UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
J Prim Care Community Health. 2023 Jan-Dec;14:21501319231168342. doi: 10.1177/21501319231168342.
Adverse childhood experience (ACE) exposure is associated with increased risk of poor health outcomes. Several tools to identify ACEs during pediatric practice exist, but few include all 10 ACEs from the original ACE study and none have established predictive validity.
Assess predictive validity of the ACE score reported during routine pediatric practice using the Whole Child Assessment (WCA).
This retrospective cohort study included children ages 3 to 8 years presenting for well-child care at a low-income resident clinic between May 25, 2016 and March 31, 2018, and ages 5 to 8 years presenting for well-child care at a private insurance clinic between November 1, 2017 and March 31, 2018. Patients with chronic health problems were excluded to prevent confounding by preexisting health problems. The charts of children with 0 to 1 ACEs (lower risk) and 2+ ACEs (higher risk) at baseline were reviewed to collect data on health and psychosocial outcomes at follow-up from diagnoses documented in the medical record and parent-reported outcomes on the WCA. Logistic regression models adjusted for age, gender, and clinic were used to analyze differences in outcomes. We hypothesized that children in the higher risk group at baseline would have more health and psychosocial problems at follow-up.
The initial cohort (n = 907) had 669 children with 0 to 1 ACEs and 238 children with 2+ ACEs. At follow-up (mean 718 days, range 329-1155 days), children in the higher risk group had statistically significantly higher rates of ADHD/ADD, school failure/learning problem, and other behavioral/mental problems. Parents of these children also reported on the WCA higher rates of children being nervous or afraid, feeling sad or unhappy, having trouble paying attention or staying still, getting angry or into fights, bullying, poor sleep, and healthcare utilization. There were no statistically significant differences in various physical health concerns measured.
This study supports the predictive validity of the WCA to identify subpopulations at risk of developing poor mental health and social-emotional outcomes. While more research is needed to facilitate translation into pediatric practice, these results highlight the strong influence of ACEs on mental health outcomes.
不良儿童经历（ACE）的暴露与不良健康结果的风险增加有关。在儿科实践中存在几种识别 ACE 的工具，但很少有工具包含原始 ACE 研究中的全部 10 种 ACE，也没有一种工具具有既定的预测有效性。
使用整体儿童评估（WCA）评估在常规儿科实践中报告的 ACE 评分的预测有效性。
本回顾性队列研究纳入了 2016 年 5 月 25 日至 2018 年 3 月 31 日期间在低收入居民诊所接受常规儿童保健的 3 至 8 岁儿童，以及 2017 年 11 月 1 日至 2018 年 3 月 31 日期间在私人保险诊所接受常规儿童保健的 5 至 8 岁儿童。排除患有慢性健康问题的患者，以防止因预先存在的健康问题而产生混杂。对基线时有 0 至 1 个 ACE（低风险）和 2 个及以上 ACE（高风险）的患儿的病历进行回顾，以收集随访时从病历记录中诊断出的健康和社会心理结局数据，以及家长使用 WCA 报告的结局数据。使用调整年龄、性别和诊所的逻辑回归模型来分析结局差异。我们假设基线时处于高风险组的儿童在随访时会有更多的健康和社会心理问题。
最初的队列（n=907）中有 669 名患儿有 0 至 1 个 ACE，238 名患儿有 2 个及以上 ACE。在随访时（平均 718 天，范围 329-1155 天），高风险组患儿 ADHD/ADD、学业失败/学习问题和其他行为/精神问题的发生率更高。这些患儿的家长还在 WCA 上报告了更高的患儿紧张或害怕、悲伤或不开心、注意力不集中或难以安静、生气或打架、欺凌、睡眠不佳和医疗保健利用率的发生率。在测量的各种身体健康问题方面，没有统计学上显著的差异。
这项研究支持 WCA 能够识别有发展不良心理健康和社会情感结局风险的亚人群，具有预测有效性。虽然需要进一步研究以促进其在儿科实践中的转化，但这些结果突出了 ACE 对心理健康结局的强烈影响。
