The State of the Science on Adverse Childhood Experiences

The Adverse Childhood Experiences (ACEs) study was conducted to advance understanding of psychological trauma in early life as a possible determinant of adult health. In the past decade, there has been a movement to use the ACEs research questionnaire in a variety of clinical settings to screen individuals and assess their trauma score. But critics argue that the ACEs questionnaire was never intended to be used for individual-level screening, and even that harm can be done by using the questionnaire for this purpose. In the meantime, researchers have developed a protective factor questionnaire that they call the "Positive Childhood Experiences" (PCEs) survey that captures experiences that predict trauma resilience. The objective of this article is to explain the history of the ACEs questionnaire, the current controversy about its use for screening, the emergence of the concept of PCEs, and implications for occupational therapy practitioners and researchers.