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7 Positive Childhood Experiences (PCE’s) that Shape Adult Health and Resiliency – Illustrated

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In 2019 researchers at Johns Hopkins University published results of the first large-scale study that sought to identify “Positive Childhood Experiences” that helped protect kids from the negative effects of traumatic experiences¹, (read the full-text journal article here). The Seven Positive Childhood Experiences (PCE’s) they identified (illustrated below) are categories of childhood/adolescent experiences that are connected to improved mental health and social connectedness in adults.

Handwritten text written in black, surrounded by two gold stars: Identifying positive childhood experiences that shape mental health in adults.
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 jamanetwork.com/journals/jamapediatrics/fullarticle/2749336

By now, most counselors, pediatricians, teachers, and other people who work with children know about ACES: The “Adverse Childhood Experiences” scale. ACE’s predict, based on measuring the number of traumatic or adverse events experienced, which kids are likely to struggle developmentally and emotionally as they mature.  (You can take the ACES quiz here).

Handwritten text written in black surrounded by gold stars: Results from a survey-based study of 6,188 adults at Johns Hopkins shows seven childhood experiences linked to good mental health and adults.

New results from a survey based on a study of 6188 adults at Johns Hopkins shows that there are 7 childhood experiences that can be statistically linked to good mental health in adults.

What has been less well understood is why a small percentage of kids with high ACE scores have normal development and good adult emotional health. What factors created a level of resiliency in these kids that helped them to survive and thrive despite difficult childhoods?

Supporting Kids through COVID using PCEs

A therapist-designed activity book created to help kids process COVID-19 and thrive beyond quarantine

This PCE study was the inspiration for my book Covid Kid’s Activity Book – A Workbook for Kids and Families to Build Community and Resilience through Quarantine and Beyond available now in print and instant digital download. This workbook for ages 4-11 is designed to help kids process, understand, and integrate the PCE’s they are experiencing, even in the midst of a pandemic. This may help kids grow resilience to current and future adversity.

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Handwritten text written in black, surrounded by gold stars: We know the effects of ACES (adverse childhood experiences) but how do we move from data on reducing trauma toward learning how to develop resiliency starting in childhood?

Even before researchers defined ACE’s and demonstrated the link between high ACE scores and lower high school graduation rates, increased mental health diagnoses, higher rates of incarceration, and other poor outcomes, there has been an enormous focus on decreasing adverse childhood experiences. Research shows that these positive childhood experiences can help promote lifelong health, even for kids who’ve had multiple adverse childhood experiences (four or less).

This study helps shape research moving in an additional direction: how to support kids who have experienced one or more traumatic events, and kids who have not yet experienced a traumatic event but will in the future. Could PCE’s help researchers identify ways to help grow resilience in kids who are then able to become healthier adults?

Handwritten text written in black, surrounded by gold stars: This study suggests that not just reducing aces but increasing PCE's contributes to growing resilient kids able to become healthier adults. Read more in JAMA pediatrics article 2749336.

Kids who experience many PCE’s learn to trust the support of social connections, and social connectedness is linked to adult mental health. Adult survey respondents who reported high levels of adulthood social and emotional support (i.e. family, partners, and friend circles they trusted, were open with, and looked to for support) were more likely to have experienced a high number of PCE’s during their childhood.

 Kids who experience many PCE’s during childhood become adults who can seek support and get care- and adults who can seek support and get care have improved symptoms even if mental illness is present. 
Handwritten text written in black, surrounded by gold stars: Survey respondents with high levels of adulthood social and emotional support were more likely to have high PCEs.

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Positive Childhood Experiences help build resiliency to future adverse experiences

To learn more about PCE’s you can read the full-text journal article of this study for free on JAMA Pediatric’s website. To purchase a copy of this poster, choose an option below. Please note that the purchase price paid is compensation for artistic work only and does not include rights to republish.

