Getting Started with ACEs

The term adverse childhood experiences (ACEs) comes from a 1998 study between Kaiser Permanente and the CDC, which found 10 categories of adversities in three domains experienced by 18 year olds: abuse, neglect, and/or household challenges.

An ACE screening evaluates children and adults for ACEs experienced by age 18:

Abuse: physical, emotional, and sexual abuse
Neglect: physical and emotional neglect
Household challenges: growing up in a household with incarceration, mental illness, substance dependence, absence due to separation or divorce, or intimate partner violence

Many common chronic medical conditions of childhood and adulthood are associated with ACEs and toxic stress. Pediatric providers have a unique opportunity to prevent or at least ameliorate many chronic medical conditions in childhood and adulthood by screening and addressing ACEs and SDOH often throughout childhood. Teaching families how to raise resilient children results in resilient adult will have a lasting impact. The science of trauma and toxic stress' impact on health is a growing field with strong evidence.

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Due to the COVID 19 pandemic, everyone is experiencing stressors including anxiety, illness, loss of social contact, and financial insecurities. In addition to this circumstance, children are exposed to adverse experiences that impair their health and development. As pediatricians, we can identify strengths that family already has in coping with adverse experiences and identify potential additional supports, incorporate asking about COVID related stressors, what families are doing to reduce the stress, and what additional support might be helpful to well check visits. Finally, pediatricians should incorporate the PEARLS screening tool into their well child visits to provide a starting point to explore family strengths and needs.