Mirroring our wildfires, controversies have been flaring up recently in the pediatric world regarding ACEs screening. While most pediatricians are heavily engaged in serving pandemic-traumatized families, academic pediatricians have been debating the value of an ACEs score and its use in predicting future health disorders. A recent article by JR Baldwin et al. at University College London, looked at two large cohorts of children and adults who had participated in a series of ACEs evaluations, followed by documentation of later health problems 18 years to 45 years later. The most relevant study for pediatricians was the Environmental Risk Longitudinal study of twins born in the 1990s in England and Wales. Using a statistical tool called the ROC curve, the authors evaluated the usefulness of an elevated ACEs scores in predicting later mental health and physical health problems. Using the data from over 2200 children, Baldwin et al. concluded that ACEs scores “have poor accuracy in predicting an individual’s risk of later health problems.”1
UCSF Professors Edward L. Machtinger MD, Alicia Lieberman PhD and Marguerita Lightfoot PhD subsequently refuted the conclusion that ACEs scores were faulty tools for guiding individual-level clinical decision-making. These authors noted that “It is well known that trauma exposure alone does not predict how an individual will respond” and pointed to the complexities of the issue. “Health sequelae from trauma exposure develop in the context of one’s eco-system, including protective and risk factors (e.g. the presence or absence of supportive individuals), material resources, and individual strengths and vulnerabilities2.” While the authors of the first article saw the ACEs score as a prediction, Machtinger et al saw it as an opportunity to intervene and prevent significant impacts from childhood trauma.
Image Credit: Imaginary play can help build self-regulation skills, allowing children to develop resilience that counteracts traumatic stress. For more information on executive function from the Center on the Developing Child, please go to: developingchild.harvard.edu
