P3A151: Aces Questionnaires: Let's Talk About It

Background: There is substantial evidence that Adverse Childhood Experiences (ACEs) are associated with health risk behaviors in adulthood, ranging from smoking, alcohol use, and risky sexual behavior. ACEs included psychological/emotional abuse, physical neglect, and the psychological neglect of basic needs (Ramiro et al, 2010). Children with specific developmental disabilities, such as autism, have been found to have an increased risk for ACEs. Screening children for these experiences is recommended due to their long-term impact, and community experiences such as discrimination and neighborhood violence are often included (Benard et al, 2022). In our clinic sites, very few caregivers endorsed discrimination or community violence on their ACEs form, despite high rates of violence and racial discrimination in the greater Baltimore area. First, we aimed to understand if the number of ACEs reported by caregivers of children in a clinical sample differed based on the method of inquiry. Specifically, we aimed to investigate differences between written and oral reports of ACEs, with a focus on targeted interview probes in the discrimination and community violence items. Second, we aimed to identify themes in respondents’ interpretation of the ACEs items in oral interviews.

Methods: Caregivers were recruited from two developmental behavioral pediatrics specialty clinic sites in the greater Baltimore area. Parents completed the paper version of the Center for Youth Wellness ACEs questionnaire divided into two sections. During the oral interview, we asked additional probes focused on community violence exposure and discrimination items in section 2 of the questionnaire. To answer Aim 1, we compared the written versus oral answers to section 1,section 2, and the total score using paired t-tests. For Aim 2, we qualitatively explored themes in participants’ responses to the oral questions.

Results: A total of 35 patients and their caregivers participated in the study. We found a statistically significant difference (p <.05) between the mean total number of ACEs reported in an oral interview (1.63) versus on the written questionnaire (1.03). There was also a statistically significant difference in mean ACEs reported in section 2 of the questionnaire; oral interview with 0.60 and written questionnaire with 0.37. Our preliminary qualitative analyses included themes of uncertainty if the caregiver is able to answer from the child’s point of view and uncertainty of certain events in the child’s life.

Conclusion: We identified a small, yet statistically significant difference in the number of ACEs reported in written versus oral questionnaires. Our results suggest the potential benefit of administering the ACE survey orally, in order to, discuss specific items with the patient and caregiver. Furthermore, our results suggest the importance of including the child in the interview when possible, as caregivers were not fully knowledgeable about some items. Future research with larger samples is needed to confirm findings.