8 Myths About Screening For Adverse Childhood Experiences

“The Clinical Relevance of Attachment Theory and Research

There's now overwhelming empirical support for the fact that early experience is a powerful force in development. But what can clinicians draw from this work, beyond feeling reassured that their clinical intuition isn't simply an "article of faith"? For one thing, this extensive work can bring perspective to questions such as why change is so difficult and why emotional closeness can be so scary to some people. Long before children have the language and conceptual tools to process experience, negative or even traumatic patterns of interaction are incorporated in the brain, the functioning of their psyche, and even in the molecules that control the expression of their genes. Therefore, people can get "lost in familiar places" as they continually recreate their earliest patterns of interactions across the lifespan. One role of a therapist is to bring awareness to such patterns and then intentionally create new pathways for clients to take as they unlearn their long-established habits.
Another important implication of attachment research is that it's possible to develop a secure state of mind as an adult, even in the face of a difficult childhood. Early experience influences later development, but it isn't fate: therapeutic experiences can profoundly alter an individual's life course. Further, therapists can learn from attachment researchers' hard-earned insights into human development which features of relational experience are the most effective at optimizing well-being. When parents are sensitive to a child—when they pay attention to and tune in to the signals sent by the child, make sense of these signals and get a glimpse of the child's inner experience, and then respond in a timely and effective manner—children are likelier to thrive. The essential features of a therapeutic relationship mirror this process in many ways.
The brain continues to remodel itself in response to experience throughout our lives, and our emerging understanding of neuroplasticity is showing us how relationships can stimulate neuronal activation and even remove the synaptic legacy of early social experience. Developmental trajectories are complex, often having "islands" of positive relational experience, even within largely negative histories. Through therapeutic relationships and reflective practice, one can make contact with these islands—the "angels" in the nursery, to quote developmental psychologist Alicia Lieberman—and cultivate their growth to the benefit of parents, children, and adults alike. In this way, clinical practice can use the power of our attachment relationships.” 

we can find strain in the attachment relationships in peds at 4 months with the ages and stages social emotional... 

And the ASQ is the kind of thing peds should do... Just saying. 

https://www.drdansiegel.com/up...he-verdict-is-in.pdf

I wouldn’t screen as there are no available treatments that are also effective for most of our patients.  CBT is not effective for significant attachment trauma or dissociation which most severely traumatized patients have and I am not willing to be a partner in drugging traumatized kids which is too often what happens in the real world we all live and work in.  

“Only the most easily protocolized treatments, like CBT, prolonged exposure, medications, and EMDR, have been thoroughly researched. Interestingly, though medications have been shown, over and over again, to be only marginally helpful for PTSD, they keep being prescribed to the tune of billions of dollars per year. In contrast, somatic therapies, such as Sensorimotor psychotherapy and Somatic Experiencing, haven’t been thoroughly researched for their efficacy, nor has hypnosis, which for about a century was widely regarded as the treatment of choice for PTSD. There’s also little “hard” evidence for Internal Family Systems therapy, or neurofeedback, even though many clinicians who specialize in the treatment of traumatized individuals consider these among the most effective treatments currently available.

 The result of the politics of diagnosis and “evidence-based” treatments is that in most settings that depend on insurance reimbursement, clinicians are mandated to use treatments of questionable efficacy. The fact that study after study shows that these mandated treatments have at best a 40 percent drop in symptomatology, which is only slightly better than placebo, after a third of the patients drop out, seems not to have raised enough concern about wasted lives and wasted resources to affect their growing influence. Meanwhile, the VA, by its reliance on evidence-based approaches, has been a major factor in discouraging the expanded exploration of effective treatments. So once again, we’re faced with a political reality: many of the treatments sophisticated clinicians would consider most effective are only available to people who can pay out of pocket.”

https://www.psychotherapynetwo...00-0000-000000000000

Might we consider all forty+plus categories of ACES ('Adverse Community Environments' and 'Adverse Childhood Experiences') found in the World Health Organization's WHO ACE International Questionnaire ?