A Shift in Focus: From Adverse Childhood Experiences (ACEs) to Positive Childhood Experiences (PCEs)

Adverse Childhood Experiences

Bullying was added as an Adverse Childhood Experience (ACE) by the Center for Disease Control in 2017, placing the impact of bullying behavior on par with all other ACEs. In short, these experiences have been shown to disrupt neurological development, leading to cognitive, social, and emotional impairment. This impairment may lead to the adoption of high-risk behaviors and are the root cause of some social problems, diseases and disabilities.

At the recent 2020 “Creating Trauma Sensitive Schools” conference in Atlanta, Georgia, Dr. Robert Anda, co-principal investigator of the original Adverse Childhood Experience (ACE) Study, provided an inspiring keynote address to an audience of 1,600 educators and mental health practitioners from around the world. He shared that the power of the ACE Study was the development of a common language around childhood trauma, the evidence of the cumulative effect of ACEs, and more. Dr. Anda urged the audience to shift to a healing perspective that aims to slow the progress of childhood adversity and to reduce the intergenerational transmission of trauma. Despite the focus on ACEs recently, the research on positive and negative experiences in childhood shows the impact of these experiences on neurological and social development. He challenged the audience to teach that ACEs are not destiny and that by shifting our focus to healing, we might begin to rewrite the narratives of our lives from shame and confusion to hope and meaning.

Positive Childhood Experiences

In September 2019, this shift from a trauma focus to a healing perspective was at the heart of a study conducted by Professor Christina Bethell and her associates on Positive Childhood Experiences (PCEs) and the impact of PCEs in mediating the impact of childhood trauma. Professor Bethell of Johns Hopkins Bloomberg School of Public Health shared the purpose of this study in an interview with NPR Health: “We were especially curious to learn whether adults with multiple negative childhood experiences were less likely to have the problems associated with having [them] if they also reported having had more positive experiences” (Duffin-Simmons, 2019).

Professor Bethell and her colleagues used seven PCEs that had been selected from the Child and Youth Resilience Measure (CYRM), a valid screener for resilience. Just under 6,200 adult participants were asked the following:

Before the age of 18, how much or how often did you

  • feel able to talk to your family about feelings?
  • feel your family stood by you during difficult times?
  • enjoy participating in community traditions?
  • feel a sense of belonging in high school?
  • feel supported by friends?
  • have at least two nonparent adults who took genuine interest in you?
  • feel safe and protected by an adult in your home?

Like ACEs, these Positive Childhood Experiences are focused on relationships rather than on outcomes.

Among the findings, Professor Bethell and her team found that adults who reported no to low PCEs were four times more likely to report being treated for depression or to self-report poor mental health. Furthermore, they were much less likely to report that they had always received the social and emotional support they needed. Additionally, they found that adults who self-report more positive childhood experiences  (PCEs) have a lower likelihood of clinical depression or poor adult mental health and a higher probability of healthy adulthood interpersonal relationships.

The researchers also suggest that Positive Childhood Experiences have significant positive impact on adult mental health, even when they co-occur with Adverse Childhood Experiences. The researchers conclude, “This study adds to the growing evidence that childhood experiences have profound and lifelong effects. Results hold promise for national, state, and community efforts to achieve positive child and adult health and well-being by promoting the largely untapped potential to promote positive experiences and flourishing despite adversity.”

The Implications for Current Practice

At the recent trauma conference, Dr. Anda also shared that he wept the first time he saw the data from the original ACE Study. Statewide and focused studies since then continue to find similar results. While the initial understanding of the impact of ACEs is daunting, we must be moved to action by these results, especially as we learn the power of positive childhood experiences on all adults and their mental health, particularly those who have experienced ACEs.

First, schools must shift their focus from ACEs to creating PCEs that occur outside the family. The PCEs of feeling a sense of belonging in high school and feeling the support of friends can be developed and strengthened inside our schools with dedicated efforts in restorative practices, social-emotional learning (SEL) curriculum and instruction, and trauma-informed practices. The PCE of having at least two nonparent adults who take genuine interest in a child/young person’s life is possible by making sure that every student in our high schools has at least one adult who is responsible for a stable and consistent connection with him/her. This will take a school-wide effort of all adults in a building, from front office staff and paraprofessionals to teachers and food service personnel.

Second, instead of teaching our students about Adverse Childhood Experiences, let us instead teach them about the adolescent brain, the stress response system, the impact of mindfulness on stress, and so on. As they understand what is happening during times of peace and of stress, they become self-aware. Self-awareness, then, grows into self-management as we teach self-regulation through co-regulation. Let us help our students understand and be able to articulate what they need in order to be ready to learn.

Finally, we must be mindful that many of our children and young people will experience the most powerful PCEs at school. Because of this, our priorities in schools must be to establish, strengthen, and maintain a sense of safety and a sense of community first. Safe and supportive schools are fertile ground for student learning. Most importantly, our school environments become rich places to build the relationships that will make an impact on adult mental health.

Becoming trauma informed begins as we understand the long lasting impact of Adverse Childhood Experiences. This new understanding must then be shifted toward eradicating ACEs. In schools this is possible through providing Positive Childhood Experiences, and the opportunities for PCEs are found everywhere in our schools. In this way, we are able stop the trajectory of pain and isolation for this generation and those to come.


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;173(11):e193007. doi:10.1001/jamapediatrics.2019.3007.

Duffin-Simmons, C. (2019). Positive childhood experiences may buffer against health effects of adverse ones. NPR Public Health. Retrieved from https://www.npr.org/sections/health-shots/2019/09/09/759031061/positive-childhood-experiences-may-buffer-against-health-effects-of-adverse-ones.

Author Bio

Julie E. McDaniel-Muldoon, PhD

Social Media Director, International Bullying Prevention Association (IBPA)

Advanced Trauma Practitioner and Trainer, Starr Commonwealth (www.starr.org)

Licensed Trainer and Certified Restorative Practitioner, International Institute for Restorative Practices (www.iirp.edu)

Safety and Well-Being Consultant, Oakland Schools (Waterford, Michigan)

Email: julie.mcdaniel@oakland.k12.mi.us

Blog: https://jemmuldoon.blogspot.com/

Twitter: @jemmuldoon

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