A Critical Assessment of the Adverse Childhood Experiences Study at 20 Years

URL: https://www.sciencedirect.com/science/article/pii/S0749379718323584?dgcid=author

June 2019
This year marks the 20th anniversary of publication in this journal of the first of many articles on the adverse childhood experiences (ACEs) research by Drs. Felitti, Anda, and colleagues.1 As we celebrate the impact of this seminal research, it is also imperative to assess critically its serious limitations: an unrepresentative study population and narrow operationalization of childhood adversity lead to undercounting adverse experiences and misrepresenting their social distribution. Placing ACEs research—and the movement it has generated—in the wider contexts provided by the social determinants of health framework,2 and by the rapidly growing biology and neuroscience of early childhood adversity,3, 4, 5 can enrich ACEs research and extend its impact to shaping primary prevention policies that address social and economic conditions producing adversity.