Center for Health Journalism contributor and veteran reporter Bill Heisel’s piece “Could widespread screening for childhood adversity do more damage than good?” raises some important questions. However, the piece could have benefited from more of Heisel’s usual scientific rigor.
To take one example, Heisel attributes a key finding — that adverse childhood events (ACEs) are associated with an increased risk of life-threatening illnesses — to the excellent news and advocacy site ACEsTooHigh. To quote his article:
“ACEsTooHigh, an ACEs news site popular with people interested in the topic, says that even scoring four out of 10 means you are much more likely to have a serious disease:
“As your ACE score increases, so does the risk of disease, social and emotional problems. With an ACE score of 4 or more, things start getting serious. The likelihood of chronic pulmonary lung disease increases 390 percent; hepatitis, 240 percent; depression 460 percent; attempted suicide, 1,220 percent.”
This is akin to suggesting that a prominent physicists’ club originated the theory of relativity because its members have the equation printed on their sweatshirts. It is puzzling that Heisel does not attribute these findings to the original source: a landmark study by the Centers for Disease Control and Prevention and Kaiser Permanente led by Dr. Vincent Felitti and Dr. Robert Anda.
Heisel writes: “If you want to see for yourself what goes into the science on adverse childhood events, take an assessment yourself.” Taking the assessment will give you a sense of how many adverse experiences you may have gone through in your childhood. But if you want to understand the science behind the assessment, you could start by reading the CDC-Kaiser Permanente ACE Study.
Nowhere in the piece does Heisel mention this seminal research, which, as the CDC notes, is “one of the largest investigations of childhood abuse and neglect…and later-life health and well-being” ever done, involving 17,000 HMO members from Southern California. The federal agency has devoted an entire section to the study in its “Violence Prevention” center alone. The omission of the study in Heisel's article is particularly striking because the ACEs Too High article to which he attributed the statistics is citing them from the CDC-Kaiser Permanente study, which it discusses in detail.
(Note: After I published this article, it was brought to my attention that Heisel had written a "Part I" story about ACEs for CHJ that discussed the Felitti study, which he called "seminal." That is good to know, but I still believe that it is important to attribute or link scientific findings to the original source in every article, because readers may not have read earlier stories -- even in a series.)
Heisel's assertion that reporters can do more harm than good with “bold claims about life expectancies being chopped by decades or the rates of serious chronic diseases skyrocketing for those with higher scores” is also over-reaching. These are not ‘bold claims’; they are statistically valid findings first reported in 1998 and backed up by hundreds of other ACEs and disease studies since that time. These “claims” are no bolder than saying cigarettes are linked to lung cancer — something that Big Tobacco disputed for decades even though the science was incontrovertible.
Heisel’s argues that ACEs screening is premature until we have evidence-based interventions — an argument he attributes to sociologist and University of New Hampshire professor David Finkelhor. This is certainly a reasonable caution, but in fact we do have enough evidence already to offer some simple but effective interventions:
- Intergenerational trauma researchers from UCLA, including pediatrician Adam Schnickedanz; Dr. Alonzo Folger and team at the Cincinnati Children’s Hospital Children’s Medical Center in Ohio; and others have found interventions such as peer-to-peer parent coaches; parental self-care; a strong support network; therapy for mothers (if indicated) and helping families create warm, consistent family routines are effective in helping kids and families who are facing adversity and/or toxic stress.
- Other clinicians have stressed that the impact of ACEs can be greatly reduced and in some cases even eliminated through healthy interventions. In the journal Academic Pediatrics, Dr. Bob Sege of Tufts University outlined the HOPE framework: Health Outcomes From Positive Experiences. It calls on clinicians and families to actively promote positive childhood experiences that contribute to healthy development and well-being, including play, supportive and nurturing relationships, safe and protective schools and homes, and community involvement that creates a feeling of connectedness, to “prevent or mitigate the effect of adverse childhood experiences.”
- A recent systematic review published in the American Journal of Preventive Medicine echoed many of these findings. The review found that parenting education, social support referrals, mental health counseling and connecting families to community-based services made a significant difference in the outcomes of children exposed to ACEs. “In other words, it’s not that hard to improve the quality of the parent-child relationship, which can reduce child maltreatment and long term [consequences],” said study author and pediatrician Ariane Marie Mitchell. Scientific studies have also shown that the key domains of wellness — sleep, nutrition, exercise, nature, healthy relationships, mental health and mindfulness — can also help reduce and heal toxic stress resulting from childhood trauma.
One very real issue is that clinics nationwide urgently need more funding for behavioral health and evidence-based interventions such as parenting education. We also need to change the social inequities that contribute to ACEs and trauma. As Heisel himself writes, “If ACEs are one more reason to work toward [eliminating spousal abuse, child maltreatment, and bullying], then they could prove a useful tool.”
The Center for Youth Wellness has helped develop one of the tools designed to screen for ACEs, and we are aware of both the limitations and the benefits of such tools. Heisel admits that he “nearly” made an appointment with a doctor after an ACEs screening revealed he had five ACEs. “What might be lurking inside me that I haven’t bothered to uncover? High blood pressure? High blood sugar? Tumors?” he writes, perhaps jokingly.
Of course, an ACE score is not a diagnosis, and an increased risk does not mean that you will develop a disease; it’s simply knowledge that’s worth having. Discussing with a doctor the results of an ACE screening — which may point to an increased risk of certain conditions — can help determine a patient’s next steps. When it comes down to it, Heisel might do well to make that appointment.
Sincerely,
Diana Hembree, MSFS
Science Writer, Center for Youth Wellness
Diana Hembree, MSFS, is a former senior editor at Time Inc. Health and former news editor of the Center for Investigative Reporting. Her work has appeared on PBS Frontline, Hippocrates, the Times of London syndicate, Forbes online, Inside Philanthropy, HealthDay, and many other outlets.
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