Adverse Childhood Experiences (ACEs): What Have We Learned and What's Next?

Abstract

Childhood trauma research and practice have multidisciplinary origins and seek to identify, prevent, and mitigate maltreatment sources in childhood. Since the seminal 1998 Centers for Disease Control and Prevention-Kaiser Permanente Adverse Childhood Experiences study, the concepts of adverse and positive childhood experiences (ACEs and PCEs, respectively) have gained traction and interest. ACEs research has recently expanded to evaluate family and community sources of adversity. A lack of consensus on the operationalization and measurement of these constructs limits our understanding of their role (whether protective or risk factors) and utility for research or interventions. We review research on ACEs/PCEs and child development, adult health, and intergenerational outcomes, discuss their measurement, and provide an advanced conceptualization of ACEs/PCEs for public health. Use of the proposed expanded framework can aid researchers in elucidating the role of ACEs and PCEs across the life course in a contextually relevant manner. Researchers should consider contextual and sociocultural factors when developing and adapting instruments to measure ACEs/PCEs.