On Becoming Trauma-Informed: Role of the Adverse Childhood Experiences Survey in Tertiary Child and Adolescent Mental Health Services and the Association with Standard Measures of Impairment and Severity

Attention, Externalizing and Internalizing Problems Mediated Differently on Internet Gaming Disorder Among Children and Adolescents With a Family History of Addiction as an Adverse Childhood Experience

BACKGROUND

This study aimed to examine the factors associated with internet gaming disorder (IGD) and the mediating role of pediatric symptoms (attention, externalizing problems and internalizing problems) in children and adolescents with a family history of addiction as an adverse childhood experience (ACE).

METHODS

A total of 2,586 children and adolescents (mean age = 14.04 ± 2.34; age range = 11-19 years; 50.5% boys) completed the Internet Game Use-Elicited Symptom Screen and the Pediatric Symptom Checklist-17. IBM SPSS Statistics 21 was used to calculate descriptive statistics and Pearson correlation coefficients and to conduct multiple regression analyses. Mediation analysis was performed using the Sobel test and the SPSS PROCESS macro. Serial multiple mediation analysis was performed using bootstrapping with 5,000 replications.

RESULTS

The higher levels of Attention problems (β = -0.228, P < 0.001) and externalizing problems (β = -0.213, P < 0.001) were associated with IGD. Furthermore, the indirect effect of the independent variable on the dependent variable through the mediators was significant (Sobel's T: Z = -5.006, P < 0.001). These findings suggest that attention and externalizing problems mediate the effect of family history of addiction on IGD.

CONCLUSION

This study demonstrated the associations among the family history of addiction, IGD, and pediatric symptoms (attention, externalizing problems, and internalizing problems) among Korean children and adolescents. Therefore, we need to pay attention to pediatric symptoms and develop systematic alternatives to improve mental health among Korean children and adolescents with a family history of addiction as ACEs.

Can the adverse childhood experiences (ACEs) checklist be utilized to predict emergency department visits among children and adolescents?

Background

Extensive literature has shown an association of Adverse Childhood Experiences (ACEs) with adverse health outcomes; however, its ability to predict events or stratify risks is less known. Individuals with mental illness and ACE exposure have been shown to visit emergency departments (ED) more often than those in the general population. This study thus examined the ability of the ACEs checklist to predict ED visits within the subsequent year among children and adolescents presenting to mental health clinics with pre-existing mental health issues.

Methods

The study analyzed linked data (n = 6100) from two databases provided by Alberta Health Services (AHS). The Regional Access and Intake System (RAIS 2016–2018) database provided data on the predictors (ACE items, age, sex, residence, mental health program type, and primary diagnosis) regarding children and adolescents (aged 0–17 years) accessing addiction and mental health services within Calgary Zone, and the National Ambulatory Care Reporting System (NACRS 2016–2019) database provided data on ED visits. A 25% random sample of the data was reserved for validation purposes. Two Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression models, each employing a different method to tune the shrinkage parameter lambda (namely cross-validated and adaptive) and performing 10-fold cross-validation for a set of 100 lambdas in each model were examined.

Results

The adaptive LASSO model had a slightly better fit in the validation dataset than the cross-validated model; however, it still demonstrated poor discrimination (AUC 0.60, sensitivity 37.8%, PPV 49.6%) and poor calibration (over-triaged in low-risk and under-triaged in high-risk subgroups). The model’s poor performance was evident from an out-of-sample deviance ratio of − 0.044.

Conclusion

The ACEs checklist did not perform well in predicting ED visits among children and adolescents with existing mental health concerns. The diverse causes of ED visits may have hindered accurate predictions, requiring more advanced statistical procedures. Future studies exploring other machine learning approaches and including a more extensive set of childhood adversities and other important predictors may produce better predictions. Furthermore, despite highly significant associations being observed, ACEs may not be deterministic in predicting health-related events at the individual level, such as general ED use.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-021-01392-w.

