So much has been written about the adult consequences of children being exposed to toxic stressors early in life including poverty, food insecurity, abuse, neglect and a host of others. What has not been well described is whether these ACEs in childhood can be modified through preventive interventions offered by preschool. Giovanelli et al. (10.1542/peds.2015-4016) however have attempted to answer that question in presenting follow-up date on more than 1200 low-income minority children enrolled prospectively in a longitudinal cohort that started back in 1979-1980. The results are disturbing and show how many adverse adult consequences are associated with ACEs ranging from reduced likelihood of graduating high school to mental health issues to criminal activities. Unemployment is also associated with having multiple ACEs, and sadly the particular preschool intervention by itself that was tried in this study did little to ameliorate the outcomes described in this paper.
Does this mean that early intervention should not be tried in children with ACEs? Of course not—but finding the right type of intervention continues to be something that this study cannot answer. If you need to understand the ramifications of not identifying the ACEs in your pediatric patients or even more importantly, if you need to understand why we continue to look for studies that show more successful interventions than the just the one studied by these authors, then reading this article will increase your awareness and make you eager to continue to read more studies studies on ways to temper the effect of ACEs so that our low-income patients have better odds of not just surviving in their environment, but eventually thriving as adults.
