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Pyramid

Description of Adverse Childhood Experiences Pyramid: This figure depicts a pyramid divided into five layers. Each layer represents the manner in which adverse childhood experiences influence health over the lifespan, from conception (the bottommost layer) to death (the top of the pyramid). The pyramid is not solid, but has space between each layer that represent the scientific gaps in our knowledge of the relationships between the layers. The bottom layer of the pyramid is labeled “adverse childhood experiences”. The next layer up the pyramid is labeled “social, emotional, and cognitive impairment”. The third layer is labeled “adoption of health-risk behaviors”. The fourth layer is labeled “disease, disability, and social problems,” and the top-most layer is labeled “early death”. This then represents the conceptual pathways that lead from adverse childhood experiences early in life to health problems and mortality many years later.

The ACE Pyramid represents the conceptual framework for the Study. During the time period of the 1980s and early 1990s information about risk factors for disease had been widely researched and merged into public education and prevention programs. However, it was also clear that risk factors, such as smoking, alcohol abuse, and sexual behaviors for many common diseases were not randomly distributed in the population. In fact, it was known that risk factors for many chronic diseases tended to cluster, that is, persons who had one risk factor tended to have one or more others.

Because of this knowledge, the ACE Study was designed to assess what we considered to be “scientific gaps” about the origins of risk factors. These gaps are depicted as the two arrows linking Adverse Childhood Experiences to risk factors that lead to the health and social consequences higher up the pyramid. Specifically, the study was designed to provide data that would help answer the question: “If risk factors for disease, disability, and early mortality are not randomly distributed, what influences precede the adoption or development of them?” By providing information to answer this question, we hoped to provide scientific information that would be useful for the development of new and more effective prevention programs.

The ACE Study takes a whole life perspective, as indicated on the orange arrow leading from conception to death. By working within this framework, the ACE Study began to progressively uncover how childhood stressors (ACE) are strongly related to development and prevalence of risk factors for disease and health and social well-being throughout the lifespan.

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Page last reviewed: January 10, 2008
Page last modified: December 12, 2005
Content source: Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion
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Adverse Childhood
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4770 Buford Hwy, NE
MS K-67
Atlanta, GA 30341-3717

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