What the new PACEs Science 101 misses

The new PACEs Science 101 provides a useful – but far too limited -- resource for training and teaching. It summarizes only part of the science of positive and adverse childhood experiences. Remember that the original ACE Study was an example of social epidemiology—the study of how social conditions, especially inequality—affect the distribution of disease in populations. Although the PACEs Science overview effectively brings in the neurobiology of stress to the study of adversity, it leaves out much of the social epidemiology and social science of positive and adverse childhood experiences that are at the heart of PACEs science.

By missing the social science and social epidemiology of PACEs, the overview does not effectively address a central goal of social epidemiology and the ACE Study—primary prevention. In the original article, Drs. Felitti, Anda and colleagues observed that: “Primary prevention of adverse childhood experiences has proven difficult and will ultimately require societal changes that improve the quality of family and household environments during childhood.” Since their writing in 1998, we have a much clearer idea about the policies and resources needed to make those societal changes, shaped by our understanding of the social determinants of health (https://health.gov/healthypeop...-determinants-health).

Many of those policies focus on supporting families with economic resources, access to affordable child-care, and family leave policies, for example. These policies do not suppose that adversity is confined to the poor but rather recognize that both adversity and positive childhood experiences are distributed inequitably. Achieving equity means highlighting and addressing inequities rather than playing them down.

An integrated social and natural science of PACEs goes well beyond PACEs Science 101 and includes nine elements that are elaborated in the attached pdf document, Toward An Integrated Science of PACEs:

1. The fundamental insights coming from the CDC-Kaiser Permanente ACE Study.
2. The brain science—the neurobiology of toxic stress—that helps explain the impact that childhood adversity can have on the brain and body.
3. The social science of PACEs that examines the interconnections between the neurobiology of toxic stress and the social and cultural circumstances of children and families. It acknowledges the presence of childhood adversity and positive childhood experiences at all income levels and in all social groups but emphasizes, at the same time, their unequal frequency across class, race, ethnicity and place.
4. The risks of negative developmental, physical, mental health and behavioral consequences of toxic stress caused by adversity for infants and children as well as adults.
5. Ways of preventing toxic stress and of overcoming its effects, especially by supporting positive childhood experiences and resilience building.
6. The basis for trauma-informed approaches that alter institutional and professional practices in order to provide support for individuals who have experienced childhood trauma as a result of adversity.
7. Lessons for designing social policies that reduce childhood adversity and promote positive childhood experiences. Reports from the CDC, the California Funders’ Group, Harvard Center on the Developing Child, and the National Academy of Science provide convergent recommendations.
8. Support for a common language to talk about adverse and positive childhood experiences and their effects on children and adults.
9. Encouragement of the careful and appropriate use and interpretation of data and evidence.