ACEs: Not a winning hand after all?

When the concept of ACEs (Adverse Childhood Experiences) broke onto the scene, with the dissemination and discussion of the CDC-Kaiser ACE study, this seemingly common-sense understanding of the link between painful experiences in childhood and poor outcomes later on in life was embraced by many as the new Holy Grail.

This American study had apparently found evidence across a large sample group of the impact of ten specific childhood experiences on adult health functioning; and the greater the number of adverse experiences, the worse the outcome. And it made perfect sense that someone taking an interest in you and your welfare early on might enable you to have a more secure sense of self and improve your life chances. The concentration on ACEs was timely, linking in with a focus on trauma-informed work, and the growing understanding of the the changes in the brain and the later outworking of developmental trauma by young children and even adults.

But almost immediately concern began to grow about the way ACEs were being used as an over-simplistic explanation of life trajectories; about their inappropriate and even dangerous use as a diagnostic tool; and about the focus on the individual to the exclusion of wider societal factors in determining health and well-being. Putting the focus on the individual themselves, and adopting a deficit model, creates a situation whereby a person becomes defined by what has happened to them. It is clear that certain events can have more or less devastating consequences to individuals, to communities and even to whole societies; and indeed it is important to keep this wider impact in mind. But by adopting a narrow focus we misuse “big data”, which is designed to tell us about large populations, not specific individuals. At issue is the interpretation of the data, the wholesale adoption within public policy, and the way this squeezes out other understandings and responses.

So does this study have something helpful to tell us, and can we make use of the insights it apparently offered?

This special themed edition of Social Policy and Society examines the ACEs concept and offers a critique of both its development and its use. The introduction, Adverse Childhood Experiences, Implications and Challenges, by Edwards, Gillies and White, is open access. Abstracts can be viewed for the other papers, with the exception of the final ‘Useful Sources’ which is also available in full, but access generally demands payment or subscription, though authors will often look favourably on a request to view a particular paper.

Steptoe, A., Marteau, T., Fonagy, P. and Abel, K., ACEs: Evidence, Gaps, Evaluation and Future Priorities

Asmussen, K., McBride, T. and Waddell, S. The Potential of Early Intervention for Preventing and Reducing ACE-Related Trauma

Hartas, D. Assessing the Foundational Studies on Adverse Childhood Experiences

Kelly-Irving, M. and Delpierre C. A Critique of the Adverse Childhood Experiences Framework in Epidemiology and Public Health: Uses and Misuses

White, S., Edwards, R., Gillies, V. and Wastell, D. All the ACEs: A Chaotic Concept for Family Policy and Decision-Making?

Macvarish, J. and Lee, E. Constructions of Parents in Adverse Childhood Experiences Discourse

Davidson, E. and Carlin, E. ‘Steeling’ Young People: Resilience and Youth Policy in Scotland  

Joy, E. and Beddoe, L. ACEs, Cultural Considerations and ‘Common Sense’ in Aotearoa New Zealand

Gillies, V., Edwards, R. and White, S. Some Useful Sources

See also The Social Policy Blog, commenting on the White, Edwards, Gillies and Wastell article.


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