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Explaining “A Short Adverse Experiences Measure Among Mothers of Young Children”

Adverse childhood experiences (ACEs) are a specific set of household-level adversities children may experience, including emotional and physical abuse, neglect, and other household stressors. Since the concept was first introduced in a 1998 study, thousands of studies spanning a variety of populations and countries have related ACEs to worse health. This includes a growing number of studies by Children’s HealthWatch and others showing intergenerational links between parents’ past exposure to ACEs and their children’s health.

These findings have led to discussion about whether to screen for parent or caregiver ACEs in pediatric settings, and how to use the resulting information. One hesitation from providers is that the questionnaire can be burdensome to staff and parents because of its length and sensitive nature. Because of these concerns, Wade et al developed a shortened measure that includes only 2 of the original 11 items: report of childhood emotional abuse and/or household substance use. They developed and tested the short measure using data from the Behavioral Risk Factor Surveillance System. However, this was a largely older (55% aged ≥ 45 years), white-race (85%) sample, leaving it unclear if the measure is valid among racially diverse parents in pediatric settings.

To address this gap, we tested a slightly modified version of the 2-item measure against the full 11-item ACE questionnaire among 3999 biological mothers of children under the age of 4 who participated in the Children’s HealthWatch survey.

The questions on the 2-item measure we tested are:

1. Did a parent or other adult in the household often or very often swear at you, insult you, put you down, or humiliate you OR act in a way that made you afraid that you might be physically hurt?

2. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?

We found that the 2-item measure could be useful in pediatric settings to identify mothers who have experienced significant child adversity.

There are many considerations in deciding whether to ask parents about their ACEs, and these are often specific to each research or healthcare setting. Providers might be able to use information about parent ACEs to inform appropriate referrals or frame provider-parent discussions, or to help in developing trauma-informed parent support services. However, the ACE questionnaire was developed to provide population-level information, not as a diagnostic tool or as the basis for individual treatment decisions. Potential benefits for facilitating care that is family-centered, trauma informed, and strengths-based must be weighed carefully against the burden of administering the questionnaire and risks like re-traumatizing parents or subjecting them to blame. Our results show that the 2-item short measure may be a useful addition to pediatric providers’ and researchers’ toolbox in making decisions about whether and how to incorporate parent ACEs into their work.