Adverse childhood experiences: Can individual screening scores predict future health?

Children may be resilient, but the long ranging impact of adverse childhood experiences has become increasingly researched and better understood. An investigation in JAMA Pediatrics looks into whether screening for them can be used to accurately predict any individual risk for health problems later on in life.¹

The researchers used 2 birth cohorts: the Dunedin Multidisciplinary Health and Development Study, which included 1037 participants who were born between 1972 and 1973 and were followed until they were aged 45 years; and the Environmental Risk (E-Risk) Longitudinal Twin Study, which used 2232 participants who were born between 1994 to 1995 and were followed up until they were aged 18 years.

A total of 2009 participants from E-Risk and 918 participants from the Dunedin cohort were included in the research. The researchers found that in the E-Risk cohort, participants with higher adverse childhood experience were at greater risk of later health problems (any mental health problem: relative risk, 1.14 [95% CI, 1.10-1.18] per each additional adverse childhood experience; any physical health problem: relative risk, 1.09 [95% CI, 1.07-1.12] per each additional adverse childhood experience), Additionally, they found that adverse childhood experience scores were linked with health problems independent of the information that a clinician would typically have. However, they found that adverse childhood experience scores had poor accuracy when used to predict individual risk of later health problems (any mental health problem: area under the receiver operating characteristic curve, 0.58 [95% CI, 0.56-0.61]; any physical health problem: area under the receiver operating characteristic curve, 0.60 [95% CI, 0.58-0.63]; chance prediction: area under the receiver operating characteristic curve, 0.50). In the Dunedin cohort, the findings were consistent when using prospective and retrospective adverse childhood experience measures.

The investigators concluded that despite the efficacy of using adverse childhood experiences to predict the average group difference in health, such scores are not effective in accurately predicting one person’s risk of later health problems. They believe that their findings indicate that use an adverse childhood experience screening to target interventions would be an ineffective way to protect an individual from poor outcomes.

Reference

1. Baldwin J, Caspi A, Meehan A, et al. Population vs individual prediction of poor health from results of adverse childhood experiences screening. JAMA Pediatr. January 25, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2020.5602