Peer-reviewed article
Pediatrics adverse childhood experiences and related life events screener (PEARLS) and health in a safety-net practice
Neeta Thakur, Danielle Hessler, Kadiatou Koita, Morgan Ye, Mindy Benson et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how adverse childhood experiences (ACEs) affect health outcomes in children aged 0-11 years attending a safety-net clinic in California. Researchers tested a screening tool called PEARLS to see if different ways of screening for ACEs would help identify at-risk children. The study found that children who experienced more adversities had worse general health, weaker executive functioning, and higher rates of stomachaches and asthma. The screening approach used did not change the relationship between adversities and poor health outcomes.
Key points
- 76% of children in the study reported experiencing at least one adversity
- Median number of adversities reported was 2, with a range of 1-5
- Each additional adversity was associated with a 0.94-point decrease in perceived general health
- Children with higher ACE scores had greater odds of stomachaches (1.14) and asthma (1.08)
- Different screening approaches (item-level vs aggregate-level) did not affect the strength of associations between adversities and health outcomes
Limitations
The study is cross-sectional, so it cannot establish whether ACEs cause poor health or if the relationship is bidirectional or confounded. The findings are specific to a high-risk urban pediatric population in one location, which may limit generalizability to other settings or populations.
Abstract
BACKGROUND: Adverse Childhood Experiences (ACEs) are associated with behavioral, mental, and clinical outcomes in children. Tools that are easy to incorporate into pediatric practice, effectively screen for adversities, and identify children at high risk for poor outcomes are lacking. OBJECTIVE: To examine the relationship between caregiver-reported child ACEs and related life events with health outcomes. PARTICIPANTS AND SETTING: Participants (0-11 years) were recruited from the University of California San Francisco Benioff's Children Hospital Oakland Primary Care Clinic. There were 367 participants randomized. METHODS: Participants were randomized 1:1:1 to item-level (item response), aggregate-level (total number of exposures), or no screening for ACEs (control arm) with the PEdiatric ACEs and Related Life Event Screener (PEARLS). We assessed 10 ACE categories capturing abuse, neglect, and household challenges, as well as 7 additional categories. Multivariable regression models were conducted. RESULTS: Participants reported a median of 2 (IQR 1-5) adversities with 76 % (n = 279) reporting at least one adversity; participants in the aggregate-level screening arm, on average, disclosed 1 additional adversity compared to item-level screening (p = 0.01). Higher PEARLS scores were associated with poorer perceived child general health (adjusted B = -0.94, 95 %CI: -1.26, -0.62) and Global Executive Functioning (adjusted B = 1.99, 95 %CI: 1.51, 2.46), and greater odds of stomachaches (aOR 1.14; 95 %CI: 1.04-1.25) and asthma (aOR 1.08; 95 %CI 1.00, 1.17). Associations did not differ by screening arm. CONCLUSION: In a high-risk pediatric population, ACEs and other childhood adversities remain an independent predictor of poor health. Increased efforts to screen and address early-life adversity are necessary.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Screening for adverse childhood experiences (ACEs) and related life events using the PEARLS tool, with randomization to item-level screening, aggregate-level screening, or control (no screening)
- Population
- Children aged 0-11 years (n=367) attending a safety-net primary care clinic in Oakland, California
Key finding
76% of participants reported at least one adversity