ACE study

A bit of controversy!

At university , quite a few years ago now ( I’m not over the hill I just have a better view than most) I had to submit a dissertation , I chose the effects of smoking and public policy,I thought it might be easy .Those were the days with only one carriage on the subway that was non smoking , smoking in restaurants and bars was the norm and non smoking sections of a coffee shop presumed that smoke could read and air wouldn’t move. A night out would provide you with smoky smelling clothes on the floor the next morning.

I worked like mad on this dissertation , spent public holidays in the library ( yes they used to be open) and personally handed it over to my professor, like I was handing him my first born child. A week later he handed it back for me to make changes , I was so gutted. He made an appointment to see me and told me how good my writing was ( obviously gone down hill from then) , I was so confused . I had laid it on thick about the horrors of smoking , I included a picture of the Marlborough Cowboy from the ads that died of lung cancer , I costed out a policy change …it was perfect. Then he told me ……you haven’t included the other side of the story , to prove you are right .So off I went to write up something I didn’t believe in , the research of how smoking is not connected to cancer and how freedom should allow smoking everywhere . This is the point of my post ( thank goodness there is a point I hear you cry), we need to look at the other side…….yep …the dark side.

I have seen websites about childhood trauma pointing people to a survey on their website , that they call the ACE score ,they usually title it something like ..” Find out if you have childhood trauma , take the test”. My blog , has now topped over 8,000 individuals in its first week ( I know right?) and I have thought about pinning it to mine . However , it’s not what Im about , it just didn’t feel right , I would rather people get their diagnosis from a medical expert than a quiz. Someone in my family has ADHD , I won’t tell you who , the hoops that we had to jump through to get them diagnosed , took about a year , so a quiz that gives you a score just seems a bit wrong.

To be fair I don’t think the ACE score was ever meant to be a definitive test , its crude , its not a standardised measure and its not a bit like going to get your blood pressure checked at the Drs or blood tests for that matter ( although admittedly its less painful). Standardised tests , have to go through many reviews and constant questions about their effectiveness . The ACE screening tool , is not really a diagnostic test but many professions are treating it as such.

The Test…..

Often called the CDC-kaiser Permanente adverse childhood experiences study ( I wonder why they shorten it to the ACE Test?). The original study was undertaken in 1995-97 in two waves of data collection. The data collected has never been made public .The CDC website describes the study as “One of the largest investigations of childhood abuse and neglect and household challenges and later life health and wellbeing ” ( is it just me or is there a lot of ‘and’s in that sentence?).

Its birth as an idea began in an Obesity clinic run at Kaiser , Dr Felitti was a specialist in preventative medicine , in around 1985 . He was puzzled by a large number of of regular drop outs, especially of successful weight loss l patients , from his treatment programme , leading to further investigation and face to face interviews . In the face to face interviews he seemed to be getting no answers to his drop out rate . He inadvertently asked a wrongly worded question leading to a patient revealing childhood abuse. This led to questions and similar abuse reports from other patients , to avoid possible bias he asked other colleagues to continue with the questions , they turned up with the same results. They interviewed 286 individuals , from the obesity clinic the majority reported abuse as a child , the eureka moment was realising that the obesity , the food they were eating was to deal with the real problem and that was …abuse. These women had been on a weight loss merry round , loosing weight , increasing their anxiety as they became thinner leading to putting on the weight again . They also reported the use of other coping behaviours such as smoking, drinking or drugs.

The questions had to be answered , was the conclusions in this small obesity clinic correct? San Diego was ideal for the meta study and it was decided to stay at Kaiser Permanente . A year of research and the study was ready for data , Dr Felitti teamed up with Dr Robert Anda from the CDC who also had a background in a similar field. They designed trauma related questions and focused for the first time on eight main types of childhood trauma , later increasing that to 10. The initial surveys began in 1995 to 1997 as we saw earlier, but participants were followed for more than 15 years after that, 17,421 participants data were used . Dr Anda sat at his computer at home in Atlanta , looking through his findings and in his words” I wept , I saw how much people had suffered and I wept”.

Poor

Before this study , abuse was known, but presumed to be a thing that affected poor people , those with low socioeconomic status, if you like …other people .This study of mainly white ( 84%) well educated in good health changed that . It was the first time researchers had looked at multiple types of trauma and proved a direct link to chronic disease , mental illness prison and issues effecting employment. They also proved that ACEs often happened in conjunction with another type of ACE and the more the number of ACEs the worse the outcome. To quantify the risk the ACE scoring system was developed by Anda and Felitti. No trauma and the score was zero , a score of over 4 and adverse effects are more significant. This research I think we can all agree was a life changing moment for childhood trauma survivors , it started to change everything , perhaps not as quickly as we might hope but the train has left the station…….

Now please get to the point !

I know Im getting there like a drunk man trying to get home , but we needed to know what the scoring system was before we knock it .

There is movement in society , society is starting to embrace the ACE study , here in the UK the opposition Labour Party has a plan for a trauma informed justice system , The Scottish and Welsh Governments are formulating their own ACE policies . Washington State was the first in the America to embrace the ACE study , Ace task forces are being set up across the globe . All this will cost money and much is based on that ACE score , so it better be good.

The trouble with a crude scoring system is this , an individual has a torrid time in their childhood with one type of abuse , they have an ACE score of 1 , you will be fine , but they are not . Another individual has some low level abuse for a short time , the abuse comes as four different types . I think we can agree any abuse is awful , but the second individual will score a 4 on the ACE scale and both will be given help based on that score. The trouble is that the ACE score was never designed to do this, it was designed to aid the research we looked at above , its unclear how its being used or by whom. It’s wonderful for looking at populations and the impact of childhood trauma on them , it’s a wonderful tool for policy makers , but not as a screening test to provide financial or medical support , or for putting on random websites, for that matter.

The conclusion, is that the ACE score is a fantastic scoring tool for the things it was designed for, but there is a concern it is being used for screening and is being used in areas it was not designed to be involved in .

I hope as ever you are all keeping well , thanks again for spending time on my site when there is so much content out there , it means a lot . See you soon

citations

Volume 2020
Number 43 Possibilities and Problems in Trauma-Based and Social Emotional Learning Programs

April 2020

Occasional Paper Series

Article 4

Trauma by Numbers: Warnings Against the Use of ACE Scores in Trauma-Informed Schools

Alex Winninghoff University of Georgia

020 Aug;59(2):293-295.

 doi: 10.1016/j.amepre.2020.01.009.Epub 2020 Mar 25.

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

Robert F Anda ¹, Laura E Porter ², David W Brown ³

Affiliations expand

• PMID: 32222260
• DOI: 10.1016/j.amepre.2020.01.009

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