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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Baldwin JR, Danese A. Research, Practice, and Policy Implications of Adverse Childhood Events—Reply. JAMA Pediatr. 2021;175(8):867–868. doi:10.1001/jamapediatrics.2021.0813
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