Using the ACE Score As a Guide – Not a Diagnosis
Using the ACE score as a guide and not a diagnosis is critical. ACEs (Adverse Childhood Experiences) refers to traumatic incidents in childhood and were identified in the epidemiological CDC-Kaiser Adverse Childhood Experiences Study (ACE Study).
Using the ACEs Score as a Guide is helpful, but not when it’s used a simply a number with diagnosis following from there.
This study of 17,000 participants looked at how 10 types of childhood trauma (ACEs) affect long-term health. These include: physical, emotional and sexual abuse; physical and emotional neglect; living with a family member who’s addicted to alcohol or other substances, or who’s depressed or has other mental illnesses; experiencing parental divorce or separation; having a family member who’s incarcerated; and witnessing a mother being abused.
Why Using the ACE Score As a Guide is So Important
The “not a diagnosis is critical” portion of this blog topic has to do with how the ACEs 10 question questionnaire score is used. And to address this all important concern, I invite you to watch the 23 minute video I share below, created by one of the ACE Study co-principles, Dr. Robert Anda. I URGE you to watch it.
Why?
Because the ACE Score is NOT a diagnostic tool in and of itself. And treating it as such can have grave consequences like those shared by Sirena Wheeler in her post for PACESConnection titled, “Erasing My ACEs,”
The new doctor greeted me cheerfully when entering the room, smiled while hearing what brought me in, and efficiently told me she’d have me fixed, back up and running in no time. And then, this appointment changed to reflect many of my recent interactions with healthcare professionals. She opened my medical record, and scanned the contents for any particular warnings and red flags. She paused, noting my ACE score. I watched as her expression darkened, and she seemed to bank all the hope she’d had for me to a reserve for other patients. The mood of the room became somber, with, “I see you have an ACE score,” setting the tone. Setting me up. The quick, assured solutions offered to me just moments before evaporated, leaving a bare recognition that I am a long-suffering human, who is just suffering a little more in a particular area at the moment. No future, only a product of my past. The quick change in direction was brushed aside with a murmur of explanation stating, “You may not respond to therapies as well as other patients.” I was handed a far less expensive, but more difficult to endure treatment, and told that there would be no further ‘care’ offered at this practice if I did not fully comply. My questions about follow-up were ignored. And then, the door closed. Like others had before, after re-traumatizing me through grilling questions about my street drug use, my latest suicide attempts, if I was being honest with a psychiatrist, and whether I had sexual partners outside of my marriage. Nothing in my personal record pointed towards these interrogations, they were a product of my physicians’ bias. Answering in the negative was met with skepticism that meant I wasn’t believed. It was hinted that answering in the positive would only allow the physician to pass more responsibility for my care on to others in my medical team because the lifestyle complexities meant that it was “not their department.” Crestfallen, with no offer of support, I alone was responsible for the coordinating of my care.
Dr. Robert Anda, “Inside the ACE Score: Strengths, Limitations and Misapplications”
Dr. Robert Anda provides a concise overview of the ACE Study and study findings and the important cautions for its uses in this short video.
Not to Say Using It Isn’t Important
I know from personal experience and the experiences of those with whom I’ve worked over the years, learning about the ACE Study and completing the ACE questionnaire provides some profound “ah ha” moments and insights. It and learning about the resulting science on the ACEs-toxic stress connection explains so much. This, in turn, frees a person to find ways to do things differently, as I’ve shared in my post, “The Legacy of Untreated Secondhand Drinking-Related ACEs.”
But as Dr. Anda cautions in this video, and as Sirena Wheeler’s story shows, when used simply as a diagnostic tool, it can do far more harm than good.
Lisa Frederiksen
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