Families trust and look to their pediatricians for guidance about parenting and help with managing behavioral, mental health and developmental problems. Pediatricians have since realized that how parents raise their children is heavily rooted in the parent’s own childhood experiences. As you may know cumulative adverse childhood experiences, especially in the first three years of life, have a profound negative effect on a child’s physical health, brain development and mental health.
This study by Szilagyi et al., looked at factors associated with whether pediatricians inquire about parent’s adverse childhood experiences. They used data from the 85th Periodic Survey of the American Academy of Pediatrics (AAP), which included 302 practicing pediatricians who answered questions regarding their beliefs about childhood stressors and their role in advising parents and whether they asked about parents’ ACEs. The AAP now encourages pediatricians to promote resilience through early identification and management of families at risk, focusing on strengthening the child and family as well as, teaching effective positive parenting strategies. As of 2013 there wasn’t a validated screening tool in place so the recommendation was to inquire about ACEs during well child visits.
Below are they survey results they found:
Asking about Parental ACEs- only a small proportion recall asking parents about their childhood adversities. 61% did not ask about any parental ACEs. 24% asked about 1 to 2 parental ACEs, and only 15% asked about 3 or more parents ACEs. The most frequently asked ace was about family history of mental illness
Familiarity with ACEs study- respondents were largely unfamiliar with the ACEs study. Only 2% were very familiar, 8% were somewhat familiar and 13% were vaguely familiar and 76% were not at all familiar.
Beliefs about impact of ACEs- Nearly all respondents recognized the impacts of ACes on developmental and mental health outcomes. They were in agreement that excessive or prolonged stress can have a negative impact on brain development and educational achievement as well as coping with future stress.
Parenting and Role of Pediatrician- 84% of pediatricians agreed that stable and supportive adult relationships can mitigate the negative effects of persistent childhood stress. They also feel that they have an effect on influencing positive parenting skills and that screening for social-emotional risk factor should be within the scope of the pediatric medical home.
This study demonstrated that there was indeed a lack of knowledge around adverse childhood experiences. The American Academy of Pediatrics has since been working hard to fill the knowledge gap addressed in this study. One of the challenges addressed in moving forward was who should be screened and is there a need for universal assessment?
What do you think?
Original article for reference:
Szilagyi, M., Kerker, B. D., Storfer-Isser, A., Stein, R. E., Garner, A., O'Connor, K. G., & ... McCue Horwitz, S. (2016). Pediatric Practice: Factors Associated With Whether Pediatricians Inquire About Parents' Adverse Childhood Experiences. Academic Pediatrics, 16668-675. doi:10.1016/j.acap.2016.04.013
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