The Conundrum of How to Use the ACEs Research

ACEs word cloud

I am assuming readers of this blog are familiar with the ACEs research that has been so widely distributed in recent years as people realize the powerful implications of its results. Research unequivocally proves that early childhood adversities can have a profoundly negative impact on someone’s life as an adult. The research evokes several very important questions for us as a society to ask ourselves: what to do with it, how to use it in order to prevent future ACEs in children’s lives and how to use the information about an individual’s ACE score in ways that are helpful.

An article written on August 18, 2020 by The Imprint describes how Dr. Nadine Burke Harris is promoting ways to have universal screening in order to better address the ACEs scores of patients. Pediatricians may be unaware of the underlying causes of some of the physical and mental health issues they see in their offices. Dr. Harris and others have noted how adverse childhood experiences create a public health crisis in society where individuals, families and communities and ultimately our whole country must deal with the repercussions of these adversities. They can so powerfully damage and destroy individuals’ physical and emotional health and well-being.

Dr. Harris’ goal is to use the screening processes to contribute to cutting toxic stress by half in the next generation.

Diagnosis - Trauma. Medical Concept  with Blurred Text and glasses.

Research clearly shows the power of childhood adversities leading to so many negative health outcomes in adults and raises concerns about using surveys to figure out a person’s ACEs score. They question how the results of these surveys might be used inappropriately. “Critics …warn that answers on the forms could lead more families in low-income and Black and brown communities to become entangled with child welfare authorities. What’s more, physicians who aren’t familiar with trauma may inadvertently harm patients by the very nature of the questions, and their lack of sensitivity….There is another worry among mental health experts when it comes to ACEs: its innate potential to simplify the complex ways that children experience life.”

The article highlights feedback from Dr. Bruce Perry, a neuroscientist at Northwestern University’s School of Medicine and one of the nation’s leading experts in treating trauma. They state that he described ACE screening tools as “… too simplistic for individual clinical work. He said they are more appropriately used for epidemiology studies and public awareness campaigns about childhood development. 

When used on patients in an exam room, Perry said ACEs screens are often misapplied and poorly explained, leaving people feeling ‘profound’ violations of their privacy. In some instances he’s encountered, adult patients attribute too much to a high score, feeling they had discovered the reasons for their health challenges, and chalking them up to things that happened in their childhoods, not what they needed to do in the present to address them. 

What’s left out of the health assessments, Perry said, are the myriad ways humans and their health are shaped by their experiences in life, ‘including the timing, pattern and intensity of adversities.’ Above all, he added, what is not being measured in the screenings is the protective forces in a person’s life such as connection to family, community and culture: ‘A person’s history of connectedness is likely more important in determining their current health than their history of adversity.’

Concept of domino effect of the white figures of the man is falling from behind the red little man.

At a conference where Dr. Perry was the guest lecturer, I remember him saying a simple statement that captures so much of what we need to appreciate about trauma and about studies like the ACEs research: “Trauma is messy.” As a student of trauma I am overwhelmed by its complex nature, the hundreds of thousands of ways people are impacted uniquely, the struggles that are created as a result of unresolved trauma, especially in early childhood, and how incredibly difficult it is to somehow help someone unpack what happened to them in childhood in order to find some form of resolution, recovery and healing.

I think for any of us who are working to be students of trauma we need to deeply respect its nature, its complexities and its “messiness.” We love to find one-size-fits-all quick solutions to life’s problems. When it comes to addressing trauma, I don’t think there are any universal quick fixes. We need to be very mindful as we navigate whatever approaches are generated to addressing the impact of trauma and to focus on doing no harm with whatever approaches are generated.

Invitation for Reflection

  1. To what extent do you agree or disagree with some of the perspectives shared in this article about screening for ACEs?
  2. What are some of the concerns you have about this kind of screening?
  3. Do you have any thoughts about ways we might use the ACEs research to help promote healthier families while not doing potential harm?

Diane Wagenhals, Program Director, Lakeside Global Institute