Do Pediatricians Ask About Adverse Childhood Experiences in Pediatric Primary Care?

Published:August 07, 2015DOI:



      The stress associated with adverse childhood experiences (ACEs) has immediate and long-lasting effects. The objectives of this study were to examine 1) how often pediatricians ask patients' families about ACEs, 2) how familiar pediatricians are with the original ACE study, and 3) physician/practice characteristics, physicians' mental health training, and physicians' attitudes/beliefs that are associated with asking about ACEs.


      Data were collected from 302 nontrainee pediatricians exclusively practicing general pediatrics who completed the 2013 American Academy of Pediatrics Periodic Survey. Pediatricians indicated whether they usually, sometimes, or never inquired about or screened for 7 ACEs. Sample weights were used to reduce nonresponse bias. Weighted descriptive and logistic regression analyses were conducted.


      Only 4% of pediatricians usually asked about all 7 ACEs; 32% did not usually ask about any. Less than 11% of pediatricians reported being very or somewhat familiar with the ACE study. Pediatricians who screened/inquired about ACEs usually asked about maternal depression (46%) and parental separation/divorce (42%). Multivariable analyses showed that pediatricians had more than twice the odds of usually asking about ACEs if they disagreed that they have little effect on influencing positive parenting skills, disagreed that screening for social emotional risk factors within the family is beyond the scope of pediatricians, or were very interested in receiving further education on managing/treating mental health problems in children and adolescents.


      Few pediatricians ask about all ACEs. Pediatric training that emphasizes the importance of social/emotional risk factors may increase the identification of ACEs in pediatric primary care.


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      Linked Article

      • Moving From Social Risk Assessment and Identification to Intervention and Treatment
        Academic PediatricsVol. 16Issue 2
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          Clinical care seeks to match the right patient to the right treatment. Clinicians use histories and physicals to guide assessment and to determine diagnosis and management plans. This pattern of assessment, identification, and treatment typically focuses on symptoms and diseases. However, mounting evidence suggests that social determinants of health (SDH) may be just as, if not more, relevant to clinical outcomes than many of the medical or biologic determinants that often dominate our focus. It is therefore natural to consider how we might reliably and effectively integrate assessment, identification, and treatment of the SDH into clinical practice.
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