Adverse Childhood Experiences (ACEs): An Overview of Definitions, Measures, and Methods

In this chapter, we review definitional and measurement issues in the field of adverse childhood experiences (ACEs) and urge a shift toward using ACEs as a public health tool in the service of primordial prevention. We start with a review of the historical context of ACEs research and issues in defining and measuring abstract constructs like ACEs. We then summarize the results of a scoping review of 1300 ACEs articles published between 1999 and 2019. Results show that there is no scientific consensus on a clear, well-justified definition of ACEs or empirical evidence for using ACEs checklists as clinical tools for screening or treatment at the individual level. We provide quantitative evidence that the dominant narrative in this field starts with ACEs and ends with negative outcomes, with a disproportionate emphasis on how to address outcomes at the individual level rather than how to address the root causes of ACEs at the societal level. Holding individuals responsible for their problems and for taking action to address their own risk factors (i.e., privatizing risk) is not an effective way of addressing the roots of these risk factors and reducing leading causes of morbidity and mortality at the population level. Moving forward, we suggest that researchers define risk factors such as ACEs to be used as (1) public health, not clinical, tools, (2) mediators, not root causes, of health and health inequities at the population level, and (3) facilitators of upstream, not downstream, solutions to prevent adversities.