Adverse Childhood Experiences (ACEs): A measurement tool for public health practitioners and clinicians.

Measuring Risk Factors

We understand that exposure to Toxic Stress during childhood can lead to negative health outcomes in adulthood. We also know that great variation exists between individuals and their experiences, and that not all experiences influence outcomes in the same way. To improve the way practitioners and policy-makers develop intervention and treatment plans for people with health problems, it’s important to understand how, and to what degree, a person has been affected by childhood trauma. 

What are ACEs?

Negative, stressful, traumatizing events that occur before age 18 are referred to as adverse childhood experiences (ACEs). ACEs are divided into 10 categories that fall under the umbrellas of abuse, neglect, and household dysfunction. These experiences create toxic stress. Children with ongoing, unmitigated toxic stress develop patterns of adaptive and physiological disruptions that compromise health over the lifespan.

The term ACE has been in use since 1998, when U.S. not-for-profit healthcare consortium Kaiser Permanente published the results of its Adverse Childhood Experiences (ACE) Study, a joint research project with the Centers for Disease Control. This population-based study of more than 18,000 adults examined the connection between negative early experiences and adult health outcomes; it found that a higher level of exposure to intense childhood stress, triggered by ACEs, had a clear, dose-response relationship to an individual’s likelihood of developing physical, behavioural, and social problems in adulthood.

After the original ACE Study was completed, related research continued across the U.S., contributing to a growing body of knowledge about the effects of childhood stress. Two of the researchers instrumental in pioneering the ACE Study are members of the Alberta Family Wellness Initiative (AFWI) faculty. Watch them describe the origins of ACEs below. 

The ACE Questionnaire

The ACE Questionnaire was developed to assess an individual’s exposure to toxic stress during the first 18 years of life. The questionnaire asks participants about negative experiences related to abuse, neglect, and household dysfunction, and assigns participants an ACE score based on how many of these types of experiences they encountered. The higher the ACE score, the greater the risk for that individual to develop physical, social, and behavioural problems.

Delivering Better Care

For people already dealing with chronic health and social problems, an ACE score can help to determine what types of interventions and treatments will be most effective. Some adults with high ACE scores are the parents of young children. In this case, the ACE Questionnaire can determine intervention strategies that treat the parents while preventing their children from experiencing intergenerational abuse, neglect, and dysfunction. 

Increasingly, ACE screening is also used in pediatric settings. This allows practitioners to identify children experiencing, or at risk for, toxic stress, and to use integrated multi-disciplinary care models to address symptoms and sources. Early detection programs are designed to correct the course of development; they also contribute to the body of knowledge about mechanisms that link toxic stress to negative health outcomes.

Treatment, Not Diagnosis

The ACE Questionnaire should not be thought of as a diagnostic tool; some people with high ACE scores are nevertheless resilient, meaning they avoid negative outcomes, while some people with low ACE scores struggle with a range of health challenges in adulthood. The questionnaire isn’t designed to measure factors like genetic makeup, nor does it account for the presence of positive mitigating factors. Its purpose is to supply vital background information that helps practitioners when assessing individual patient needs. It also helps to feed the body of scientific knowledge about ACEs, which leads to better organizational and systemic decisions about healthcare practice, social and community services, education, justice, and policy.

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