Is there an official list of ACEs aside from the original 10? This came up around a discussion about medical trauma, with one person hesitant to give it the formal term "ACE" because they weren't aware of any longitudinal studies about it. However, medical trauma is recognized by the National Child Traumatic Stress Network as a category of events that can cause pediatric traumatic stress. This journal article argues that there is currently no universal definition of childhood adversity and that one is needed.

So if there is no official list or definition of what can be considered an ACE, what parameters or criteria do you use to determine what is or isn't an ACE? 

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If we think of Dr. Shapiro's work on Big T and little t traumas, we can help people explore the subjective nature of classifying an event as traumatic. Further, thinking about concepts such as temperament and resilience further complicates the creation of a single list. One person's subjective experiencing of an event, could be significantly different than another's. Thus the difficulty in what constitutes an adverse experience.

While this may seem as an impediment, as a helper, I find it liberating. I don't have to concern myself with defining an ACE for my client, she can do the defining...and explore resolution.

Hope this helps...

Janie, I agree with Roberto - what is considered "traumatic" is defined by the individual and is impacted by many factors. I have seen Dr. Nadine Burke Harris explain that the original 10 ACEs are the ones that are most studied but that we have growing evidence that supports that any source of toxic stress - especially during key developmental periods - will have similar effects on the body's neurological, endocrine, and immune systems if the child does not have adequate buffering elements (resilience) in their lives.  

Thanks Vanessa. For additional data on ACEs, one can refer to the Philadelphia ACE Study, which incorporates additional questions that include inner city, gang violence, war, militia and other experiences. I have included these in a curriculum I co-authored with Dr. Stephanie Covington, an early pioneer helping women who've suffered trauma, titled Exploring Trauma: A Brief Intervention for Men.


I had a feeling that was the case. It seems that we may have to do some work shifting mindsets around this -- I think sometimes those of us who work in health care and public health are too attached to "evidence-based" ideas when there's not going to be a RCT or longitudinal study on every aspect of the subject because the scope of the issue so large. 

Janie Ginocchio, The World Health Organization's 'WHO ACE International Questionnaire' has a greater number of questions/scenarios of Adversities....and its available in over 100 languages on the WHO website. There used to be an icon on their 'home page', but that's changed. I believe Jane Stevens has the web address for the current version's location, or you can use the search function at WHO's homepage.... Hope it's helpful in availing a sequence of 'additional ACEs' for you ....

Last edited by Robert Olcott

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