Practitioner Review: Twenty years of research with adverse childhood experience scores – Advantages, disadvantages and applications to practice

Rebecca E. Lacey · Helen Minnis

415 citations0/0 files storedJournal of Child Psychology and Psychiatry

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Child Abuse and Trauma Child and Adolescent Psychosocial and Emotional Development Child Welfare and Adoption

Abstract

BACKGROUND: Adverse childhood experience (ACE) scores have become a common approach for considering childhood adversities and are highly influential in public policy and clinical practice. Their use is also controversial. Other ways of measuring adversity - examining single adversities, or using theoretically or empirically driven methods - might have advantages over ACE scores. METHODS: In this narrative review we critique the conceptualisation and measurement of ACEs in research, clinical practice, public health and public discourse. RESULTS: The ACE score approach has the advantages - and limitations - of simplicity: its simplicity facilitates wide-ranging applications in public policy, public health and clinical settings but risks over-simplistic communication of risk/causality, determinism and stigma. The other common approach - focussing on single adversities - is also limited because adversities tend to co-occur. Researchers are using rapidly accruing datasets on ACEs to facilitate new theoretical and empirical approaches but this work is at an early stage, e.g. weighting ACEs and including severity, frequency, duration and timing. More research is needed to establish what should be included as an ACE, how individual ACEs should be weighted, how ACEs cluster, and the implications of these findings for clinical work and policy. New ways of conceptualising and measuring ACEs that incorporate this new knowledge, while maintaining some of the simplicity of the current ACE questionnaire, could be helpful for clinicians, practitioners, patients and the public. CONCLUSIONS: Although we welcome the current focus on ACEs, a more critical view of their conceptualisation, measurement, and application to practice settings is urgently needed.

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References

1979The Ecology of Human Development 1998Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults 1967The social readjustment rating scale 1981The Ecology of Human Development 2017The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis 1989Vulnerable but Invincible: A Longitudinal Study of Resilient Children and Youth 2010Childhood Adversities and Adult Psychiatric Disorders in the National Comorbidity Survey Replication I 2004Adverse childhood experiences and the risk of depressive disorders in adulthood

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