The Relevance of the Adverse Childhood Experience International Questionnaire to Working Children: Knowledge Gaps and Implications for Policy Makers

Abstract

(1) Adverse childhood experiences (ACE) are a global challenge, prioritized in the United Nations’ Sustainable Development Goals. The ACE questionnaire is widely adopted in the USA as a tool for measuring population-level trends, such as negative health, behavioral, and economic outcomes. Intuitively, children in resource-scarce settings are exposed to higher levels of trauma. To understand the global picture, the World Health Organization (WHO) adapted the ACE international questionnaire (ACE-IQ), to inform policy and target interventions. However, evaluation of whether the ACE-IQ captures the experiences of around 160 million working children remains limited. (2) I applied the ACE-IQ scoring tools to detailed case studies of working children, comparing issues highlighted by holistic assessment to those captured by the ACE-IQ. (3) The ACE-IQ struggles to capture nuance across cultural contexts. As a consequence, application of the ACE-IQ as a policy tool risks “policy failure”. The tool reflects prevalent Western concerns, such as school attendance and parental supervision, but global concerns affecting working children such as forced economic migration and famine are neglected. This limitation produces “policy myopia”, sidelining certain global challenges. (4) The ACE-IQ is a useful public health tool, increasingly used to define policy goals. However, given the limitations of the ACE-IQ, the consequences of prioritizing these particular policy goals need to be actively acknowledged and mitigated.

Self-identification by Sexual and Gender Minorities as a Crucial Aspect of Inclusion in a Study of Adverse Childhood Experiences in Haiti

“…The WHO in 2022 describes the ACE-IQ as a structured instrument for individuals aged 18 or older, which assesses: …some of the most intensive and frequently occurring sources of stress that children may suffer early in life…multiple types of abuse; neglect; violence between parents or caregivers; other kinds of serious household dysfunction such as alcohol and substance abuse; and peer, community, and collective violence… The ACE-IQ enables: (1) comparison of ACEs across nations, associations between ACEs and health risk behaviors and health outcomes in adult life, advocacy for increased investments to reduce ACEs, development of appropriate prevention programs (WHO, 2020b). Critics of the ACE-IQ address its lack of focus on unique LIC/LMIC concerns but grant that it is credible, valid, and reliable (Pereira, 2019;Rutter, 2021).…”

“…The ACE-IQ enables: (1) comparison of ACEs across nations, associations between ACEs and health risk behaviors and health outcomes in adult life, advocacy for increased investments to reduce ACEs, development of appropriate prevention programs (WHO, 2020b). Critics of the ACE-IQ address its lack of focus on unique LIC/LMIC concerns but grant that it is credible, valid, and reliable (Pereira, 2019; Rutter, 2021).…”

“…Although the ACE-IQ may lack focus on global concerns unique to LIC/LMIC (Pereira 2019; Rutter 2021), it is widely considered credible, valid, and reliable in global health research. For Haitian SGM, whose identities and social positions in the local, regional, and global environments constitute explicit risks to their safety and health, knowledge of ACEs is crucial.…”

New and Old Challenges in Pediatric Health Policies

“…In this context, this Special Issue of Children brings to the foreground the humanitarian crisis in Yemen, as Coulibaly-Zerbo et al present the adaptations in the nutrition program, in order to maintain the delivery of essential nutrition services to children under the age of five, providing a case study for other countries worldwide that might face similar challenges [ 11 ]. Moreover, in this Special Issue, Rutter critically evaluates the underlying concepts in the application of the adverse childhood experiences international questionnaire (ACE-IQ) as a policy tool, highlighting that the tool successfully covers school attendance and parental supervision, which mainly pertain to Western concerns, whereas global concerns, namely forced economic migration and famine, are not taken into account [ 12 ]. Huang et al also focus on early life mortality, analyzing risk factors for Sudden Infant Death Syndrome (SIDS) in a case–control study on 953 SIDS cases and 1:10 matched controls, showing that the odds of SIDS were higher among offspring of younger mothers (aged less than 20 years) and infants in the eastern region of Taiwan [ 13 ].…”

Interventions and strategies for addressing behavioural effects of adverse childhood experiences: a scoping review.

“…The original ACE study was a 7-item scale, that examined three types of child maltreatment and four types of "dysfunctional" family experiences (Felitti et al, 1998b). The original ACE study was reviewed and published again as a 10-item questionnaire which has been widely used for understanding traumatic experiences (Rutter, 2021), and classifying adverse childhood experiences. It is the 10-item questionnaire which has been used as the focus of this study, considering that it has been the most used and published study.…”