Maybe you took an online quiz about adverse childhood experiences and got a number that surprised you. Or maybe you have always sensed that the way you grew up still shapes how you feel today. This article explains what adverse childhood experiences (ACEs) are, how they can affect adult life, what an ACE score really means and how therapy can help you heal, no matter what your number is.
The short version: your past is part of your story, but it is not your destiny. Many people with hard childhoods go on to build steady, connected lives, and support can help at any age.
What are adverse childhood experiences?
Adverse childhood experiences are stressful or traumatic events that happen before age 18. The term comes from a large study by the U.S. Centers for Disease Control and Prevention (CDC) and Kaiser Permanente in the late 1990s. Researchers asked adults about ten types of childhood hardship, then looked at their health later in life.
The original ten ACEs fall into three groups.
Abuse
emotional abuse
physical abuse
sexual abuse
Neglect
emotional neglect
physical neglect
Household challenges
a parent or caregiver with a mental illness
a parent or caregiver with an alcohol or drug problem
violence toward a parent or caregiver
parents who separated or divorced
a family member who went to jail
Since then, many researchers have pointed out that the list leaves out other real hardships, such as bullying, racism, poverty, community violence, the death of a parent, foster care or living through war. If something on that wider list happened to you, it counts too.
What is an ACE score?
An ACE score is simply a count. You get one point for each of the ten types you experienced. If you lived with a parent who drank heavily and your parents also divorced, your score would be two.
Researchers found that, as a group, people with higher scores were more likely to have health problems later in life. These included depression, anxiety, substance use, heart disease and other chronic illnesses. The idea is that long-term stress in childhood can affect a growing body and brain.
What your ACE score can't tell you
This is the part online quizzes often skip. An ACE score was built to study large groups of people. It was never meant to predict what will happen to one person. Here is what it leaves out:
How severe or how long. A single event and years of daily fear both count as one point.
What helped. The score says nothing about the caring grandparent, teacher, coach or neighbour who made you feel safe.
How you made sense of it. Two siblings in the same home can come away with very different stories.
Everything after 18. Your relationships, work, therapy and choices since then matter a great deal.
So if your score is high, please don't read it as a sentence. And if your score is low but you still struggle, that is valid too. Some painful experiences, like constant criticism or feeling invisible, don't show up neatly on the list.
What self-esteem really is
Self-esteem is the opinion you have of yourself. The NHS puts it simply: when self-esteem is healthy, we tend to feel positive about ourselves and about life, and we cope better with ups and downs. When it's low, we see ourselves in a more negative, critical light and feel less able to take on challenges.
Healthy self-esteem is not the same as thinking you're better than everyone else. It's more like a steady floor under your feet. You can make a mistake, get criticized or have a bad day without feeling like your whole worth is on the line.
Signs your self-esteem could use some work
Low self-esteem can look different from person to person. Common signs include:
harsh self-talk, like "I'm so stupid" or "I always mess things up"
trouble accepting compliments
comparing yourself to others and always coming up short
people-pleasing and finding it hard to say no
avoiding new challenges because you expect to fail
feeling like a fraud, even when you're doing well
needing a lot of reassurance from others
The NHS notes that low self-esteem often begins in childhood, shaped by messages from parents, teachers, friends and the media. It can also be worn down later by things like bullying, a difficult relationship, job loss or ongoing stress.
How to build self-esteem, step by step
The steps below build on each other. Pick one or two to start, and come back to the rest later.
Step 1, notice your inner critic
You can't change a thought you don't notice. For one week, jot down the harsh things you say to yourself. Write the situation too. For example: "Presentation at work. Thought: everyone could see I was nervous. I looked like an idiot."
Many people are surprised by how often the critic speaks, and how cruel it is. Simply noticing it is the first step to loosening its grip.
Step 2, question the thought
This is a core CBT skill. Take one of your harsh thoughts and look at it like a detective would. Ask yourself:
What's the evidence for this thought? What's the evidence against it?
Is there another way to see what happened?
Am I treating a feeling as a fact?
Then write a more balanced thought. Not a fake-positive one, just a fairer one. "I was nervous, and I still got through the whole presentation. Two people asked good questions, so they were listening."
Step 3, write down your strengths
The NHS suggests writing a list of positive things about yourself, plus good things other people have said about you. Aim for at least five, and keep adding to it. Keep the list somewhere you'll see it.
