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Editorials

Addressing adverse childhood experiences: implications for professional practice

Warren Larkin and Peter Cairns
British Journal of General Practice 2020; 70 (693): 160-161. DOI: https://doi.org/10.3399/bjgp20X708929
Warren Larkin
Warren Larkin Associates Ltd, PO Box 657, Lancashire PR6 6PL; Visiting Professor, University of Sunderland, Sunderland, UK. Email:
Roles: Consultant Clinical Psychologist
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  • For correspondence: wlarkin@warrenlarkinassociates.co.uk
Peter Cairns
Wester Hailes Medical Practice, Edinburgh, Scotland.
Roles: GP
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INTRODUCTION

It has been over 20 years since the publication of seminal research by Felitti et al, highlighting the powerful relationship between adverse childhood experiences (ACEs) and a wide range of health and wellbeing outcomes.1

Since the landmark ACE study was published, a compelling body of research has accumulated confirming the strong and proportionate relationship between experiences of childhood adversity and the manifestation of detrimental health and social outcomes later in life.2,3 We have learnt that ACEs are relatively common and are amenable to detection. We have an evolving understanding of the neurodevelopmental links between adversity and poor mental and physical health outcomes. We have evidence that the negative effects of ACEs can be mitigated through psychosocial and resilience building interventions.4 However, despite this growing awareness, it is not obvious that ACEs have yet been approached as a significant public health problem in the UK.

ACE enquiry is becoming more common in the US primary care system and in paediatric medicine, with emerging evidence of significant human and financial payoff.2 In the UK there is a growing interest in routine or targeted ACE enquiry, with early indications that this might offer opportunities for GPs to alleviate suffering via therapeutic relationships.5 Nonetheless, it is still relatively rare for healthcare professionals in the UK to routinely enquire about these experiences and their impact on a patient’s health. In this editorial we hope to explore some of the enablers and barriers related to implementing ACE enquiry in a UK primary care context.

WHAT ARE ADVERSE CHILDHOOD EXPERIENCES?

The ACEs concept most often refers to a list of ten categories of abuse, neglect, and household dysfunction, experienced before the age of 18 years. These are: parental mental illness; parental substance misuse; parental alcoholism; living with a parent or adult who went to …

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British Journal of General Practice: 70 (693)
British Journal of General Practice
Vol. 70, Issue 693
April 2020
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Addressing adverse childhood experiences: implications for professional practice
Warren Larkin, Peter Cairns
British Journal of General Practice 2020; 70 (693): 160-161. DOI: 10.3399/bjgp20X708929

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Addressing adverse childhood experiences: implications for professional practice
Warren Larkin, Peter Cairns
British Journal of General Practice 2020; 70 (693): 160-161. DOI: 10.3399/bjgp20X708929
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  • Article
    • INTRODUCTION
    • WHAT ARE ADVERSE CHILDHOOD EXPERIENCES?
    • RESILIENCE
    • WE CAN’T KEEP DOING THE SAME THINGS AND EXPECT DIFFERENT OUTCOMES
    • WHAT IS REALISTIC IN PRIMARY CARE?
    • WHY ARE SERVICES NOT ALREADY ASKING?
    • WHAT ABOUT IN THE UK?
    • CONCLUSION
    • Notes
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More in this TOC Section

  • Stroke: time to address cognition
  • Was enough, and is enough, being done to protect the primary care workforce from COVID-19?
  • Primary care networks: are they fit for the future?
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