Center on the Developing Child.
Harvard Graduate School of Education.
Pediatrics. 2022 Jun 1;149(6). doi: 10.1542/peds.2021-054493.
As the science of adversity and resilience advances, and public awareness of the health consequences of stress grows, primary care providers are being increasingly asked to address the effects of adverse experiences on child wellbeing. Given limited tools for assessing these effects early in life, the authors explore how enhanced capacity to measure stress activation directly in young children could transform the role and scope of pediatric practice. When employed within a trusted relationship between caregivers and clinicians, selective use of biological measures of stress responses would help address the documented limitations of rating scales of adverse childhood experiences as a primary indicator of individual risk and strengthen the ability to focus on variation in intervention needs, assess their effectiveness, and guide ongoing management. The authors provide an overview of the potential benefits and risks of such expanded measurement capacity, as well as an introduction to candidate indicators that might be employed in an office setting. The ultimate value of such measures for both pediatricians and parents will require vigilant attention to the ethical responsibilities of assuring their correct interpretation and minimizing the harm of inappropriate labeling, especially for children and families experiencing the hardships and threats of racism, poverty, and other structural inequities. Whereas much work remains to be done to advance measurement development and ensure its equitable use, the potential of validated markers of stress activation and resilience to strengthen the impact of primary health care on the lives of young children facing significant adversity demands increased attention.
随着逆境与适应力科学的发展，以及公众对压力对健康影响的认识不断提高，初级保健提供者越来越多地被要求解决逆境经历对儿童福祉的影响。鉴于早期评估这些影响的工具有限，作者探讨了如何通过增强直接测量幼儿压力激活的能力，改变儿科实践的角色和范围。当在护理人员和临床医生之间建立信任关系时，选择性地使用压力反应的生物学测量，可以帮助解决有记录的将儿童逆境经历评分量表作为个体风险的主要指标的局限性，并增强关注干预需求变化、评估其效果和指导持续管理的能力。作者概述了这种扩展测量能力的潜在益处和风险，以及可能在办公环境中使用的候选指标。对于儿科医生和家长来说，此类措施的最终价值需要高度关注正确解释的道德责任，以最小化不适当标签的危害，尤其是对于那些正在经历种族主义、贫困和其他结构性不平等带来的困难和威胁的儿童和家庭。虽然在推进测量开发和确保公平使用方面还有很多工作要做，但验证的压力激活和适应力标志物的潜力，有望增强初级保健对面临重大逆境的幼儿生活的影响，这值得我们给予更多关注。
