Conceptualizing and measuring childhood adversity: A comprehensive critique of the adverse childhood experiences measure and offering a new conceptualization of childhood adversity.

Abstract

The landmark adverse childhood experiences (ACEs) study conducted by Kaiser Permanente and the Centers for Disease Control shook the bedrock of the scientific community, highlighting the commonality of ACEs and identifying a dose-response relationship with poor health outcomes. The seminal findings led to a surge in ACEs research and a growing body of empirical literature; however, the ACEs measure has numerous conceptual and measurement issues that are often overlooked in the research. Such problems include a lack of a clear conceptual definition of what constitutes an ACE, item formulation and coverage, item scoring, and lack of contextual information. The current article aims to integrate existing critiques of the ACEs measure, extend critiques in greater detail, and proffer new ideas related to the conceptualization and study of ACEs. In preference to conceptualizing ACEs consistent with existing literature, we make a case that there are four unique and conceptually distinct subcategories of ACEs that should be conceptualized independently as individual adversities that frequently co-occur. We provide recommendations for researchers and discuss the utility of the ACEs measure as a screening tool. (PsycInfo Database Record (c) 2024 APA, all rights reserved).