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Handwritten text written in black, inside a thin-lined black box, with two gold stars: Lead researcher Dr. Christina Bethell and co-authors propose that kids with high PCE's become adults who are able to seek and get care and support, which improves symptoms even if mental health illness is present.

The relationship between PCE’s in childhood and good mental health in adults is dose-responsive; that means the more PCE’s a child gets the better their adult mental health is likely to be.

Handwritten text written in black, inside a thin-lined black box, with two gold stars: The relationship between PCE's and good mental health is dose-responsive. The more a child gets, the better adult health.

Take my PCE Quiz to Learn your Score:

 

Positive Childhood Expereinces

Take this Quiz to Find Out Your Score.

 

[No data is saved from your entry. Use of this quiz is subject to this site's terms of use. This quiz is not a psychological test or measure. The results may be used solely for entertainment and educational purposes.]

1 / 7

As a child and teenager, was there an adult in your home who made you feel safe and protected?

2 / 7

As a child and teenager, can you think of at least two adults who were not your parents who took a genuine interest in you?

3 / 7

As you grew up, did you feel like you had one or more friends who supported you?

4 / 7

If you attended high school, did you feel a sense of belonging either in the school or with a specific group of friends or teammates?

5 / 7

As a child and teenager, did you feel like your family supported you when you were going through difficult things?

6 / 7

As a child and teenager, did you feel able to talk with family about your feelings?

7 / 7

As a child and teenager, did you enjoy being a part of traditions in your community?

7 Positive Childhood Experiences

1. Ability to talk with family about feelings.

Thoughts, feelings, and experiences are shared in an open and honest way, and dialogue around feelings is welcomed. This could be through a parent checking-in every so often, or even sharing their own feelings (in an appropriate way) to encourage the child to share. Sharing emotions also promotes emotional intelligence in growing minds by identifying and expressing a felt experience.

PCE One. Ability to talk with family about feelings. (Handdrawn black-ink doodled image of child talking to adult)

2. Felt experience that family is supportive in difficult times.

When a difficult experience occurs in a child’s life, a parent offers support through presence and/or expresses support through words. Taking the time to notice and be with the child through this helps them to feel as though the parent is by their side and on their side. It doesn’t have to be much, but even just a little moment can go a long way in teaching the child that they matter.

PCE Two. Felt experience that family is supportive and difficult times. (Handdrawn black-ink doodled image of child holding paper being encouraged by an adult)

3. Enjoyment in participation in community traditions.

Traditions, in general, allow us to feel part of a greater whole. Having traditions in childhood creates a rhythm that both binds us to the greater whole, and also connects us to our families. Celebrating traditions allow for meaningful moments to be had within families and among communities. This can help a child feel connected, garner a greater sense of community, and promote life-long (positive) memories.

PCE Three. Enjoyment and participation in community traditions. (Handdrawn black-ink doodled image of family around a campfire)

4. Feeling of belonging in high school.

High school can be a tough experience, but belonging can be found in many places. This sense of belonging can come from participation in extracurricular activities, through joining clubs or groups that share a similar interest, or through simply finding peers to connect with in a meaningful way. Feeling connected and having positive relationships is key to feeling as though they belong.

PCE Four. Feeling of belonging in high school. (Handdrawn black-ink doodled image of two kids playing musical instruments)

5. Feeling of being supported by friends.

Similar to feeling supported by family – it is important that children feel that support from their friends. A parent is essential here because they are the model for a child’s first understanding of relationships. A parent can model what it looks like to have healthy, supportive relationships with friends, and encourage their children to find the same qualities in friends they choose.

PCE Five. Feeling of being supported by friends. (Handdrawn black-ink doodled image of a phone showing supportive texts)

6. Having at least two non-parent adults who genuinely care.

While it is important for a child to feel supported by their family, it is also important that they have supportive adults outside the home. These adults could be teachers, counselors, coaches, mentors, a friend’s parent, etc. It is an adult who is a positive influence with whom they have a healthy attachment; a person they feel they can talk to or turn to besides their parent(s).

