and We forget at our peril that equally (?more) important is the positive presence of good things, the importance of assets, single anchoring relationship, its not what happened to you but how you have managed to process what has happened – quality of relationships it the key buffer. Females and several racial/ethnic minority groups were at greater risk for experiencing 4 or more ACEs. There are events not identified in the ACEs research which will impact in the same way. He brings together brain development, early years, trauma and ACEs research and the key protective factor being the quality of relationships, particularly in the first year of life, and why we need to be careful in how we offer support in the aftermath of traumatic events. The ACE Study –probably the most important public health study many people do not know about –had its origins in an obesity clinic on a quiet street in San Diego. Adverse childhood experiences (ACEs) have emerged as a major research theme. Turner, Niall Can lead to medicalisation of social construct & There is often enthusiasm as an answer to all social ills. Nobody arguing otherwise. Usage data cannot currently be displayed. * Views captured on Cambridge Core between . we really need to focus on the 0 ‑ 2 age range to make the most difference. Specifically, the ACE Study model relies strongly on the idea that adverse childhood experiences create a burden of psychological stress that changes behavior, cognitions, emotions, and physical functions in ways that promote subsequent health problems and illness. It’s toxic stress that matters and how this cumulated over time; and the long term impact of this. Keith, Scott W. Published online by Cambridge University Press: URL: /core/journals/social-policy-and-society. As with many simplified concepts, ACEs present limitations. A critique of the critique, Implementing well being into all policies. Research in this space can be obscuring cause and effect, confounding, random variation. Of course there is Potential for a narrow conceptualisation of social problems. Email your librarian or administrator to recommend adding this journal to your organisation's collection. ACEs is an explanatory factor at cohort level. ( Log Out /  Davies, Mike As the ACEs concept becomes popular in the context of policy interventions, concerns have emerged. The ACEs evidence base for interventions has limitations that have not been fully addressed. ACEs have a dose-response relationship with many health problems. ( Log Out /  It is structured around three themes – framing, research, implementation with some of the common criticisms I hear in each of those themes. 2020. From a public health perspective, ACEs are useful for describing the need to act upon complex social environments to prevent health inequalities at a population level. Many people do not realize that exposure to ACEs is associated with increased risk for health problems across the lifespan. See here for one of the papers. and I’m no fan of the enthusiasm for “counting and scoring”. 2020. Most are not only rigidly sticking to what ACEs were identified in the original studies. In that study, “ACEs” referred to three specific kinds of adversity children faced in the home environment—various forms of physical and emotional abuse, neglect, and household dysfunction. Bevilacqua, Leonardo ‘The Problem with ACEs’. The same issues are inherent in many other concepts that are framed as big threats. included the ACE Study questionnaires as an addendum to the document Preventing Child Maltreatment: A Guide to Taking Action and Generating Evidence. Ward, Mark These relationships suggest adverse childhoods may inhibit social movement and trap successive family generations in poverty. Fill in your details below or click an icon to log in: You are commenting using your account. The ACE framework is relatively narrow, it only covers certain events, Of course. This is a welcome addition as a mediation between the polarity in the debate around aces. Pinto Pereira, Snehal M. There’s plenty of biological plausibility and real world observational evidence. Bruce also challenges the narrow concept of how ACEs research is being used in a very clear way based on the neuro-science. ACEs explains population risk, not individual stories, ACE is the risk factor, and was always supposed to be a risk factor way of thinking about the world, or a framework for research agenda, rather than something around which to design services. Its an explanatory factor not a diagnosis. Adverse childhood experiences (ACEs) have emerged as a major research theme. A 45-year prospective epidemiologic study, Adverse childhood experiences and adult risk factors for age-related disease depression, inflammation, and clustering of metabolic risk markers, Archives of Pediatrics and Adolescent Medicine, Insights into causal pathways for ischemic heart disease: adverse childhood experiences study, Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study, The impact of adverse childhood experiences on health problems: evidence from four birth cohorts dating back to 1900, The condition of the working class in England, Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. ACEs is well intentioned but problematic model. I’m aware it may get me into hot territory. Darra, Susanne ( Log Out /  Nothing new here, nothing special to ACEs on this one. LaNoue, Marianna D. Science overwhelming! There are plenty of opportunities for “better”, some of which we are capitalising on, some we are not. D Howe, Laura nobody saying there are magic bullets inherent in a response to ACEs and nobody is over simplifying this. They make reference to an array of potentially harmful exposures occurring from birth to eighteen years of age and may be involved in the construction of health inequalities over the lifecourse. Minnis, Helen Ward, Michael R.M. Again, all valid. Agree. This video from Bruce Perry on ACEs, brain development, trauma and importance of relationship, early years and trauma debriefing is worth a watch. Abstract views reflect the number of visits to the article landing page. ( Log Out /  Tell me a model that isn’t problematic. Change ), You are commenting using your Facebook account. Of the ACE study participants who experienced one ACE category, 87 percent experienced others and over 50 percent experienced four or more. 5. We do misconstrue epidemiological and direct clinical evidence, that is different. Kelly, Yvonne Iob, Eleonora The criticism comes from several perspectives, often well founded. To draw out some of the learning gained from this research over the past decade 3. 22 Among the hypothesized pathways, adverse childhood experiences lead to depression and posttraumatic stress disorder, which in turn can … Some frame ACE as a diagnostic tool, or a diagnostic label. People being critical of the ACE framework seems increasingly common. 3. 1. Although we were unable to identify many studies that specifically identified ACEs as a reason for poor attainment and other educational outcomes, this may be due to the methodological difficulties associated with controlling for … There’s a risk that this document may be seen to perpetuate a model of evidence rooted in individuals and not structural determinants. 12 December 2017. Change ), on the problem with ACEs. and Kelly-Irving, Michelle Check if you have access via personal or institutional login, Measuring childhood adversity in life course cardiovascular research: a systematic review, Infant mortality, chidhood nutrition, and ischaemic heart disease in England and Wales, Adverse childhood experiences are associated with the risk of lung cancer: a prospective cohort study, Adverse childhood experiences and the risk of depressive disorders in adulthood, Does the influence of childhood adversity on psychopathology persist across the lifecourse? Of course early years matter, primary, secondary and tertiary prevention. However the framework and thinking that ACEs can give us can certainly open up new responses to (and reasons for) improving our primary prevention and improving resilience and our response across multiple settings and across a whole life course. and I don’t think anyone is actually doing this medicalisation in practice, not what I see. This is tricky. While ACEs are found across the population, there is more risk of experiencing ACEs in areas of higher deprivation.