What's Your Story?

Sharing – The ACEs Questionnaire Is Missing These Types of Trauma

I’ve written before about the ACE study and its limitations. Monika writes in more detail, starting with this quote and then continuing on to identify the kinds of trauma that no one was even asking yet when they developed the study and the questions being asked about trauma.

While the ACEs Study revolutionized the ways in which the medical community viewed the impact of trauma on wellness thereby emphasizing the need for mental health care and better education about trauma amongst those involved with childcare of any kind, there are some limitations to the study and the inventory that need to be addressed in order for the true nature of the impact of trauma during childhood upon health later in life to be adequately understood.

It is a start. It should never be considered the final be-all-end-all of defining trauma and the impacts it has. As Monika mentions, none of the ACE questions is looking for trauma in the form of racism, poverty, homophobia or a number of other experiences that we know are traumatizing. The original study just wasn’t looking at that, so the current ACE score might be seriously underestimating the amount of trauma someone might be carrying from their childhood.

Does that make the whole ACE thing bad? No, not at all. This information has raised the awareness of how childhood trauma can impact adult health outcomes. That is a huge step forward in treating the whole person, their trauma experiences included.

On the flip side of that, we also have to recognize that we all deal with trauma differently. As I have said before:

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.

Is that one person with a high score part of the 50.7% who may be dealing with depression, or the 49.3% that isn’t? Is the person who scores a zero at no risk for suicide attempt or addiction? Obviously, no. There are an infinite number of possibilities when it comes to one person. The statistics don’t mean much. We’d do well to remember that as we start building AI and big data risk models.

Just to give you an example. My ACE score would be in the 4 or more category. I would answer in the positive to 2 of the 10 “bad outcome” categories above. Even before I spent time in therapy and got help with my trauma, I would have only answered in the positive to 3. (I haven’t been depressed this year, I would have been that year.)

This doesn’t represent my individual fate. It doesn’t represent yours.

It does, however, represent a chance to help lower the prevalence of these things across an entire population. For that, we need to use them to encourage more resources for prevention, right alongside more resources for research and treatment options that have nothing to do with ACEs. We can do a lot more, for everyone.

When I think about Monika’s point, and my own look at the numbers, I repeat what I said back then, when looking at one individual, the ACE survey is never the whole story. There are lots of childhood experiences that go unaccounted for, there are individual levels of resilience that are not accounted for, and there are early interventions that are not considered. One traumatic experience equals one traumatic experience in the final number, regardless of whether that experience was immediately followed up with support and maybe even therapy, or if it was ignored and maybe even repeated. There are numerous factors beyond simply answering more than 4 questions yes and assuming you’re an addict, or not answering enough questions yes and assuming you aren’t. It is much more complicated than that.

The ACE information is important though because it points us back to that childhood trauma and says “what happened to you?” when treating an individual for depression, or addiction, so that we can include that in our healing. What we want to be careful with is turning it into a blunt instrument when there is still so much not being accounted for within it.


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