Relationship Between Adverse Childhood Experience Survey Items and Psychiatric Disorders

Abstract

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. METHODS This research was conducted underThe University of Calgary Research Ethics Board approval (REB15-1057). Staff training on the collection of the ACE survey, the details of data collection, storage, and retrieval, as well as the relationship of ACE scores to clinical and demographic variables have been described. 1 This article focuses on the relationship of individual ACE survey items to psychiatric diagnoses of record. For each separation from service, where applicable, at least 1 and often several psychiatric diagnoses assigned by the attending resident or psychiatrist were recorded in each patient's file and entered into the electronic Regional Access and Intake System (RAIS).

The Relationship of Adverse Childhood Experience and Clinical Outcomes for Admissions to Child and Adolescent Mental Health Services

“…The present results do not include any definition of the therapeutic type, context, milieu, or quality in relation to age or diagnosis [28]. While the accountability system is presently trauma-informed [10,11], and is possessed of the ability to measure the effect of community-level professional training on the frequency and quality of referrals from primary care [5] to date, there has not been a concerted effort to quantity the type, context, milieu, or quality of therapy with linkage to clinical outcomes. unaccounted for.…”

“…This is a necessary step in order to more precisely identify what interventions work for what forms of traumatic experience. This is especially the case given the absence of relationship between psychiatric disorders and ACE survey items in a large sample analysis, with the exception of substance use disorder [10]. The present work may be the first wherein ACEs and clinical outcomes are examined in a large clinical sample.…”

“…The results have been formidable. While there is a palpable relationship between ACE survey score and clinical severity on admission [20], there is little, if any, relationship between the ACE items and discharge psychiatric diagnosis in complex multivariable analysis [10]. These two findings point to the need to fundamentally change the pedagogical and practice approaches to assessment and treatment, especially given the movement over the last decade toward trauma-informed, -competent, and -focused treatment, foci largely that flow from wide dissemination of the ACE study results.…”

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

“…[8][9][10] This method of clinical practice measurement has been shown to inform guidelines in respect to clinical screening, assessment, and illustrated the need for a practice paradigm shift in respect to trauma-informed care assessment, diagnosis and treatment planning. 11,12 In addition to mapping onto the recent provincial SMART goals (Specific, Measurable, Attainable, Rewarding, and Timely), a the method underpinning the clinical measurement in this paper has been generalized into a model applicable to any division of medical practice and education, 13 a model recently reviewed in Family Medicine. 14 A critical piece of any strategy building capacity to improve mental health care services delivery to children and youth in the community needs to focus on the settings that young people naturally visit, such as during regular annual visits to primary care physicians.…”

“…The measurement system employed in the CanREACH evaluation has been shown to integrate well into clinical practice and, in and of itself, to be valid, reliable, and economical [ 8 - 10 ]. This method of clinical practice measurement has been shown to inform guidelines in respect to clinical screening, assessment, and illustrated the need for a practice paradigm shift in respect to trauma-informed care assessment, diagnosis and treatment planning [ 11 , 12 ]. In addition to mapping onto the recent provincial SMART goals (Specific, Measurable, Attainable, Rewarding, and Timely),a the method underpinning the clinical measurement in this paper has been generalized into a model applicable to any division of medical practice and education [ 13 ], a model recently reviewed in Family Medicine [ 14 ].…”