A February, 2020 report by the Early Intervention Foundation in London provides an excellent view of Adverse childhood experiences: What we know, what we don't know, and what should happen next (https://www.eif.org.uk/files/i...ces-key-messages.jpg ).  The report reminds us that although higher numbers of ACEs increase the likelihood of negative health outcomes in adulthood, the absolute size of the increased risk may be small. For example, in the original ACE research, intravenous drug use was10 times higher for those with 4 as  compared to 0 ACEs. But the actual odds increased from .3% to 3.5%. Over 96% of those with 4 ACEs never report using intravenous drugs (p. 10).

“A focus on the original 10 ACEs to the exclusion of other factors risks missing people who also need help. Many other negative circumstances in childhood are also associated with poor adult outcomes. These circumstances include economic disadvantage, discrimination, peer victimisation, low birth weight and child disability. For example, studies show that low family income may be a stronger predictor of poor physical health outcomes than many of the original ACE categories.” (p. 4)

“[I]ndividual risk is determined by a wide variety of factors not easily measured, including resilience and genetic inheritance. For these reasons, we believe that an ACE score, whether it includes 10 or 20 categories, is not the best method for predicting the ways in which negative experiences affect the development of an individual child.” (p.59)

The bottom lines:

• ACE scores often overpredict negative health outcomes;
• ACE scores are less important than low household income in predicting many health and behavioral issues of adults and children;
• Even enhanced ACE measures are poor predictors of developmental issues of children, making ACE screening problematic.