Is There a Hole in the ACE study?

I’ve written before about the ACE studies and surveys, and if you’ve read those you know that I think everything about ACE scores needs to be taken with a grain of salt. However, until my wife shared this news article from her alma mater I had not noticed that the question about childhood sexual abuse is somewhat more specific than it should be. Apparently, Robyn Dolson noticed it too, and decided to use her thesis work investigating why, and how it impacts the results. In short, the question about sexual abuse refers to being abused by an adult or someone 5 years or older than you.

As many of us can attest, that leaves out quite a few survivors who were abused by someone in their peer, or a slightly older, group, which happens quite frequently.

“The findings were striking,” Dolson said. “We found a group of sexual abuse survivors were completely missed by the original ACE question because their abusers were less than five years older than them. Further, this group was nearly as large as the group of survivors who were identified by the original survey, and our missed group was at the same increased risk for poor health as those identified. In addition, for many survivors in our study, being able to answer ‘yes’ to this question without the ‘5-years or older’ requirement meant they did have an ACE score of 4, which had implications for their access to services.
Now, there’s a lot I want to unpack about her work, because some of the findings matter, and some of them are limited. But here’s a quick couple of thoughts:
  1. They only surveyed women for this new look at this question. That’s a little disappointing to me, and I hope it was just a matter of time and resources available, not  equating sexual abuse with only female victims. Even so, with women the number who now answered yes was nearly doubled when taking the abusers age out of the question. That means that maybe close to half of all sexual abuse victims are not being abused by adults or “creepy old men”. Have we really integrated that into our prevention and educational programs?
  2. If they had included men, would the results be similar, would it be a smaller group, or a larger group? It’s not scientific, but I know quite a few male sexual abuse victims who were abused by older minors, or by a group of peers.
  3. That last line quoted above, if the question was written based on nothing more than a theory about how kids were being abused, and it was keeping people from access to services because they “only” had a score of 3, should we reconsider why 4 is the magic number for help? Yes, we see a higher risk at 4 than we do for kids with less, but are we actually capturing all of the possible sources of trauma? Clearly, in this one question, we’ve missed a large group of people. Who else are we missing? Why would we prevent them from getting help based on one set of survey questions as if that was the complete picture of all childhood trauma?

Again, I refer you back to what I’ve written before:

Yes, childhood can set us up for an increased risk statistically. But we need to be careful how we interpret that and treat people. Our ability to get life or health insurance should not be based on this, for example. We shouldn’t be assuming someone with a high score is an addict, or is at risk for obesity.


That’s the thing about statistics and percentages. They can help guide us to ways to help more people, and recognize risk factors. But if I point you to one individual, they don’t really tell us much about that person.

In the case of something like the ACE surveys, clearly we can see the increased risks associated with numerous adverse childhood experiences. I think we can all agree with that as a fact. But how those experiences are identified specifically, and what exact risks will play out in each individual, are not that clear. Let’s use the ACE surveys to teach ourselves, and educate others about the impact childhood trauma has, generally, but let’s not get so hung up on exact numbers and factors for each individual. Clearly, we’ve been missing a lot of sexual abuse victims, and frankly, now that I see the actual wording of the question, it’s clear that sexual abuse was being looked at through one lens when the questions were drawn up. That lens needs updating.

If your lens only includes children being sexually abused by much older adults, you need to update your prescription too. That is not a remotely accurate portrayal of child sexual abuse. You’re missing a lot.

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