Notebook

The Methodological Chaos of Adverse Childhood Experiences

By Rosalind Edwards

The methodologies behind evidence that policymakers and service providers can adopt as ‘magic bullets’ to solve social ills rarely get attention. One such bullet is the notion of Adverse Childhood Experiences (ACEs), which has been gathering speed as a basis for family policy and decision-making.  However, there are telling methodological and evidential drawbacks to ACEs, which seem to be left aside, particularly in terms of understanding and addressing the very real adversities that parents and children may face. Also, the varying definitions of what constitutes ACEs and different study designs for researching them mean that there’s no cohesive body of knowledge.

In terms of a definition, ACEs are an attempt to identify a set of traumatic conditions experienced before the age of 18, and to trace the combined ‘score’ (baldly, the number) of events in a simple causal manner through to the long-term damaged physical and mental health that these early experiences are said to create. Findings from studies using ACEs are regarded as rigorous ‘hard’ data for policy and decision-making; because they are quantitative they appear concrete and exact.

While statistical methods and evidence certainly have an important role to play in policy-making, the provisional and uncertain nature of quantitative social science in a complex and dynamic social world gets obscured in the rush to certainty. Weak measures, measurement error, missing data, and statistical significance cautions get swept aside. And yet they are evident in ACEs studies.

The need for caveats concerning ACEs evidence is compounded when the range of ‘inputs’ that are identified as adverse experiences are so ambiguous. For rigorous tracing of causal inputs through to effects, ACEs need to be a clearly defined set of experiences. And yet they lack cohesion in nature and extent. They encompass a shifting ragbag of possible abuses, dysfunction and extent of severity, timing and duration.

In standard ACEs inventories the boundaries between quite common family circumstances and abnormal experiences become blurred. For example, a ‘yes’ answer to ‘were your parents ever separated or divorced?’ is considered an ACE no matter whether it was amicable or adversarial, or occurred before the respondent was born, when a toddler, or age 17. Similarly the ACE criteria ‘living with anyone who was depressed, mentally ill or suicidal’ takes no account of who this is, for how long, and does not distinguish between the person feeling dejected and miserable or suffering clinical depression.

As the idea of ACEs gains popularity in policy and practice, the net is being cast more widely to add further situations to the standard inventories. The motley experiences reflect the agendas of the various agencies and researchers putting them forward. They include parental disability, mothers’ health, lack of childrearing routine, ‘inter-parental’ conflict, moving home, and violence involving a sibling or peer. The implication is that these different issues and the variety of combinations of them are comparable, underpinned by a common mechanism, rather than considering that different adversities may have different effects dependent on context.

There’s further chaos to the methodologies adopted by ACEs studies. Typical to a lot of research surveys into subjective wellbeing, there are retrospective studies subject to people’s recollections, and prospective longitudinal designs subject to the specificities of the temporal period they start from. There are different sources of information and assessment, from the subject of the ACEs themselves or a parent or a professional.

Whatever their methodology, though, what the vast majority of putative ACEs have in common is their narrow remit of consideration. They focus on and isolate the ‘household’ and in particular mother and child.

There’s no attention to the influence of subsequent experiences later in life in ameliorating or exacerbating the effects of stressful life events in childhood. And the concept and measurement of ACEs doesn’t capture confounding contextual issues that are beyond parental control or that can harm people emotionally and physically, such as being subject to racism/Islamophobia and misogyny. They don’t extent to contextual factors beyond the parent-child that may be harmful or mediating and supportive in the face of adversity.

In all, the methodological chaos of ACEs provides no indication of how best to intervene, can’t point to whether or not an intervention and of what type and when works, and can’t be used to predict individuals at risk. Yet it’s being implemented to drive policy and practice interventions.

Researchers investigating ACEs need to take care about claiming a body of knowledge in the face of chaotic definitions, and about the claims for certainty made in their findings about cause and effect. We have a duty to point out caveats clearly to policymakers and service providers. In turn, however tempting it may be to seize on a ‘magic bullet’ solution to social ills, policymakers and service providers need to be more cautious and questioning. And all need to widen their focus and concerns, to look outside narrow parent-child relations and address the adversities that poverty and prejudice pose for people’s mental and physical health.

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