Inside the Adverse Childhood Experience Score: Strengths, Limitations, and Misapplications []


By Robert F. Anda, Laura E. Porter, David W. Brown, et al., American Journal of Preventive Medicine, March 25, 2020


Despite its usefulness in research and surveillance studies, the Adverse Childhood Experience (ACE) score is a relatively crude measure of cumulative childhood stress exposure that can vary widely from person to person. Unlike recognized public health screening measures, such as blood pressure or lipid levels that use measurement reference standards and cut points or thresholds for clinical decision making, the ACE score is not a standardized measure of childhood exposure to the biology of stress. The authors are concerned that ACE scores are being misappropriated as a screening or diagnostic tool to infer individual client risk and misapplied in treatment algorithms that inappropriately assign population-based risk for health outcomes from epidemiologic studies to individuals. Such assumptions ignore the limitations of the ACE score. Programs that promote the use of ACE scores in screening and treating individuals should receive the same rigorous and systematic review of the evidence of their effectiveness according to the standards applied to other screening programs by the U.S. Preventive Services Task Force (USPSTF).

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Thank you, Dr. Anda and colleagues. This important and serious critique of ACEs screening as done in California is a vitally important reminder that ACE measures are not meant to be applied to individuals but rather to populations. They can be particularly useful tools to inform public policies that address public health. ACEs research makes clear that childhood adversity is a major public health issue that needs to be tackled by policies that enhance community and individual resilience and prevent social conditions causing toxic stress.

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