Screening for Adverse Childhood Experiences in Children: A Systematic Review

Abstract

CONTEXT: Adverse childhood experiences (ACEs) are associated with increased risk of poor mental health outcomes. Although there is interest in screening for ACEs for early identification and intervention, it is not known whether screening improves outcomes for children. OBJECTIVE: To systematically review whether screening for ACEs in children leads to an increase in (1) identification of ACEs, (2) referrals to services, (3) increased uptake of services, and (4) improved mental health outcomes for children and parents. DATA SOURCES: Ovid Medline, PsycINFO, CINAHL, and Center for Clinical and Translational Research electronic databases were searched between 2009 and 2021. STUDY SELECTION: Studies were included if researchers screened for current ACEs in children aged 0 to 12 years and they had a control comparison. DATA EXTRACTION: Information was extracted, including study characteristics, sample demographics, screening tool characteristics, referral rates to services, uptake rates, and mental health outcomes. RESULTS: A total of 5816 articles were screened, with 4 articles meeting inclusion criteria. Screening for ACEs increases identification of adversity and may increase referrals to services. There are limited data about whether this leads to an increase in referral uptake by families. There are no reported data addressing mental health outcomes. LIMITATIONS: There are few published control trials of moderate quality. CONCLUSIONS: There is limited evidence that screening for ACEs improves identification of childhood adversity and may improve referrals. If we are to realize the hypothesized benefits of ACEs screening on child and parent mental health, it is essential to understand the barriers for families taking up referrals.

Patient and Patient Caregiver Perspectives on Social Screening: A Review of the Literature

“…Focused on social screening tools that covered two or more social domains to reflect the growing interest in and implementation of multidomain tools. 3,6 These included but were not strictly limited to housing, food, utilities, transportation, finances, employment, social isolation, and legal issues (we excluded violence/safety concerns and adverse childhood events given the robust existing literature on those domains [12][13][14] ); 3. Took place in or informed initiatives being designed to take place within a US health care setting; 4.…”

Adverse childhood experiences and binge-eating disorder in early adolescents

“…Addressing the burden of ACEs and EDs such as BED is critical given the high prevalence of ACEs and the negative outcomes associated with EDs. Although there is limited evidence that universal screening of ACEs improves the identification of childhood adversity [6], clinicians may consider ACEs in those at risk for EDs. The findings from the current study highlight the need to consider ACEs and provide trauma-focused care when evaluating and treating children and adolescents with BED, which may improve the outcomes and lived experiences of those affected [55].…”

“…Accumulating ACEs has been particularly linked to deleterious medical, mental health, and social outcomes [4,5]. Given the high prevalence and ongoing public health burden of ACEs, additional studies and interventions are necessary to both elucidate and reduce their impact, as proposed by the American Academy of Pediatrics [6,7].…”

Adverse childhood experiences and early adolescent cyberbullying in the United States

“…The present study's findings have significant policy, clinical, and public health implications, particularly for implementing and adapting interventions for adolescents with ACEs. ACEs have been shown to affect early adolescents at a critical time of development, which suggests usefulness in screening during primary care visits such as annual physicals (Barnes et al, 2020; Jackson et al, 2021; Loveday et al, 2022) from the newborn visit to adulthood. Screen time may be an intermediary between ACEs and cyberbullying; therefore, caregiver training and education may be valuable to encourage active nurturing without the use of screens (Woods‐Jaeger et al, 2018), and the encouragement of family media use plans informed by the American Academy of Pediatrics to limit technology usage in households (Hill et al, 2016).…”