NPR broadcasted two related articles on 3-2-15 and 3-15-15 about an an interesting screening tool developed for physician to help them screen for adverse childhood experiences that may impact the person’s long term health. The articles, “10 Questions Some Doctors Are Afraid to Ask” and “Can Family Secrets Make You Sick?” discussed the Adverse Childhood Experience, or ACE, questionnaire. They also review research that finds a significantly higher incidence of some serious health problems for people with high scores on the screening tool. The ACE is based on a very large study with about 17,000 participants, and asked about potential childhood problems including: sexual, physical or emotional abuse; neglect; loss of a parent due to death, divorce or incarceration; mental illness in a parent; and drug or alcohol abuse by a parent. The researchers then compared the rates of serious health problems for high scorers to a control group, and found that, “adults who had four or more “yeses” to the ACE questions were, in general, twice as likely to have heart disease, compared to people whose ACE score was zero. Women with five or more “yeses” were at least four times as likely to have depression as those with no ACE points.”

The articles also, appropriately, notes that “correlation is not causation” but also noted that high ACE scorers have medical problems that are extremely expensive for the medical system. The articles go on to discuss the potential benefits of MDs routinely using the ACE, including the possibility that simply discussing the results with high scorers may provide some psychological benefits for them.

The “Can Family Secrets Make You Sick” article quotes Megan Gunnar, Ph.D., from the U. of MN, extensively. She has some interesting thoughts about how adverse childhood experiences may affect “executive function” circuits in the brain, and may make it harder for people with high ACE scores to make wise decisions and to take good care of themselves.

My take: The articles provide a lot of info about the ACE questionnaire, the research in support of it, and theories about what it is measuring, but seem to totally miss the possibility that regular use of the ACE could help MDs refer high scorers to appropriate, and potentially very helpful, mental health services. Mental health professionals interested in treating people with adverse childhood experiences could offer to partner with MDs and encourage them to use the ACE and to offer high scores specialized therapy.

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