Adverse Events in Children: Predictors of Adult Physical and Mental Conditions
CASE: A senior member of a 5-person pediatric group recently heard a presentation about the Adverse Childhood Experiences (ACE) study. He decided to present the study to his colleagues with the intention of incorporating a similar screening tool for ACE in their practice.
The ACE study assessed adverse child experiences recalled by 17,000 adult patients who were participating in a comprehensive medical evaluation at a large Health Maintenance Organization. The ACE questionnaire assessed emotional, physical, and sexual abuse; emotional and physical neglect; mother treated violently; household substance abuse; household mental abuse; parental separation or divorce; and incarcerated household members (http://www.acestudy.org/yahoo_site_admin/assets/docs/ACE_Calculator-English.127143712.pdf).
Thirty-six percent of the participants did not endorse any ACE. One, 2 or 3 ACE's were endorsed by 26%, 16%, and 9.5%, respectively. Four or more ACEs were endorsed by 12% of the cohort. The study found that “the major risk factors for causes of death in adults, smoking, alcohol abuse, obesity, physical inactivity, use of illicit drugs, promiscuity, and suicide attempts, were all increased by ACEs. Compared with persons with an ACE score of 0, those with an ACE score of 4 or more were twice as likely to be smokers, 12 times more likely to have attempted suicide, 7 times more likely to be alcoholic, and 10 times more likely to have injected street drugs” (2).
When he researched the ACE study further, the pediatrician discovered that there was a modified form of the ACE study questions available for parents of children and adolescents. The members of the pediatric practice were intrigued by the reported relationship between ACEs and the high prevalence of chronic physical and mental health conditions and economic outcomes. Could this be a method for pediatricians to screen for risks of serious physical and psychiatric diseases in adult life? A brisk discussion followed about what they would do with this information if the ACE screening questions were used in their practice. Is it an effective strategy for primary care pediatric practice?