Trauma cannot be quantified

Dr Jessica Taylor responds to an article from our October edition.

In the October issue, there were several long articles which supported deterministic, reductionist, and medical models of human trauma. I would like to address some key points that have concerned me as a trauma-informed psychologist, academic, and activist.
In Kyle Kelleher’s article, he argued for the use of ‘ACEs’ in clinical psychology, citing many of the usual studies without including the statement made in 2020, published by the original authors of the ACEs study, which explicitly asks us all to stop using their questionnaire, and to stop scoring individuals.

Robert Anda and colleagues, looking ‘Inside the Adverse Childhood Experience score’ in a 2020 paper, reiterate their original positions that must now be reinforced:

- Their ACE questionnaire only contains 10 possible ‘adversities’ which ignore all forms of social inequality, oppression, discrimination, illness, bullying and wider abuses. It is therefore an invalid and ill-equipped tool to use to describe, measure, investigate or discuss childhood trauma. Further to the 10 adversities being limited, many of them are flawed and require validation. For example, the ACE items only include sexual abuse if there was more than five years between the perpetrator and victim. Divorce of parents is ‘scored’ the same as being sexually abused. Domestic abuse only counts if the victim was the child’s mother. Hundreds of other traumas are not included at all.

- By far, the most important point they repeat is that ACEs is not for use to score individuals, and should never be used to make decisions, screen or predict outcomes, trauma, or health of individual people. ACEs was designed and tested on adult populations, for population level epidemiological research to explore public health approaches and investments.

I consider these arguments to be impossible to ignore. The original authors have had to release statements and articles almost two decades later because they are aware that academics and practitioners are misusing their 10 questions to score humans out of 10. The concept of childhood trauma is important, but this is not the way to do it. People are not numbers, trauma cannot be quantified. People we work with, and our family members are not fours or eights – they are whole human beings with individual experiences. Children and adults are reporting that the ACEs score makes them feel infuriated, defined and trapped – which is similar to the way Kyle describes his own mum’s feelings of constantly being defined by her ACE score.

If anything, we need to fiercely reject the use of ACEs with individuals, and respect the original authors who have asked that we stop using their framework for epidemiological research as if it is a validated psychometric or screening tool for trauma. This is such poor practice, and science in bad faith.

Dr Jessica Taylor
Director, VictimFocus

Kyle Kelleher has responded, in brief: "Dr Taylor writes that my article "argued for the use of ‘ACEs’ in clinical psychology”. I do not argue for the use of ACEs in clinical psychology at any point. I do not make a case for or against the use of ACEs clinically, or among clinical psychologists. Instead, the article used ACEs as a springboard to focus on discussing trauma with family members. The main aim of the article is to discuss family trauma."

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