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Identifying Adverse Childhood Experiences (ACEs) in Pediatric Primary Care

​Kerker BD, Storfer-Iser A, Garner A, Szilagyi M, O’Connor K, Hoagwood K, Stein REK, Horwitz SM.

Presented at the 2015 Pediatric Academic Societies Annual Meeting.

Background: Adverse childhood experiences (ACEs) have been associated with later-in-life risk taking and unhealthy lifestyles, as well as disease. The American Academy of Pediatrics (AAP) suggests that pediatric care adopt a broad framework for understanding how social/emotional and familial factors such as ACEs affect child health, but it is unclear whether pediatricians follow this recommendation or believe that screening for such factors is their responsibility.

Objectives: To examine the prevalence of asking about ACEs (with informal questions or a standardized instrument) by pediatricians, and whether feeling responsible for social/emotional and familial screening is associated with such practice, using data from the 2013 national AAP Periodic Survey.

Methods: Survey data from 321 active physicians exclusively practicing general pediatrics were analyzed. The response rate was 37%, and sample weights were used to reduce non-response bias. The weighted prevalence of pediatricians’ endorsement of responsibility for screening for familial factors, as well as whether they usually asked about the 7 ACEs available in the survey (maternal depression, parental substance abuse, parental separation/divorce, incarcerated relative, domestic violence exposure, physical or sexual abuse, emotional abuse) were examined.

Results: More than 80% of respondents agreed that screening for familial factors was within the scope of their responsibility, yet almost a third of respondents (32%) did not usually ask about ACEs. While almost half reported usually asking about maternal depression (46%) or parental separation/divorce (42%), less than a third usually ask about physical or sexual abuse (32%) or domestic violence (26%), and only 1 in 10 usually ask about incarcerated relatives (9%) or emotional abuse (10%).  Pediatricians who believed that screening for familial factors was their responsibility versus those who did not had a 3.1-fold increased odds of asking about ACEs in their practice (95% CI: 1.7-5.7, p<.001).

Discussion: Nearly one-third of pediatricians did not usually ask about any ACE, and those who did not feel responsible for screening for family factors had significantly lower odds of usually asking about ACES.  Physician training should focus on the importance of screening for familial factors within pediatric practice to more fully address the health of all patients.