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The ACEs campaign: cause for worry or celebration?

Everyone wants to help people who have been through childhood trauma, but is Scotland taking the right approach?

The ACEs campaign: cause for worry or celebration?

Everyone wants to help people who have been through childhood trauma, but is Scotland taking the right approach?

ACE-Aware Nation (sometimes known as the ACEs “movement”) has enjoyed significant attention in Scotland due to screenings around the country of a promotional film (Resilience) and a conference held in September 2018.

“ACE” stands for adverse childhood experience. Tes Scotland has recently published two pieces on the topic that offer a good summary of the emerging debate: Why I worry about the ACE-aware movement’s impact, by educational psychologist Whitney Barrett, and a response by consultant Suzanne Zeedyk, entitled: Childhood trauma: Why I celebrate the ACE-aware movement’s impact.

This begs the question: should we worry about ACEs or should we celebrate?

I aim to put forward something of a middle ground between these perspectives. I refer to the ACEs “campaign” as opposed to “movement”, as I believe this is more accurate. I identify elements of the campaign that are welcome, and others that should give cause for concern. I stop short of proposing a firm conclusion about the campaign. Instead, I suggest an alternative to the deficit-based lens of “adverse childhoods”, and a positive way forward for the campaign.

Should we worry or celebrate?

While it seems contradictory and even distasteful to celebrate anything to do with child abuse and trauma (or indeed to describe these experiences as “ace”), certain elements of the campaign deserve a cautious welcome. It has led to an additional focus on the long-term impact of childhood distress and trauma. It seeks to foreground the roles of love and compassion in childhood and in our relationships with children. It encourages practitioners to look beyond children’s “misbehaviour” and to consider instead that this might be a sign that they are struggling with something. For some people, ACEs represent a new way of understanding and talking about abuse. These contributions are important.

To come to a view on the ACEs campaign, I suggest considering the following:

  • The aims of the campaign;
  • The concepts used, especially adverse childhood experiences;
  • The “science” of ACEs;
  • The practice of ACEs “scoring”.

Aims

Organisations such as NSPCC have been working tirelessly for many years, as have many other organisations and professionals, in the areas of preventing abuse, supporting families, enabling children to speak out and researching the prevalence of abuse. Mobilising a group of supporters around these aims is welcome, but other than that, what precisely is the ACEs campaign contributing? Is it claiming that previous attempts have failed and that it is here to save the day, as Suzanne Zeedyk’s article seems to suggest? Or does it seek to build on what is already being done? Is the campaign claiming that its approaches are relevant universally to all children, regardless of context and personal histories? The main purpose seems to be about raising awareness, but what kind of awareness, and what should we DO with that awareness?

Concepts

The ACEs campaign is suddenly dominating discussions about childhood, adversity, abuse, neglect and trauma in Scotland. It is important to discuss these issues, but the usage of these terms should be specific and clear. The campaign risks conflating these concepts using the umbrella term of adverse childhood experiences. Referring to “adverse experiences” risks understating the horrors of abuse and neglect. It is abuse – why call it anything else? In addition, the term  risks suggesting that adversity of any kind is bad or traumatic. While abuse and neglect should always be considered fundamentally wrong, traumatic and preventable, the same cannot always be said for adversity. Everyone will experience adversity at some point and there is often strength and hope to be found in it. Our responses to adversity can nurture resilience and loving relationships while also defining our identities.

Science

The ACEs campaign raises awareness of important scientific studies, but it only cites studies that back up its claims. There is no recognition or discussion of the inherent contestability of ACEs research, especially the original ACEs study (Felitti et al, 1998). A select committee response detailing the problem with ACEs provides a critical summary from a social science (as opposed to medical) perspective, concluding that the “…further rolling out of the ACEs approach would be a very dangerous way to proceed” (Edwards et al, 2017). This may be frustrating for those looking for straightforward answers, but these are serious criticisms that cannot be brushed aside.