PCE Six. Having at least two non-parent adults who genuinely care. (Handdrawn black-ink doodled image of a child in sports gear being encouraged by a coach)

7. Feeling safe and protected by an adult at home.

Feeling safe and protected can look like many different things: It can look like being physically cared for – protected from physical danger. It can also look like being kept safe from overwhelming experiences. Whatever it may be, it is crucial that a child feels as though the parent(s) in their life are available and doing what they can to keep the child safe and healthy. This allows the child to focus on things beyond basic needs being met.

PCE Seven. Feeling safe and protected by an adult at home. (Handdrawn black-ink doodled image of an adult protecting a child from a barking dog)

Original summary of this illustration posted on social media: Until now, research on the impact that childhood experiences have on adult mental health has focused on adverse experiences. This week, Johns Hopkins researchers published significant new research demonstrating 7 positive experiences, that when experienced regularly in childhood, correlate to adults who are less likely to experience depression and poor mental health.

Study authored by: Christina Bethell et. al. “Positive Childhood Experiences (Free Full Text Article)

In summary, Identified PCEs in the Johns Hopkins Study include (in my words):

  • Being able to talk about feelings with family
  • Feeling supported by family in difficult times
  • Participating in community traditions
  • Feeling as though one belongs in high school
  • Feeling supported by friends
  • Feeling as though at least two non-parent adults truly care
  • Feeling safe and protected by adults at home
Image Description for Visually Impaired Readers
Handwritten text: Identifying positive childhood experiences that shape mental health in adults

Handwritten text: new results from a survey-based study of 6,188 adults at Johns Hopkins shows seven childhood experiences linked to good mental health and adults.  We know the effects of ACES (adverse childhood experiences) but how do we move from data on reducing trauma toward learning how to develop resiliency starting in childhood? This study suggests that not just reducing aces but increasing PCE’s contributes to growing resilient kids able to become healthier adults. Read more in JAMA pediatrics article 2749336. Survey respondents with high levels of adulthood social and emotional support were more likely to have high PCEs. Lead researcher Dr Christina Bethell and co-authors propose that kids with high PCE’s become adults who are able to seek and get care and support, which improves symptoms even if mental health illness is present. The relationship between PCE’s and good mental health is dose-responsive.  The more a child gets, the better adult health.

PCES:

One. Ability to talk with family about feelings. (Handdrawn black-ink doodled image of child talking to adult)

Two. Felt experience that family is supportive and difficult times. (Handdrawn black-ink doodled image of child holding paper being encouraged by an adult)

Three. Enjoyment and participation in community traditions. (Handdrawn black-ink doodled image of family around a campfire)

Four. Feeling of belonging in high school. (Handdrawn black-ink doodled image of two kids playing musical instruments)

Five. Feeling of being supported by friends. (Handdrawn black-ink doodled image of a phone showing supportive texts)

Six. Having at least two non-parent adults who genuinely care. (Handdrawn black-ink doodled image of a child in sports gear being encouraged by a coach)

Seven. Feeling safe and protected by an adult at home. (Handdrawn black-ink doodled image of an adult protecting a child from a barking dog)

Resources

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 jamanetwork.com/journals/jamapediatrics/fullarticle/2749336

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Maryrose

Tuesday 30th of March 2021

So good. Thank you.

leelyttle

Wednesday 24th of March 2021

Great work !

Betsy Campisi

Monday 8th of March 2021

Can you provide the citation for Christina Bethell's article? I can't find it. Thanks!

Lindsay Braman, MACP

Thursday 11th of March 2021

Hi Betsy, you'll find the citation and links to the original article sprinkled throughout the article, or you can click here: “Positive Childhood Experiences (Free Full Text Article)”

Annie Reese

Thursday 4th of March 2021

Thank you! Have you translated this into other languages?

Robin Greiner

Thursday 13th of August 2020

Excellent! Some of these are intuitive and I am grateful we have worked to instill in our 3 grandsons whose mother died when they were young. Excellent research!