This blog is based on an article in Social Policy and Society. To access the article click here.
The term Adverse Childhood Experiences – more popularly known as ACEs – refers to abuse and household stress. The idea has increasing traction as the way forward for policy and practice in the childhood, family and public health fields, ostensibly providing both an explanation for problems and an indicator for preventive intervention.
But there are problems with the assumptions, methodology and implications of ACEs as a guide for policy development, professional training and practice interventions for child protection. Challenges to the notion include its inconsistent measures and extrapolations, and a focus on intra-familial relations at the expense of material and social deprivation and inequalities.
The formulation of ACEs
A set of social indicators, the ACEs protocol attempts to link adverse experiences of abuse and household dysfunction in childhood or youth to later disease and health risk behaviour. ACE inventories can include being verbally abused by parents, living with a problem drinker or mental illness in the household, neglect, and feeling unloved. Four ACE experiences before the age of 18 are said to form a critical ‘dose’ for poor outcomes in adulthood.
There are attempts to develop ‘tickbox’ protocols for use in the fields of public health, social work, education and policing. The aim is to generate individual ACE scores and to make algorithmic-based decisions about who is at risk, how to target resources, and when and how to intervene. Specific families with children deemed to be at risk are then targeted for early intervention, with the intention of preventing damage and disadvantage, or at least stopping it in its tracks.
The ACEs ‘hard data’ is regarded as a firm base for policy and decision-making. This is especially the case for the increasingly interventionist UK context, prioritising precautionary action in child protection to pre-empt possible future harms. But there are some fundamental problems in treating ACEs as a rigorous and definitive guide.
Unstable knowledge base
ACEs form a chaotic and unstable knowledge base. This leads to problems with the explanatory weight that can be placed on ACEs. For rigorous tracing of causal inputs through to effects, ACEs need to be a clearly defined set of experiences. But the various definitions of ACEs do not form a cohesive body of definitive evidence and measurement. Rather they are a shifting range of possible abuses and dysfunctions with inconsistencies in claims about severity, timing and duration. For instance, common family circumstances such as parents’ divorce or separation, whether amicable or occurring when a child is 7 months or 17 years old, are given the same ACE dose weighting as exposure to domestic violence.
This chaotic approach leads a great deal of overclaiming, often with over extrapolations from small effect sizes. And there is no attention to the influence of subsequent ameliorating or exacerbating influences, such as extended family support networks or being subject to racism and hate crime.
Ignoring social deprivation
ACEs have the effect of diverting legitimate attention from adverse environments. They locate a variety of social ills within the child’s home, family and parenting behaviours. Interventions, which are frequently franchised ‘slices’ of particular models, are predominantly directed at mothers as primary attachment figures for children – either as a cause of their children’s ACEs, or as a buffer against, and solution to them. The conditions under which mothers bring up their children are skated around.
The ACEs approach focuses on intra-familial relations at the expense of considering poverty and hardship as causal in poor health and education outcomes. Because the ACE framework prioritises risk, it obscures the material and social conditions of people’s lives. Poverty is separated out from other childhood adversities and reframed as an outcome of ACEs – ACEs as causing and explaining inequality. The long-recognised relationship between child poverty, poor health, lower educational attainment and reduced life expectancy is concealed by alleged ACE causal pathways.
ACE studies and protocols cannot provide an indication of how best to intervene, or point to whether or not an intervention, of what type and when, works. Sensitivity to biographies and traumatic experiences in services, particularly those addressing mental health needs or the criminal justice systems, is obviously to be welcomed. However, ACEs form a poor body of evidence for family policy and decision-making about child protection. Coupled with the chronic lack of services and family support in the UK, it is unclear what purpose producing individual ACE scores serves save perhaps to warrant rationing decisions.
About the authors
Rosalind Edwards is Professor of Sociology at the University of Southampton. She is a co-author of Challenging the Politics of Early Intervention: Who’s Saving Children and Why (Policy Press, 2017). Rosalind tweets at @RosEdwards2 and can be emailed at firstname.lastname@example.org.
Sue White is Professor of Social Work at the University of Sheffield. She is a co-author of Blinded by Science: Social Implications of Neuroscience and Epigenetics (Policy Press, 2017). Sue tweets at @ProfSueWhite and can be emailed at email@example.com.
Val Gillies is Professor of Social Policy and Criminology at the University of Westminster. She is a co-author of Challenging the Politics of Early Intervention: Who’s Saving Children and Why (Policy Press, 2017). Val tweets at @ValGillies and can be emailed at firstname.lastname@example.org.
David Wastell is Emeritus Professor at Nottingham University Business School. He is a co-author of Blinded by Science: Social Implications of Neuroscience and Epigenetics (Policy Press, 2017). Dave tweets at @ProfDaveWastell and can be emailed at email@example.com.