Trauma
October 30, 2022
TLDR: The Limitations of the ACE Measure
This article discusses the shortcomings of the traditional Adverse Childhood Experiences (ACE) measure:
It doesn't capture the frequency of experiences, only whether they happened
It doesn't assess the severity of the experiences
It doesn't consider the individual's perception of how the experiences affected them
The standard ACE questionnaire only looks at adversity within the household, missing community/school experiences like stigma, bullying, and discrimination
Key takeaways:
Two people can have very similar events but experience them very differently
The ACE measure treats all events as equal, failing to account for context and personal impact
More comprehensive assessment tools are needed to fully understand childhood adversity
The article emphasizes the importance of moving beyond simplistic ACE scoring, and toward a nuanced, personalized understanding of how childhood experiences shape long-term health and wellbeing.
[Read full article for in-depth analysis and research insights]
One critical point is that we call them adverse childhood experiences (ACEs), not adverse childhood events. Two people could have a very similar event and they could be experienced entirely differently. One could experience much higher levels of toxic stress.
That's being said, there are a lot of shortcomings with the ACE measure. One is that it doesn't capture the frequency of an experience. It asks, did this happen? Yes, or no? There's a difference between something happening once and someone growing up in a household that happened on a consistent and regular basis.
It doesn't ask about frequency. It also doesn't ask about severity. And another question that started to become added to ACE questionnaires is the perception of the experience. Do you think that this had a major effect on you?
And so, there's an important need to not compare different events, because really what we're talking about is how they are experienced, right? One person could experience child physical abuse and they could be resilient to that exposure. They could bounce back very quickly, become a stronger person from it, and another person could have just had some emotional neglect. And that really set them up for a lifetime of mental health challenges.
Another Perspective on the ACE Measurement
The other perspective emerged from my doctoral dissertation [1]. I got involved in a cohort study of men who have sex with men (MSM) in Los Angeles, low-income, mostly black and Latino. We added the classic ACE measure, which is the ten-question ACE measure that asks five questions about childhood maltreatment. So different forms of abuse, sexual abuse, neglect, and then household dysfunction, which looks at parents going to prison using drugs, parents having a mental illness, etc.
But bringing it back to the social determinants of health conversation. The ACE measure that looks at adverse childhood experiences in the household completely misses all the adverse childhood experiences that could be happening in the community and in the school, right?
People, particularly from sexual minority groups or racial/ethnic minorities, might be exposed to a lot of stigmas (including weight stigma), bullying, and discrimination outside of the home. And so, one of the things I learned is that using just the standard household ACE questionnaire isn't going to capture the full breadth of adversity exposure. As we conclude most scientific papers, "more research is needed."
References
1. Wiss, D. A. (2022). Adverse Childhood Experiences and Mental Health Over the Life Course Among Men Who Have Sex with Men in Los Angeles County. (Publication No. 28969943) [Doctoral Dissertation, University of California Los Angeles]. ProQuest Dissertations Publishing