The Economic Impact of Providing Evidence-Based Pediatric Mental Health Literacy Training to Primary Care Physicians

OBJECTIVE

This paper presents a review of the current state of child and adolescent mental health literacy and provides current evidence of the economic impact of a pediatric mental health literacy (MHL) training program.

METHODS

Employing a case-series-comparison design, physician referrals to urgent and specialized mental health services were linked with patient-specific information comparing referrals from MHL participants and non-participating physicians. The economic impact analysis was based on changes in the admitted referral frequency and lengths of stay for the MHL group, compared to themselves pretraining, and over the same time period compared to non-participating physicians.

RESULTS

Average scheduled ambulatory admission rates per physician remained constant for trained and untrained pre-post groups. Average scheduled ambulatory admission wait time and length of stay reduced significantly post-training for MHL-trained physicians compared to pre-training and untrained physicians. In addition to reductions in length of stay, the total bed costs saving for emergency/inpatients admission deferrals was $2,932,112 or about $20,000 per MHL-trained physician.

CONCLUSION

The estimated economic impact of the MHL training shows a substantial return on investment and supports wider implementation. The MHL training program should be a key feature of mental health reform strategies, as well as continuing and undergraduate medical education.

Prevalence of and relationship between adverse childhood experiences and family context risk factors among children with intellectual disabilities and borderline intellectual functioning

BACKGROUND

Adverse Childhood Experiences (ACEs) are an overlooked risk factor for behavioural, mental and physical health disparities in children with intellectual disabilities (ID) and borderline intellectual functioning (BIF).

AIMS

To gain insight into the presence of the 10 original Wave II ACEs and family context risk variables in a convenience sample of children with ID and BIF in Dutch residential care.

METHODS AND PROCEDURES

134 case-files of children with ID (n = 82) and BIF (n = 52) were analysed quantitatively.

OUTCOMES AND RESULTS

81.7 % of the children with ID experienced at least 1 ACE, as did 92.3 % of the children with BIF. The average number of ACEs in children with ID was 2.02 (range 0-8) and in children with BIF 2.88 (range 0-7). About 20 % of the children with moderate and mild ID experienced 4 ACEs or more. Many of their families faced multiple and complex problems (ID: 69.5 %; BIF 86.5 %). Multiple regression analysis indicated an association between family context risk variables and the number of ACEs in children.

CONCLUSIONS AND IMPLICATIONS

The prevalence of ACEs in children with ID and BIF appears to be considerably high. ACEs awareness in clinical practice is vital to help mitigate negative outcomes.

Exposure to Adverse Childhood Experiences (ACEs) and Stress among the Community-based Urban Pediatric Population in Korea

BACKGROUND

This study aimed to investigate the impact of exposure to adverse childhood experiences (ACEs) and stress among the community-based urban pediatric population in Korea.

METHODS

In 2017, the analysis was conducted on 3,937 children and adolescents in an urban area in Korea based on the impact of actual traumatic experience, addiction, and mental health. The respondents were excluded if they were missing data on the survey, resulting in a final sample size of 3,556. The collected data were analyzed by applying cross-sectional and correlation analyses.

RESULTS

Among the respondents in the study group (mean age = 13.77), 43.1% were boys (n = 1,532) and 56.9% were girls (n = 2,024). Overall, 23.5% (n = 835) reported at least one ACE and 1.8% (n = 63) reported experiencing four or more ACEs. Emotional abuse (13.2%) was the most commonly reported ACE, followed by abandonment (7.7%) and physical abuse (7.5%). Self-reported measures of stress were associated with the ACE scores.

CONCLUSION

This is the first study of self-reported ACEs from a community-based pediatric population in Korea. We found that the number of the students revealed more than one ACEs was similar to the data in the US community study with self-reporting among the community samples and exposure to adverse experiences is highly correlated with various stress responses.

Impact of Central Intake Development and System Change on Per Capita Child and Adolescent Mental Health Discharges from 2002 to 2017: Implications for Optimizing System Design by Shaping Demand

INTRODUCTION

After several Canadian public hospital systems merged, a centralized intake system and associated regional access and intake system were developed and implemented for child and adolescent mental health services in 2002.

