Practitioner Review: Twenty years of research with adverse childhood experience scores – Advantages, disadvantages and applications to practice
The UK Trauma Council
Tuesday, February 23, 2021
In their practitioner review, Lacey and Minnis consider the strengths and limitations of adverse childhood experience (ACE) scores – an increasingly common and influential approach for measuring childhood adversity in public policy, research and clinical practice.
- Lacey, R. E., & Minnis, H.
- Journal of Child Psychology and Psychiatry (2020)
The strength of this approach, according to the authors, lies in its wide availability, uncomplicated administration and simple understanding of the scores. Moreover, this tool has increased awareness of the link between early adversity and increased risk of a wide range of mental and physical health problems. However, the authors also highlight a number of limitations.
For example, ACE scores are largely reliant on retrospective reports, which are likely to be biased/unreliable, and assume that each subtype of early adversity has the same association with later outcomes. Also, ACE screening measures do not consider the specific patterning of ACEs (e.g. which adversities co-occur) and overall there is an unclear rationale, according to the authors, for why the 10 original ACEs categories were selected.
This is perhaps linked to the lack of an internationally agreed definition of early adversity which then leads to a lack of consistency in the items used in different ACE screening questionnaires.
The review also highlights key messages for practitioners and identifies areas for future research. These include the need for longitudinal studies (with high quality prospective ACEs data) to examine the impact of ACEs’ co-occurrence, timing, frequency, duration and severity.
The review also warns against deterministic and possibly stigmatising messages in clinical, public policy and public health settings. These, in the authors’ view, can occur especially when inaccurate and insensitive communication takes place in relation to risk/resilience and causation versus correlation.
Finally, the review highlights the need for a broader focus on the structural “causes” of ACEs, especially on issues such as poverty and inequality.
- Research Round Up Q1-2|2020, UKTC
Association of Childhood Maltreatment With Interpersonal Distance and Social Touch Preferences in Adulthood
- Maier, A., Gieling, C., Heinen-Ludwig, L., Stefan, V., Schultz, J., Güntürkün, O., … Scheele, D.
- American Journal of Psychiatry (2020)
Childhood maltreatment is associated with an increased frequency and severity of interpersonal problems in adulthood. This has been proposed as a possible mediating factor between early adversity and later increased risk of mental health problems.
In this investigation, Maier and colleagues examined whether alterations in interpersonal distance preference and the processing of social touch may underpin maltreatment-related maladaptive interpersonal behaviour. In total, 92 adults with low, medium, and high levels of childhood maltreatment exposure were tested with an interpersonal distance paradigm and a social touch functional magnetic resonance imaging (fMRI) task during which they rated the perceived comfort of slow/affective touch (i.e. 5 cm/s) and fast/discriminative touch (20 cm/s).
Individuals with more severe childhood maltreatment scores preferred larger interpersonal distance and experienced fast touch as less comforting compared with participants with no or moderate childhood maltreatment experiences. At the neural level, differences were observed in the right somatosensory and posterior insular cortex, which correlated with lower comfort ratings. This may reflect increased salience detection, or how the brain tells you what you should pay attention to, and a motor preparation, or how the brain prepares your body to move to initiate a flight/fight response.
Moreover, severe childhood maltreatment was also associated with decreased activation in the right hippocampus in response to slow/affective touch which may reflect finding less comfort in gentle touch. In summary, childhood maltreatment was associated with a preference for a larger interpersonal distance and a tendency to experience fast touch as less comforting.
- Research Round Up Q1-2|2020, UKTC
Objective and subjective experiences of child maltreatment and their relationships with psychopathology
- Danese, A., & Widom, C. S.
- Nature Human Behaviour (2020)
Recent evidence suggests that subjective (e.g. self-reports) and objective (e.g. court-based evidence, social services/police investigations) measures of childhood maltreatment show poor agreement.
However, it remains unclear whether the association between childhood maltreatment and future mental health difficulties varies depending on how childhood abuse and neglect is measured.
To address this issue, Danese and Widom explored data from a longitudinal cohort of hundreds of children with both objective court-based evidence of maltreatment and subjective self-reports in adulthood.
They found that objective measures of childhood maltreatment alone did not heighten an individual’s risk of future mental health difficulties. Instead, the risk was heightened for adults who self-reported experiences of childhood and neglect.
In other words, these findings suggest that an increased risk of mental health difficulties may be more strongly linked to the subjective recall of abuse and neglect rather than their objective appraisal.
- Research Round Up Q3|2020, UKTC
The UK Trauma Council (UKTC) creates evidence-based resources to improve professionals and carers’ understanding of the nature and impact of trauma. The council is made up of a group of leading experts from a variety of disciplines representing children’s health and wellbeing organisations and hosted by the Anna Freud Centre. It aims to better equip all those supporting children and young people exposed to trauma.
The UKTC produces a quarterly research round up series to bridge the gap between academic researchers and busy professionals. These brief summaries are drawn from UKTC research briefings published in 2020. They are licensed under CC-BY-NC-ND 3.0.
