Childhood adversity & lifelong health: From research to action
Childhood adversity is a significant root cause of chronic illness and early death. Prevention, mitigation, and Tx of toxic stressors must be part of our paradigm of care.
PRACTICE RECOMMENDATIONS
› Refer eligible patients to an evidence-based perinatal home-visiting program and all parents to an evidence-based parenting program to prevent childhood adversity. A
› Consider screening adult patients and parents for their own history (and their children’s history) of childhood adversity. B
› Recommend trauma-focused cognitive behavioral therapy and eye-movement desensitization and reprocessing as first-line treatments for adversity and trauma. A
› Consider prescribing yoga, neurofeedback, and other neuromodulatory modalities to treat the consequences of childhood adversity and trauma. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Triple P. A randomized controlled trial of Triple P, an evidence-based, multilevel, population-based preventive intervention system that was designed to support parents and enhance parenting practices for families with at least 1 child (birth to 12 years old), demonstrated a statistically significant reduction in substantiated child maltreatment cases, out-of-home placements, and emergency room visits and hospitalizations for childhood injuries that were the result of child maltreatment.24
The Family-Centered Medical Home, a primary care strategy to reduce premature and low-birth-weight deliveries, used Medicaid dollars for services not traditionally considered “medical” to address all physical and emotional needs of mothers and families as part of the medical relationship. This program eliminated premature delivery and low birth weight,25 both considered evidence of in utero toxic stress.26
Screening can be brief: In some cases, a single question
The prevalence and impact of childhood adversity, along with the opportunity for significant health improvements and savings, inspires providers to explore screening. Existing screening programs have consistent goals27,28:
- identify unique experiences shaping our patients’ health
- reframe “What’s wrong with you?” as “What happened to you?” “What’s right with you?” and “What matters to you?”
- facilitate health education and neuro-education, particularly meaning-making and self-regulation
- prevent and mitigate the sequelae of exposure to ACEs
- promote health in this and subsequent generations.
The ACE Study screened patients in the context of a comprehensive periodic health assessment. Study participants completed an at-home questionnaire and reviewed it with their physician.1 The Urban ACE Survey added important community stressors such as neighborhood violence, bullying, and food insecurity to the original ACE questionnaire.2
Primary care tool. Wade developed a short, 2-question ACE pre-screener for primary care29 and is exploring screening for childhood adversity in pediatric practice, as are primary care clinicians around the country.
Continue to: Single-question screener