OBJECTIVES

To describe the catchment area's per capita service rates (overall and annual discharges) and changes in staff time per unit of intake activity, client wait times, and length of stay.

METHODS

Patient data (2002-2017) and census data permitted calculation of annual and overall per capita mental health service episodes of care on the basis of discharge rates. Population-based discharge rates, wait times, length of stay, and staff workload were described, referring service investment and system changes.

RESULTS

From 117,500 referrals (64% admitted and discharged; 53% female) to all regional services, 16,750 unique males and 17,140 unique females were admitted and discharged between April 1, 2002, and March 31, 2017. Per capita annual discharge rates increased over baseline 1.8-fold for both sexes, and investments increased 2.8-fold. Wait times and length of stay decreased in the 90th percentile over time for both scheduled (ambulatory) and urgent/emergent service levels. Staff workload increased.

CONCLUSION

Per capita system capacity increased but did not change in linear relation to investment, even though wait times and length of stay decreased. Steps focusing on future optimization of system capacity are discussed using a novel concept termed shaping demand, which refers to strategies for orienting/educating families after referral and before admission. Two new education programs focus on community-based primary care physicians and school-based services.

Prevalence of adverse childhood experiences (ACEs) among US children

OBJECTIVE

The purpose of this study was to estimate the prevalence of adverse childhood experiences (ACEs) among children in the United States and to examine the relationship between child and family characteristics and the likelihood of reported exposure to ACEs.

METHODS

Data were drawn from the nationally representative 2016 National Survey of Children's Health (NSCH). Parent-reported child ACE exposure was measured using counts of those reporting zero ACEs, one to three ACEs, and four or more ACEs.

RESULTS

The study sample included 45,287 children. The most prevalent types of ACE exposure experienced by children were economic hardship (22.5%) and parent or guardian divorce or separation (21.9%). Older children (34.7%), Non-Hispanic African American children (34.7%), children with special health care needs (SHCN; 36.3%), children living in poverty (37.2%), and children living in rural areas (30.5%) were more likely to be exposed to parental divorce or separation than their counterparts. Five cross-cutting factors emerged as important across outcomes: child's age, family structure, poverty, type of health insurance, and SHCN status.

CONCLUSIONS

We found high prevalence rates of economic hardship on a national level. Our findings of higher prevalence among rural children further suggest the importance of the intersection of place and ACEs. Therefore, the geographic component of ACEs must be considered by policymakers. The identification of predictive factors related to high ACE exposure can inform early interventions at the national level.

Relationship Between Adverse Childhood Experience Survey Items and Psychiatric Disorders

CONTEXT

Developmental psychopathology theory suggests a relationship between early childhood adversity and mental disorder.

OBJECTIVE

To examine the relationship between the specific items on the Adverse Childhood Experiences (ACE) survey and the International Classification of Diseases, Tenth Revision (ICD-10) categories of psychiatric diagnoses in a pediatric sample.

DESIGN

The sample included patients enrolled in the Child and Adolescent Addiction Mental Health and Psychiatry Program with both a completed ACE survey and at least 1 diagnosis of record (per admission). These criteria yielded 2 samples for each sex (ACE survey item frequencies and values in collapsed and multiple-admission groups). Data were analyzed employing tetrachoric correlation, hierarchical regression, and polychoric factor analysis.

RESULTS

Hierarchical regression analysis identified that ICD-10 diagnostic categories, except for substance disorders, were not consistently related to ACE total score and tended to reduce the magnitude of the ACE total score in the multiple-admission group. Tetrachoric correlation revealed very low (< 0.4) positive and negative correlations between ICD-10 categories and ACE items in both multiple-admission and collapsed sample groups. Polychoric factor analysis indicated that the ACE survey items and the ICD-10 categories for both sexes were independent, with only the diagnostic ICD-10 category substance disorders being marginally associated with the ACE items factor for females.

CONCLUSION

The nominal relationship between ACE items and ICD-10 diagnostic categories indicates the need to include ACE assessment in advance of differential diagnosis and implementation of conventional mental health interventions for children and adolescents.