A nurse in an outpatient behavioral facility is caring for a client who has a substance use disorder and a history of violence. Which of the following client statements should the nurse identify as being consistent with adverse childhood experiences (ACEs)? (Select All that Apply.)

A. Incoherent speech. Incoherent speech is more characteristic of acute episodes of schizophrenia rather than the prodromal phase. During the prodromal phase, symptoms are typically less severe and may not include full-blown disorganized thinking.
B. Severe delusions. Severe delusions are indicative of an active psychotic phase of schizophrenia. The prodromal phase generally involves milder symptoms that precede the onset of more severe psychotic episodes.
C. Withdrawn behavior. The prodromal phase of schizophrenia is often marked by subtle changes in behavior, including social withdrawal, decline in self-care, and changes in functioning. Withdrawn behavior is a common manifestation during this phase, signaling the beginning of deterioration before the onset of more intense symptoms.
D. Frequent hallucinations. Hallucinations are more commonly seen during the active phase of schizophrenia rather than the prodromal phase. In this early stage, clients may experience less intense symptoms and may not exhibit frequent or vivid hallucinations.

A. "My parents divorced when I was 13 years old." Divorce is recognized as an adverse childhood experience (ACE) because it can create emotional instability, financial stress, and changes in family dynamics, potentially affecting long-term mental health outcomes.
B. "We always had plenty of food in the house to eat." Having consistent access to food suggests a stable home environment, which is not classified as an ACE. Adverse experiences often include neglect, which involves a lack of basic needs such as food, shelter, or medical care.
C. "I was teased at school for wearing dirty clothes every day for weeks." Persistent neglect, such as not having clean clothing, can indicate parental neglect—one of the recognized ACEs. This can contribute to feelings of shame, social isolation, and long-term psychological distress.
D. "My parents would get in physical altercations." Witnessing domestic violence is a significant ACE that can lead to long-term emotional trauma, increased risk of anxiety, depression, and difficulty forming healthy relationships later in life.
E. "My parent went to prison when I was 12 years old." Parental incarceration is a recognized ACE, as it can cause emotional distress, economic hardship, and social stigma, increasing the child's risk for mental health disorders and substance use.
F. "My parent would swear often at my sibling and I." Verbal abuse, including frequent swearing or demeaning language, is a form of emotional abuse. Emotional abuse is a major ACE that can contribute to low self-esteem, difficulty regulating emotions, and increased vulnerability to mental health conditions.