The operationalization of childhood trauma and adversity into checklists commonly known as adverse childhood experiences, or ACEs, has become the most widely adopted methodology linking traumatic childhoods to adult outcomes. As the number of self-reported ACEs increase from 0 to 4 or more (4+), most studies find a roughly stepwise progression in risk for a wide range of negative medical and mental health outcomes. A score of 4+ ACEs, has become a de facto cutpoint, increasingly used clinically to define "high risk" status for a myriad of outcomes. Comparisons across studies using a 4+ cutpoint, however, find considerable heterogeneity in the degree of risk for the same outcomes. In addition to sample and methodological differences, certain pairs of ACEs comprising the cumulative ACE score interact synergistically to significantly increase the overall risk beyond the sum (or product) of the contributions of each ACE to the outcome. This article reviews the empirical literature on synergistic ACEs including results from a general population adult and a mixed trauma, youth sample both sufficiently powered to examine over 20 different ACE pairings for possible synergy. Synergistic pairs of ACEs vary by gender and age group. About 30-40% of the variance in outcomes is accounted for by additive synergistic interactions between certain pairs of ACEs. Across studies, sexual abuse is the most synergistically reactive ACE. The article concludes with a discussion of the implications of synergistic ACE pairings for psychologists and other allied professionals across clinical practice, prevention, research, and policy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

中文翻译：

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所有不利的童年经历都不是平等的：协同作用对不利的童年经历评分的贡献。

将童年创伤和逆境纳入通常称为不良童年经历 (ACE) 的清单，已成为将创伤性童年与成人结果联系起来的最广泛采用的方法。随着自我报告的 ACE 数量从 0 增加到 4 或更多 (4+)，大多数研究发现，各种负面医疗和心理健康结果的风险大致呈阶梯式增长。4+ ACE 的分数已成为事实上的分界点，越来越多地在临床上用于定义无数结果的“高风险”状态。然而，使用 4+ 分界点的研究之间的比较发现，相同结果的风险程度存在相当大的异质性。除了样本和方法上的差异，包含累积 ACE 分数的某些 ACE 对协同相互作用以显着增加整体风险，超过每个 ACE 对结果的贡献的总和（或乘积）。本文回顾了关于协同 ACE 的实证文献，包括来自一般人群成人和混合创伤青年样本的结果，两者都足以检查 20 多种不同 ACE 配对的可能协同作用。ACE 的协同对因性别和年龄组而异。结果中大约 30-40% 的差异是由某些 ACE 对之间的附加协同相互作用造成的。在所有研究中，性虐待是最具协同反应的 ACE。文章最后讨论了协同 ACE 配对对心理学家和其他临床实践相关专业人士的影响，预防、研究和政策。（PsycInfo 数据库记录 (c) 2021 APA，保留所有权利）。