Integrating and Synthesizing Adversity and Resilience Knowledge and Action: The ICARE Model

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This article proposes a model for understanding the effects of adverse childhood experiences (ACEs) as dynamic and interrelated biobehavioral adaptations to early life stress that havepredictable consequences on development and health. Drawing upon research from multipletheoretical and methodological approaches, the intergenerational and cumulative adverse andresilient experiences (ICARE) model posits that the negative consequences of ACEs resultfrom biological and behavioral adaptations to adversity that alter cognitive, social, andemotional development. These adaptations often have negative consequences in adulthoodand may be transmitted to subsequent generations through epigenetic changes as well asbehavioral and environmental pathways. The ICARE model also incorporates decades ofresilience research documenting the power of protective relationships and contextual resources in mitigating the effects of ACEs. Examples of interventions are provided thatillustrate the importance of targeting the dysregulated biobehavioral adaptations to ACEs anddevelopmental impairments as well as resulting problem behaviors and health conditions.

Original languageEnglish
Pages (from-to)203-215
Number of pages13
JournalThe American psychologist
Issue number2
StatePublished - 2021


  • Adverse childhood experiences (aces)
  • Adversity
  • Biobehavioral adaptations to stress
  • Protective and compensatory experiences (paces)
  • Resilience


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