What Your ACE Score Can’t Tell You
July 30, 2026I’ve been holding onto a small idea I wanted to send you, because it rarely makes it into a doctor’s office and it quietly changes how you read almost everything you’ll hear about childhood and health.
You’ve probably come across the ACE score, a count of adverse experiences from early life. It’s real, and the research behind it matters. But here is the part almost no one says out loud: that score was built as a population research tool. It was never meant to say what will happen to any one person. One of the original authors of the ACE study has cautioned, in print, against using the score to forecast an individual’s risk at all.
I ran into the same limit in my doctoral dissertation research. In a longitudinal cohort of low-income, predominantly Black and Latino men who have sex with men in Los Angeles, the sheer number of adverse experiences did not line up in a neat, climbing pattern with the outcomes we studied. What mattered was which kinds of adversity a person carried, and even that shifted from one outcome to the next. A single tally quietly erased the very information that would actually help someone.
Here is the part I most want you to keep: your history is not a verdict. What happened is not the thing I try to treat, and it is certainly not something a number can grade. The biology it set in motion is where the real leverage tends to live, and that part is far more open to change than most people are told.
I wrote the whole thinking down, why I ask about your life before I look at your labs, and how a timeline rather than a tally changes what I actually test, in a new piece. If any of this lands for you, that’s where I’d go next.
Read it here: https://fxmedmentalhealth.com/blog/adverse-childhood-experiences-mental-health/
Warmly,
David Wiss, PhD, RDN, FMCP
Founder, FxMed Mental Health
P.S. If you registered for the Unified Theory webinar and never found the time to watch, the replay is still up: https://fxmedmentalhealth.com/webinar/unified-theory/