By Dr Rebecca Lacey, October 29, 2019, ACAMH.

Rebecca Lacey is a Senior Research Fellow in life course social epidemiology in the Department of Epidemiology and Public Health at University College London. Her research interests lie in the long-term health effects of early life adversities and effects of social relationships on health using longitudinal population datasets.

When bad things happen to children, they can potentially have long lasting consequences throughout their lives – they often don’t do as well as their peers at school and work, in their family lives and their health may well be worse. There is no magic wand to stop bad things happening, but how we measure the impact of those bad things is absolutely key to helping these children fare better. In the last two decades huge weight has been given to Adverse Childhood Experience (ACE) scores – where the number of adversities that a person has experienced have been added up, but there are serious concerns about the uses of ACE scores in research, policy and practice.

Practitioners are urged to communicate messages about risk in a sensitive way which is not deterministic or stigmatising and does not conflate population level and individual level risk. We also urge caution around implementing routine enquiry, particularly on how data are used, the availability of evidence-based interventions and again messages about determinism, stigma and what is an ACE apply here. A focus on the structural ‘causes’ of ACEs is also warranted, particularly focusing on child poverty and inequality.

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