Improved Screening for Adverse Childhood Experiences

ACES The Institute for Innovation & Implementation at the University of Maryland School of Social Work has partnered with Harvard's Center for the Developing Child's Frontiers of Innovation Community to develop a new project aimed at better screening adults for Adverse Childhood Experiences (ACEs). This team has developed a child ACE screening instrument in an effort to understand the intergeneration effects of trauma specifically the relationship between a parent and child's ACE scores. Thousands of families across the country will be screened to examine ACE screening results, child social and emotional development and parent functioning; as well as, determining if these instruments are a useful tool in triaging families to more appropriate services ultimately leading to better outcomes. The Institute is leading the collection of prevalence and outcome data across multiple states and programs.

ACEs are defined as events that include growing up in households in which there was recurrent physical or emotional abuse; sexual abuse; substance abuse; chronic mental health disorders; domestic violence; or an incarcerated household member. There is a negative cumulative effect with ACEs; and, in a national study, the more ACEs a respondent reported the poorer health, mental health and educational outcomes later in life. (Felitti et al., 1998).

In addition, the stress of chronic childhood trauma known as toxic stress (chronic exposure to adversity), in the absence of the buffering protection of a supportive adult relationship, can lead to the release of hormones that physically damages a child's developing brain and have impact well into adulthood (Shonkoff & Garner, 2012). Such disruption may result in anatomic changes and/or physiologic dysregulations that are the precursors of later impairments in learning and behavior as well as the roots of chronic, stress-related physical and mental illness (Shonkoff, 2010). Sadly, these effects are structural, chemical, neuropsychological, chromosomal, cognitive, and social emotional. This high level of chronic stress is shown to impact memory and contextual learning, which makes it difficult to distinguish danger versus safety. Thus, brain changes in response to early childhood toxic stress could explain, at least in part, the relationship between exposure to adverse events and subsequent developmental problems (Shonkoff, 2010).

However, environmental factors such as the presence of a caring and responsive adult who helps the child cope with stressors can buffer the impact of the stress. Such caregivers provide important opportunities to observe, learn, and practice healthy, adaptive responses to adverse experiences (Shonkoff & Garner, 2012). Fisher and colleagues (2005) have also shown that a therapeutic environment can have a positive impact on adverse patterns of cortisol dysregulation that is also associated with more responsiveness by children and satisfaction by caregivers.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.

Shonkoff, J. P., & Garner, A. S. (2012). The Lifelong Effects of Early Childhood Adversity and Toxic Stress. Pediatrics, 129(1), e232 -e246.