As pediatricians, we all want to do the right things to improve the well-being of children and maximize their future outcomes.
Mitigating the negative impact of adverse childhood experiences (ACEs) on long-term health outcomes of children has been a primary focus of the American Academy of Pediatrics (AAP). Much of the focus over the past few years is reframing the issue to promote Positive Childhood Experiences (PCEs) and help families provide safe and stable nurturing environments.
It seems like with my second blog on the topic and a new study in month’s Pediatrics, the evidence is turning away from screening for ACEs.
In 2022, Loveday et al published a systematic review in Pediatrics on the lack of evidence supporting ACEs screening. And now Anna Austin, PhD, and colleagues at the CDC have added to the concerns about ACEs screening (10.1542/peds.2024-067307). In their State of the Art Review being early released in Pediatrics this week, the authors conclude that “we do not yet have sufficient evidence regarding the potential benefits, challenges, and harms of ACEs screening in healthcare and other settings. In the absence of this evidence, we cannot assume that screening will not cause harm and that potential benefits outweigh potential harms.”
The authors’ key takeaway is that until there is better research to “determine whether and how ACEs screening can be used to appropriately guide clinical response,” the potential for harm outweighs the benefit of screening.
We are left exactly where we were 2 years ago when Drs. Jee and Forkey commented on the Loveday paper, noting “Screening without appropriate office-based guidance and supported linkages to community resources appears to have limited evidence of benefit as noted in Loveday and colleagues’ review, and may be potentially harmful; yet pediatricians can use a resilience-informed team-based and community approach to assist families in navigating their most pressing health and social needs.”
While we await further research, pediatricians still need to be aware of the context surrounding our patients, and we can still practice trauma informed care. Using a social determinants of health (SDOH) screening tool to better understand the context of each patient and family does have value, especially when you can couple positive screens with connections to resources in the office or community. And while there is not yet strong evidence of utility in asking the ACEs questions to everyone, providing trauma-informed care to an individual within a child health system remains important.
But even more importantly, we need to advocate for the resources and policies that allow all families to be able to provide safe and stable nurturing environments for all children. If I sound like a broken record, it’s because I said the same thing 2 years ago—we haven’t figured this challenge out yet but we need to keep pushing for better solutions for families and communities.