Scoring

The ACEs “scoring” tool (a checklist that provides an ACEs score between one and 10) is designed for population-level epidemiological research. It was never meant for use in clinical, educational or public settings. Nonetheless, the ACEs campaign appears to explicitly advocate its use without any obvious caveats. The promotional film Resilience shows rooms full of people calculating their “ACE score”, which involves thinking about whether they experienced abuse, neglect or “dysfunction” in childhood. There is little exploration of the extremely problematic ethics of this practice. The very act of asking people this question could be a source of trauma.

Asking children about this, without their consent, is completely unethical. It would force them to reflect on something that they might not even understand or remember. Assigning an ACE score to a child without their knowledge or participation is equally problematic. How would a practitioner know if their assessment is accurate or if the child agrees with it? What would happen with that information? This is a direct violation of children’s rights to privacy, consent and participation among others, and it risks perpetuating hierarchical adult-child relationships that can inadvertently lead to unjust or discriminatory practices (Davis et al, 2014).

Adults cannot simply “tell” children what their identities are or stand in paternalistic judgement about the adversity in their lives. The ACEs campaign should provide a clear message as to whether it endorses ACEs scoring – but it has not done so. I suspect this is because scoring is a fundamental part of the ACEs methodology and powerful proponents of the ACEs approach in the US support universal scoring and screening. There are also examples emerging of ACEs scoring being utilised in Scotland, which is very worrying. Even if scoring isn’t used, the campaign advocates that practitioners can and should make judgements about the quality of life experienced by children and families. This risks perpetuating a “blame and shame” culture that holds children and families completely responsible for their circumstances, leaving unjust social inequalities beyond challenge.

At best, these worries are symptomatic of a series of mistakes, for which the ACEs campaign can be forgiven. It is easy to mistake the emperor’s new clothes for a silver bullet. Jumping on a bandwagon out of desperation for solutions to intractable problems is entirely understandable. However, there are deliberate and calculating attempts to circumvent critique by promoting a campaign using “common-sense” language of relationships and cuddles, gaining support (practical, financial or political) and creating a profitable “ACEs industry” in Scotland. My hope is that the former explanation is closer to the truth and that the campaign is listening and reconsidering its message.

Hopeful childhoods

What would happen if we were to turn this discourse on its head by talking about “hopeful childhoods” instead of “adverse childhoods”? Could we take a positive and affirmative stance, coming from a place of love and hope as opposed to fear and adversity? This is not to say that we should ignore childhood adversity or deny that it exists. Many children experience adversity, but their childhoods and lives do not necessarily need to be defined by it. Empathy, love, compassion and social justice should not be situated within a context of adversity and anger. This only serves to undermine and debase these precious principles. Doing so does not make us more “aware”, it blinds us to more hopeful alternatives. Instead of starting an angry battle cry of “we have to do something!”, we can subtly shift our thinking to a stronger and more hopeful perspective of something can be done.

A way forward?

If promoters of the ACEs campaign were willing to recognise and discuss critical perspectives on these issues, that would be worth celebrating. We all want the same thing, after all, which is to prevent harm coming to children, to improve their circumstances, to establish trust and loving relationships. In doing so, we should consider the possibility of unintended and potentially harmful consequences of evangelical campaigning.

I would like to suggest two things that could start a productive dialogue. Firstly, we could recognise the practices that are currently working for children and build on the strengths of those endeavours. Secondly, we could recognise that children have complex views of social justice and adversity, and that their perspectives should be front and centre of any discussion about childhood – adverse, hopeful or otherwise (Davis et al, 2014).

Gary Walsh is a PhD researcher at the University of Glasgow School of Education

References

Davis, J, Hill, L, Tisdall, K, Cairns, L, McCausland, S (2014), “Social justice, the common weal and children and young people in Scotland”, The Jimmy Reid Foundation

Edwards, R, Gillies, V, Lee, E, Macvarish, J, White, S, Wastell, D (2017), “The Problem with ACEs”, submission to the House of Commons Science and Technology Select Committee inquiry into the evidence-base for early years intervention (EY10039)

Felitti, VJ, Anda, RF, Nordenberg, D, Williamson, DF, Spitz, AM, Edwards, V, Koss, MP and Marks, JS (1998), "Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study", American Journal of Preventive Medicine, vol. 14, no. 4, pp. 245-258

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