Strengthening the Predictive Power of Screening for Adverse Childhood Experiences (ACEs) in Younger and Older Children

• In Event: Investigating the Value of Screening for Adverse Childhood Experiences (ACEs) in Predicting Poor Health

Abstract

Introduction: Research based on the Adverse Childhood Experiences (ACEs) framework is growing at a rapid rate. This literature points consistently to the large number of later mental and physical health conditions that are associated with the accumulation of exposures to stressful conditions in childhood. Given this evidence, there is increasing interest in routine screening for ACEs to help identify high-risk children who would benefit from interventions. However, much of the existing literature has relied on ACEs items used in early studies (e.g. Felitti et al., 1998), not chosen through any systematic empirical process. There has not yet been sufficient research concerning which particular set of ACEs would be most predictive as a potential screening tool.

Hypotheses/Specific Aims: The goals of this study were to: 1) identify which set of ACEs items has the strongest association with level of current trauma symptomatology, separately for younger (ages 2 to 9) and older (ages 10 to 17) children; 2) compare these sets to the original ACE measure on variance explained in trauma symptoms; 3) Establish “high ACEs” cut-off points that maximize both the sensitivity and specificity of each measure; and 4) Determine if the new proposed ACEs items are able to identify significantly more youth with clinically-relevant levels of trauma symptoms than the original ACEs measure.
Methods: The current study used pooled data from three National Surveys of Children’s Exposure to Violence (NatSCEV) conducted in 2008, 2011, and 2014 (N=11,896). Each survey collected information on children aged one month to 17 years. The three samples were obtained from a mix of random digit dialing and address based sampling methods. Telephone interviews were conducted with children 10 years and older and with caregivers, if the randomly selected child was under age 10. Forty different ACEs, covering 11 different conceptual domains were considered in the current study. ACEs were assessed with items from The Juvenile Victimization Questionnaire (JVQ), the Lifetime Childhood Adversity measure (Turner, et al. 2006), and additional questions asked in the parent screener survey.

Results: Analyses showed a different set of 15 items to best predicted trauma symptoms for younger (2-9-year-old) compared to older (10-17-year-old) youth. Some conventional ACEs, like physical and emotional abuse, proved important for both age groups. However, family-related factors were more predictive for younger children, while community and peer violence exposures were more predictive for older children. Our new proposed measures explained substantially more variance in subsequent trauma symptoms than did the original ACE measure (R2=.31 vs .18 for 2-9-year olds; R2=.26 vs .43 for 10-17-year olds; p<.001 for all) and identified a larger percentage of children with high levels of trauma.

Conclusion: Although the newly derived measures represent an important starting place in efforts to develop effective screeners, we argue that research on the efficacy of ACEs screening is still underdeveloped. More rigorous construction of screening tools and more thorough evaluations of their comparative utility in clinical settings are needed to be successful in the goal of early intervention.

Authors

• Heather Turner, University of New Hampshire
  Presenting Author

• David Finkelhor, University of New Hampshire
  Non-Presenting Author

• Kimberly J Mitchell, University of New Hampshire
  Non-Presenting Author

• Lisa Jones, Crimes Against Children Research Center
  Non-Presenting Author

• Megan Henly, University of New Hampshire
  Non-Presenting Author