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ACEs: Evidence, Gaps, Evaluation and Future Priorities

  • Andrew Steptoe (a1), Theresa Marteau (a2), Peter Fonagy (a3) and Kathryn Abel (a4)


There is strong evidence linking adverse childhood experiences (ACEs) and poor outcomes in adulthood both in terms of mental and physical health. Gaps in both the evidence base and research priorities still exist. These include understanding how to identify and assess risk in children who have experienced ACEs, and also the development and, importantly, the evaluation of interventions. Outstanding gaps include whether there are sensitive periods during childhood, the role of resilience/protective factors, the causal relationships, biological mechanisms and relative risk of ACEs for particular negative outcomes. ACEs affect individual children differently and chronic exposure appears to increase the risk of poor outcomes in adulthood, meaning interventions should also be tailored to the individual children, families and communities. Generally, there needs to be better evaluation of interventions and dissemination of this information to ensure that their use is evidence based. More input from affected communities, clinicians, funding bodies and Government departments is required to identify research priorities and ensure gaps in the evidence base are addressed.



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