OBJECTIVES: Screening for parental adverse childhood experiences (ACEs) in pediatric settings can be burdensome because of the questionnaire’s length and sensitive nature. Rapid screen- ing tools may help address these challenges. We evaluated a 2-item short ACE measure devel- oped for adults in a cross-sectional sample of mothers of young children in an urban pediatric emergency department.
METHODS: From January 2011 to March 2020, we administered the ACE questionnaire in English or Spanish to 3999 biological mothers of children aged <4 years in a pediatric emergency de- partment in Philadelphia, Pennsylvania. We assessed sensitivity and specificity of a shortened 2-item ACE measure defined as report of childhood emotional abuse and/or household sub- stance use, using 41 ACEs on the full questionnaire as the standard. We assessed convergent validity by comparing associations of the 2-item and standard measures with maternal, house- hold, and child outcomes using adjusted log-binomial regression.
RESULTS: Mothers were racially and ethnically diverse (54% Latina, 35% Black non-Latina); 94% of children were publicly insured. Thirteen percent of mothers reported childhood emo- tional abuse and 16% childhood household substance use; 23% reported at least 1 of these and 6% both. Compared with 41 ACEs on the full questionnaire, the 2-item measure had sen- sitivity 88% and specificity 90%. In adjusted models, high adversity was associated with poor maternal, household, and child outcomes.
CONCLUSIONS: A 2-item ACE measure assessing childhood emotional abuse and household sub- stance use may be useful in pediatric settings to identify mothers who may have experienced significant child adversity and inform development, testing, or provision of comprehensive family supports.