ACEs are important risk factors for ill health and prevention of ACEs is key. However, because people respond differently to childhood adversity, ACE scores do not determine an individual’s future health outcomes. Therefore, allocating health interventions based on ACE screening is likely to be ineffective in preventing poor health.Lead researcher Dr Jessie Baldwin, Wellcome Trust post-doctoral fellow at UCL and visiting researcher at KCL
28 January 2021
Screening for adverse childhood experiences (ACEs) has low accuracy for identifying individuals at high risk of developing mental and physical illnesses
New research from King’s College London suggests that screening people for adverse childhood experiences (ACEs) is not helpful to identify individuals at greatest risk for health problems later in life. A study published in JAMA Pediatrics shows that ACE screening had low accuracy in predicting mental and physical health problems at an individual level.
The ACE screening questionnaire assesses exposure to a variety of childhood adversities: physical, sexual and emotional abuse, emotional and physical neglect, domestic violence, parental substance abuse, mental illness and incarceration.
Because these experiences are associated with higher risk of health problems in the population, it is assumed that all individuals reporting a high number of ACEs will benefit from health interventions to reduce their risk of disease.
ACE screening is increasingly being used by doctors in the US (with a $160 million initiative in California), and is starting to influence NHS practice in parts of the UK.
However, some people are more resilient to childhood adversity than others, and there are many reasons beyond childhood adversity that may lead to health problems. Therefore, it was not known whether ACE screening can accurately identify individuals at risk of later physical and mental health problems.
The researchers tested this by studying two population-based cohort studies of nearly 3,000 people from the UK and New Zealand, assessed for ACEs and later mental and physical health problems as part of the E-Risk Study and Dunedin Study, respectively.
The results showed that on average, groups of people with higher ACE scores (indexing the number of adversities experienced) had greater risk of later mental and physical health problems.
However, ACE scores had poor accuracy in identifying individuals at risk of later mental and physical health problems. Predictive accuracy was similarly low when ACEs were assessed by asking parents to report on their children’s experiences, or through self-reports from adults.
Allocating interventions based on ACE scores alone is a risky strategy. Many people at risk of disease would be missed because they did not have high ACE scores. Others who have high ACE scores but low risk of developing disease would be offered unnecessary interventions. We must develop better prediction models to help identify risk of disease among individuals with adverse childhood experiences and offer helpful interventions.Senior researcher Professor Andrea Danese, from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London