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Comment & Response
May 10, 2021

Research, Practice, and Policy Implications of Adverse Childhood Events—Reply

Author Affiliations
  • 1Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, England
  • 2Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
  • 3Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
  • 4National and Specialist CAMHS Trauma, Anxiety, and Depression Clinic, South London and Maudsley National Health Services Foundation Trust, London, England
JAMA Pediatr. 2021;175(8):867-868. doi:10.1001/jamapediatrics.2021.0813

In Reply We thank Machtinger et al for their interest in our study.1 We found that individuals respond differently to adverse childhood experiences (ACEs), with some children developing later health problems, and others not doing so (Figure 2).1 Many children who had no or few ACEs also developed later health problems. Consequently, ACE scores had low accuracy in predicting individual risk for later health problems (Figure 3).1 We therefore suggested that targeting interventions based on ACE scores alone is likely to be ineffective, as it might result in over-referrals (of individuals with high ACE scores who will not develop health problems) and under-referrals (of individuals with low ACE scores who will develop health problems). However, we highlighted that more research is needed to establish whether ACE scores can be used alongside other clinically available information to accurately predict individual poor health outcomes.

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