Dr Alan Meehan Finally, then, to some of  the “Current Issues in ACE Research.” So,   the topic of ACEs has become an area of increased  focus and debate in recent years. However,   the way that ACEs are defined or thought  about during some of the discussions that   have been had in recent years, does not always  reflect the progress that’s been made in ACEs   research since it was first  defined over 25 years ago. In particular, a range of other adversities,  beyond the ten original ACEs that I described   earlier, have now been linked with adverse  experiences and adverse health outcomes in   young people. And most notable examples  of these include peer victimisation,   community violence and discrimination. And like  the original ten ACEs, these experiences have also   been linked with poor health and in some studies,  these additional adversities appear to be more   strongly linked with unfavourable life  outcomes than some of the original ACEs. So,   Researchers have started to consider  whether the original ACE framework,   as it was originally defined, needs to be  updated or expanded to reflect this wider   pool of adversities that are also associated  with negative health outcomes in adulthood. Also, up to now, when a person’s history of  adversity has been measured in a clinical setting,   it’s usually done using an ACE questionnaire. And  as part of this, patients are asked whether or not   they’ve ever experienced each of the ten main ACEs  and then, the number of different ACE categories   they report experiencing is added up to – into a  total ACE score, which ranges from zero to ten. Now, although the simplicity of that scale makes  it pretty easy for Clinicians to administer and   to understand, many have argued that this way  of measuring ACEs doesn’t really fully capture   each individual’s unique experience of adversity.  So, for example, the typical ACE score does not   tell us anything about the frequency or the  number of times a particular ACE occurred,   the duration of each adversity and also, the  timing in terms of when in a young person’s   life the ACE occurred. So, all of those factors  might influence an individual’s specific level of   vulnerability or resilience to childhood adversity  and as a result, there’s been some debate about   whether more detailed, nuanced assessments  of ACEs are needed in clinical practice. As part of those efforts in public health  and in clinical services to identify ACEs,   some Clinicians and Researchers,  particularly in the United States   and the UK, have recommended universal ACE  screening within frontline services. So,   the idea here is that universal screening would  help to identify those young people at the   greatest risk of later health difficulties  in order to support prevention and early   intervention initiatives for those individuals.  However, the ACE score, the simple ACE score,   can’t really provide us with much information  about individuals’ specific type of risk because   their score out of ten could be reached through  many different combinations of individual ACEs. So, to take an example here, although  two individuals might both obtain an   ACE score of four, one might report experiencing  emotional, physical and sexual abuse and physical   neglect. While the other might report just living  in a household where their parents were divorced,   where one parent had mental illness or  abused substances, our – and another   parent had been incarcerated or been sent  to prison. So, based on these adversities,   those two individuals’ levels of risk and  the kind of treatment strategies that are   likely to be most effective for them will be  quite different. However, just from the ACE   screening and the simple ACE score alone, this  might not be clear to a Clinician in terms of   what they should do or what they should do  in terms of follow-up care or interventions. On a related note, many studies have also  demonstrated that the ACE score seems to be   useful for identifying groups of people within a  population who are at increased risk for adverse   outcomes based on the number of ACEs they report.  However, this doesn’t mean that it can accurately   predict how any specific individual will  fare into the future. So, in this way,   a high ACE score can provide a rough indicator  of those groups of people who might benefit from   services or follow-up care, but it can’t tell a  practitioner who’s administering it what a given   individual is specifically at risk for, nor what  they can do about it. So, potentially, in future,   things like prediction modelling methods that  are based on machine learning and artificial   intelligence might provide a more accurate  way of identifying an individual’s unique   risk for unfavourable outcomes following  childhood adversity. But at the moment,   efforts to, kind of, create such ACE prediction  models are still at a relatively early stage. Finally, much of the literature on  ACEs has focused on the downstream   effects or the consequences of childhood  adversity, rather than the underlying   causes. And this has limited our ability  to engage in primary prevention efforts,   where we’d hope to target the factors known  to lead to ACEs in order to minimise them for   occurring altogether. Rather than always trying  to simply mitigate their impact on health and   development after they’ve already happened.  So, in particular, ACEs really represent   very complex constructs and they involve  both genetic and environmental influences,   and many of those overlap with other health  conditions that might be at play, as well. So, for example, the risk of experiencing ACEs  is usually greater in individuals who have some   genetic liability for poor mental health and  the association between ACEs and poor mental   health is usually partly accounted for by  wider genetic and environmental factors. So,   as a result of all of that, future  research is really needed, as well,   to test both the causal effects and the  pathways that lead to adversity and also   work out the independent contribution of  ACEs to the risk for mental and physical   health conditions over and above the other  influential factors that might be involved.