title: Do Pediatricians Ask About Adverse Childhood Experiences in Pediatric Primary Care?
abstract: OBJECTIVE
  The stress associated with adverse childhood experiences (ACEs) has immediate and long-lasting effects. The objectives of this study were to examine 1) how often pediatricians ask patients' families about ACEs, 2) how familiar pediatricians are with the original ACE study, and 3) physician/practice characteristics, physicians' mental health training, and physicians' attitudes/beliefs that are associated with asking about ACEs.
  
  
  METHODS
  Data were collected from 302 nontrainee pediatricians exclusively practicing general pediatrics who completed the 2013 American Academy of Pediatrics Periodic Survey. Pediatricians indicated whether they usually, sometimes, or never inquired about or screened for 7 ACEs. Sample weights were used to reduce nonresponse bias. Weighted descriptive and logistic regression analyses were conducted.
  
  
  RESULTS
  Only 4% of pediatricians usually asked about all 7 ACEs; 32% did not usually ask about any. Less than 11% of pediatricians reported being very or somewhat familiar with the ACE study. Pediatricians who screened/inquired about ACEs usually asked about maternal depression (46%) and parental separation/divorce (42%). Multivariable analyses showed that pediatricians had more than twice the odds of usually asking about ACEs if they disagreed that they have little effect on influencing positive parenting skills, disagreed that screening for social emotional risk factors within the family is beyond the scope of pediatricians, or were very interested in receiving further education on managing/treating mental health problems in children and adolescents.
  
  
  CONCLUSIONS
  Few pediatricians ask about all ACEs. Pediatric training that emphasizes the importance of social/emotional risk factors may increase the identification of ACEs in pediatric primary care.
authors.affiliation: Nathan Kline Institute of Psychiatric Research, Orangeburg, NY; Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY. Electronic address: Bonnie.Kerker@nyumc.org.
authors.forename: Bonnie D
authors.initials: BD
authors.lastname: Kerker
authors.affiliation: Statistical Research Consultants, LLC., Schaumburg, Ill.
authors.forename: Amy
authors.initials: A
authors.lastname: Storfer-Isser
authors.affiliation: University of California at Los Angeles, Los Angeles, Calif.
authors.forename: Moira
authors.initials: M
authors.lastname: Szilagyi
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Ruth E K
authors.initials: RE
authors.lastname: Stein
authors.affiliation: Case Western Reserve University, School of Medicine, Cleveland, Ohio.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Garner
authors.affiliation: American Academy of Pediatrics, Elk Grove Village, Ill.
authors.forename: Karen G
authors.initials: KG
authors.lastname: O'Connor
authors.affiliation: Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY; New York State Office of Mental Health, Albany, NY.
authors.forename: Kimberly E
authors.initials: KE
authors.lastname: Hoagwood
authors.affiliation: Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Horwitz
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D002665:Child Psychiatry / Q000193:education; D016241:Child of Impaired Parents; D002675:Child, Preschool; D003866:Depressive Disorder; D004243:Divorce; D017579:Domestic Violence; D000069581:Exposure to Violence; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009035:Mothers / Q000523:psychology; D015999:Multivariate Analysis; D010372:Pediatrics / Q000193:education; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011795:Surveys and Questionnaires
keywords: ACE; adverse childhood experiences; pediatric primary care; screening