ND Review: Adverse childhood experiences

So what are adverse childhood experiences? and is there a test for it? There are many, in fact, this is an easy one to download and keep on your computer, while this is online and gives a scorein the end.

Points to ponder (downloadable form)

It is important to remember that these tests are old, American, and although they consider almost all types of adversity they give very limited scenarios where they expect that type of abuse to occur. Different test use slightly different wording to ensure that wider range of hypothetical situations can be included.

For example, in the form I shared:

  1. Question 1 does not account for just-enough neglect, i.e. a form of neglect where parents/caregivers do just enough to give an impression of being adequate, while being very neglectful, and very painfully so, in reality. There may also be other nuances of how neglectful a caregiver may be and the additional psychological effect of this toxic mind-game. This question also expects a person to make a judgement, yet in many cases a person may not consider their experience to be as described. Thinking “I shouldn’t have eaten because I was bad” can be considered neglect if it was given as an excuse, it is emotional abuse if it was used as punishment, and personally I would consider it also physical because it causes harm to the body.
  2. Question 2 in some questionnaires includes being abandoned specifying being adopted or entering the care system while others only ask about divorce. So, wording can affect the final score. The discontinuity of care is rather important according to Attachment Theory (even taking into account the criticsm that can be made of that theory, watch this space because there is a post coming!)
  3. Question 3, as a child one might not have known about the parent’s mental health, or be told, or could have been given other reasons for odd behaviour. Also, some questionnaire ask about any mental illness, while others specify depression. Again, the wording can affect scoring, especially for us auties!
  4. Interestingly, while Question 4 asks about parents taking drugs, there is no mention of a child being drugged/medicated maliciously/unnecessarily. I believe that should be considered physical abuse. Also, it is difficult to assess the damage that such tactics would have in the long run, especially in terms of being able to make sense of the past and of flashbacks to aid appropriate processing and recovering. We have found different degrees of consciousness affect memory, flashbacks, understanding, and processing.
  5. Similarly, Question 8 specifically asks about being physically hurt, while other questionnaires also consider restraints. Also, it must be remember that not all physical damage presents as bruises. Unexplained development of specific muscles and muscle groups can also identify some form of physical abuse.

So, without critiquing each question individually, it is possible to see how the wording of each specific question and the attitude of the questioner can make a great deal of difference in the final score.

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Image of a nerdy child writing with a quill in what looks like a medieval convent, light-hearted perspective

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We have identified above how the questions can be quite difficult to answer correctly. I have found that there is a fluctuation in my score between 5 and 7 depending on the wording. Usually the question of abandonment and the one about physical abuse can be contentious too.

Also, when doing an ACE test, we are usually dealing with what can be extremely traumatic experiences where dissociative amnesia might come into play. It seems that sexual abuse is especially pernicious causing many to forget it, or to remember it as their own fault.

Further, there are types of abuses, such as the one caused by ABA and methodologies/medication aimed at “correcting” behaviour that span all different classes of abuse and whose aggregate effects are not evaluated.

Finally, there are two additional types of abuse that are not being considered:

  1. Institutional betrayal. This can include any service and cause medical trauma, or specific institutionalisation related trauma.
  2. Spiritual abuse. In psychology there is increasingly an appreciation of the psycho-spiritual benefits of certain practices, so spiritual abuse should be recognised as a very destructive type of adverse childhood experiences,

To conclude, ACE scores are useful to give a general indication of minimum levels of toxic stress they endured, but it is in no way an appropriate method to assess a person’s emotional, mental, physical, and spiritual state.

Below is an infographic, because those things are quite nice!

Source: Ace and Toxic Stress FAQ