PC2038: Prospective Validity of the Whole Child Assessment in a Generally Healthy Pediatric Cohort

Background: Exposure to adverse childhood experiences (ACEs) is associated with increased risk of poor health outcomes. Several tools to identify ACEs during pediatric practice have been developed, but few include all ten ACEs identified in the original ACE study and none have established prospective validity. The aim of this study was to assess prospective validity of the ACE score reported during routine pediatric practice using the Whole Child Assessment (WCA).

Methods: This study included children ages 3 to 8 years who presented for well-child care at a low-income resident clinic between May 25, 2016, and April 4, 2018, and ages 5 to 8 years who presented for well-child care at a private insurance clinic between November 1, 2017, and March 31, 2018. Patients with chronic health problems were excluded from the initial cohort to prevent confounding by the presence of preexisting health problems when evaluating the impact of ACEs on health outcomes. Chart reviews were conducted to collect data on and analyze differences in follow-up health and psychosocial outcomes between children with 0-1 ACEs (lower risk group) and 2+ ACEs (higher risk group) at baseline. Follow-up data was obtained from diagnoses documented in the medical record, as well as parent-reported outcomes on the WCA. We hypothesized that children in the higher risk group would have more health and psychosocial problems at follow-up compared to children in the lower risk group.

Results: The initial cohort (n=907) consisted of 669 children with 0-1 ACEs and 238 children with 2+ ACEs at baseline. At follow-up (mean 718 days, range 329 days to 1155 days), children in the higher risk group had statistically significant higher rates of ADHD/ADD (4.11, 1.124–15.033, p=0.033), school failure/learning problem (7.403, 1.921–28.527, p=0.004), and other behavioral/mental problems (2.084, 1.087–3.995, p=0.027). At follow-up, parents of children in the higher risk group also reported higher rates of being nervous or afraid (OR 1.807, 95% CI 1.029–3.176, p=0.040), feeling sad or unhappy (2.122, 1.123–4.012, p=0.021), having trouble paying attention or staying still (1.978, 1.26–3.105, p=0.003), getting angry or into fights (3.943, 2.158–7.206, p< 0.001), getting bullied (3.112, 1.638–5.913, p=0.001), poor sleep (2.796, 1.81–4.317, p< 0.001), and healthcare utilization at other clinics (1.934, 1.092–3.424, p=0.024). There was no statistically significant difference in various physical health concerns measured.

Conclusion: This study supports the prospective validity of the WCA, particularly with respect to predicting patient populations at risk of developing poor mental health and social-emotional concerns. While more research is needed to facilitate translation into pediatric practice, these results suggest that identifying and addressing ACEs may help to prevent poor outcomes.