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Could widespread screening for childhood adversity do more damage than good?

Could widespread screening for childhood adversity do more damage than good?

Picture of William Heisel

[This is the second of two posts. Find part 1 here — Eds.]

If you want to see for yourself what goes into the science on adverse childhood events, take an assessment yourself. You might be surprised at what you find.

At the core of the problem with reporting on ACEs is the screening survey. Or surveys, I should say. The original ACEs survey from the mid-1990s now has multiple versions in use. They all ask such broad questions that it could be easy to capture many people in one of the ACEs buckets. For example, if your parents separated or divorced before you were 18, you have at least one ACE.

If you take the screening survey that most closely hews to the original – as recently posted by NPR – you may find nothing that resembles the kind of childhood you had. Good for you. This means you have not experienced many of the traumas that a growing group of researchers now believe can lead to a range of health and other societal problems.

I took the test, though, and ended up with an ACEs score of five out of 10. That would be considered quite high in the ACEs community. Less than 9% of people have five or more ACEs, according to one report.

ACEsTooHigh, an ACEs news site popular with people interested in the topic, says that even scoring four out of 10 means you are much more likely to have a serious disease:

As your ACE score increases, so does the risk of disease, social and emotional problems. With an ACE score of 4 or more, things start getting serious. The likelihood of chronic pulmonary lung disease increases 390 percent; hepatitis, 240 percent; depression 460 percent; attempted suicide, 1,220 percent.

I must admit, when I first saw that number – five out of the 10 adverse childhood experiences – I nearly made an appointment with a physician. What might be lurking inside me that I haven’t bothered to uncover? High blood pressure? High blood sugar? Tumors?

In fact, it may be reckless to recommend that we push for more screening of childhood adversity. And this is exactly the problem with what I see in so many stories related to ACEs: When stories make bold claims about life expectancies being chopped by decades or the rates of serious chronic diseases skyrocketing for those with higher scores, they can create heightened anxiety without a real solution.

This is the kind of thinking that can be prompted by a simple screening with no support or services built around it. If I take a blood test and find out I have HIV, I can get treated and take precautions when having sex. If I am told that I have a high ACEs score, what can I do? We still don’t have a firm grasp on what interventions or therapies can unwind or mend the purported effects of childhood adversity and trauma.

“This raises the question: is it ethical or justified to screen for conditions when proper treatment cannot be assured?” writes University of New Hampshire sociologist David Finkelhor in a 2017 article in the journal Child Abuse & Neglect. “Moreover, until the intervention package is fairly well specified, it will be hard to disseminate any successful model with any fidelity. So referral of high ACE individuals to behavioral health providers may have benefit, but it is an extremely non-specific intervention that will be hard to build on systematically.”

In addition, if we try to take a step further back and consider ways to prevent ACEs, we enter more uncharted terrain, from a public health standpoint. One window into the state of the evidence around prevention is an analysis conducted by the U.S. Preventive Services Task Force and published in 2013. The task force focused on child maltreatment, which encompassed both active child abuse and child neglect. The task force concluded that there was not enough evidence for the benefits of preventive measures to curb childhood maltreatment to be able to make a recommendation, saying “that the evidence is insufficient to assess the balance of benefits and harms of interventions delivered in primary care to prevent child maltreatment.”

I encourage everyone to read the full piece by Finkelhor, and also to spend more time understanding what can and what cannot be explained by ACEs. As Finkelhor suggests, reducing traumatic experiences is a noble goal in and of itself.

We should be working to prevent spousal abuse.

We should be working to prevent childhood neglect.

We should be working to eliminate bullying in schools.

If ACEs are one more reason to work toward those goals, then they could prove a useful tool, but take care in how you write about the evidence underlying them so that you don’t create a unwanted side effect through your reporting. This is area where it’s easy to get ahead of the science, which is very much in progress.

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Related: Why we should think critically when reporting on childhood adversity

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