengthen the Foundations of Resilience: Working Paper 13.