Predictive Validity of the Whole Child Assessment in a Generally Healthy Pediatric Cohort

Abstract

Background: Adverse childhood experience (ACE) exposure is associated with increased risk of poor health outcomes. Several tools to identify ACEs during pediatric practice exist, but few include all 10 ACEs from the original ACE study and none have established predictive validity. Objectives: Assess predictive validity of the ACE score reported during routine pediatric practice using the Whole Child Assessment (WCA). Methods: This retrospective cohort study included children ages 3 to 8 years presenting for well-child care at a low-income resident clinic between May 25, 2016 and March 31, 2018, and ages 5 to 8 years presenting for well-child care at a private insurance clinic between November 1, 2017 and March 31, 2018. Patients with chronic health problems were excluded to prevent confounding by preexisting health problems. The charts of children with 0 to 1 ACEs (lower risk) and 2+ ACEs (higher risk) at baseline were reviewed to collect data on health and psychosocial outcomes at follow-up from diagnoses documented in the medical record and parent-reported outcomes on the WCA. Logistic regression models adjusted for age, gender, and clinic were used to analyze differences in outcomes. We hypothesized that children in the higher risk group at baseline would have more health and psychosocial problems at follow-up. Results: The initial cohort (n = 907) had 669 children with 0 to 1 ACEs and 238 children with 2+ ACEs. At follow-up (mean 718 days, range 329-1155 days), children in the higher risk group had statistically significantly higher rates of ADHD/ADD, school failure/learning problem, and other behavioral/mental problems. Parents of these children also reported on the WCA higher rates of children being nervous or afraid, feeling sad or unhappy, having trouble paying attention or staying still, getting angry or into fights, bullying, poor sleep, and healthcare utilization. There were no statistically significant differences in various physical health concerns measured. Conclusion: This study supports the predictive validity of the WCA to identify subpopulations at risk of developing poor mental health and social-emotional outcomes. While more research is needed to facilitate translation into pediatric practice, these results highlight the strong influence of ACEs on mental health outcomes.