If this feels awkward, start small. "I'm a loyal friend." "I'm good with my hands." "I make my kids laugh." Small counts.
Step 4, practise self-compassion
Self-compassion means treating yourself the way you would treat a good friend who is struggling. Psychologist Dr. Kristin Neff, a leading researcher in this area, describes three parts:
Self-kindness instead of self-judgment. Being warm and understanding toward yourself when you fail or feel inadequate.
Common humanity instead of isolation. Remembering that everyone struggles and makes mistakes. You're not the only one.
Mindfulness instead of over-identification. Noticing painful feelings without pushing them away or getting swept up in them.
Try this the next time you mess up. Put a hand on your chest and say, "This is hard right now. Everyone makes mistakes. What do I need?" It may feel strange at first. That's normal.
Resilience and protective factors
Researchers have also looked at what helps children do well despite hard times. These are sometimes called positive childhood experiences or protective factors. They include:
at least one safe, caring adult
feeling like you belonged at school or in your community
friends who supported you
traditions, culture or faith that gave you comfort
activities where you felt capable
The encouraging news is that protective factors keep working in adulthood. Safe relationships, community and support can still help your nervous system settle and grow. Therapy is one of those safe relationships.
How therapy helps with childhood trauma
Healing from childhood trauma is not about reliving every painful memory. It is about feeling safer in your body and your life today, and slowly changing the patterns that no longer serve you.
A trauma-informed therapist will go at your pace. Early sessions often focus on building trust and coping skills, like grounding and calming your body when you feel flooded. Later, when you are ready, you can work with the memories and beliefs that still hurt.
Approaches that can help include:
Trauma-focused talk therapy, which helps you understand how the past shapes your reactions now. Learn more on our trauma and PTSD counselling page.
EMDR (Eye Movement Desensitization and Reprocessing), which helps the brain process painful memories so they feel less charged. Read more about EMDR therapy.
Internal Family Systems (IFS), which helps you understand the protective "parts" of you that formed in childhood and treat them with compassion. See our IFS therapy page.
Body-based approaches, which help you notice and calm stress responses held in the body.
Many of our therapists have experience with childhood trauma. Our care team can help match you with someone whose approach feels right.
Things you can start today
Therapy is not the only place healing happens. A few small steps can make a difference:
Notice your patterns with curiosity, not blame. Try asking, "What was this reaction trying to protect me from?"
Practise grounding. Name five things you can see, four you can hear and three you can touch when you feel overwhelmed.
Build safe connections. Spend time with people who feel steady and kind.
Care for your body. Sleep, movement and regular meals help a stressed nervous system.
Set small boundaries. Saying no in low-stakes moments builds confidence for bigger ones.
If you are a parent, you might worry about passing things on to your children. Noticing that worry is already a protective step. Working on your own healing is one of the kindest things you can do for your family.
Getting started at Transformation Counselling
We offer trauma counselling in person in Waterloo, Kitchener, Cambridge and Ottawa, and online across Ontario. You don't need a doctor's referral. Evening and weekend appointments are available.
Sessions with our therapists are $130 to $200, and there is a one-time $50 setup fee. Many workplace benefit plans cover therapy, and we can help you check your coverage.
If you are in crisis or thinking about suicide, call or text 9-8-8, any time. In Waterloo Region you can also call Here 24/7 at 1-844-437-3247. In an emergency, call 911.
Frequently asked questions
Do I need to remember everything to heal?
No. Many people have gaps in their memories of childhood. Therapy focuses on how you feel and cope now, and you never have to push to remember things.
Is a high ACE score a diagnosis?
No. An ACE score is a research tool, not a diagnosis. It can be a helpful starting point for a conversation with a therapist, but it does not define you.
Will therapy make me feel worse before I feel better?
Talking about hard things can bring up feelings. A good trauma therapist will build safety and coping skills first and go at a pace that feels manageable. You are always in charge of what you share.
Can I heal if my family never admits what happened?
Yes. Healing does not depend on an apology or on anyone else changing. Therapy can help you find your own sense of peace and decide what kind of relationship with family feels right for you.
Is it too late to get help as an adult?
It is never too late. The brain can keep learning and changing throughout life, and many people start this work in their 40s, 50s or later.
Take the first step
You don't have to sort through your past alone. Book a free 15-minute consultation with our care team, and we will help you find a therapist who understands childhood trauma. Or you can book an appointment directly.