Many mental issues and psychological disorders originate in the affected people’s childhood. When people experience prolonged exposure to stress and its sources as children, their psyche may remain traumatized even in adolescence and adulthood, if not a whole life (Lang et al., 2017). That is why the psychological society continuously invents and develops prevention techniques that allow screening for harmful exposure and preemptively protect the children’s mental state. In particular, an adverse childhood experiences (ACEs) framework is known and appreciated for its consistency in connecting childhood traumas to the patient’s mental state. However, the adversities it promotes for the screening lack the proper systematic and empirical development. The predictive success of the chosen criteria undoubtedly validated the framework, but some studies show that specific adversities have a much more significant impact on the patient’s mental state than others (Turner et al., 2020). Consequently, the ACEs framework will be critically evaluated on the example of the recent screening conducted by Portico (CAMH Professional Videos, 2017). In addition, the practitioner’s communication techniques will be discussed on whether they achieved their purpose and if there is room for improvement.
The default ACEs list advises practitioners to screen children for experiences from three major areas. Firstly, there is a need to define whether a child is subjected to any abuse, either physical, emotional, or sexual (Turner et al., 2020). Secondly, a practitioner should understand if any type of neglect is present, either physical or emotional (Turner et al., 2020). Lastly, the remaining set of items concerns kinds of household dysfunctions, such as relatives’ mental illness, incarceration, violent treatment from their parents’ side, divorce, or drug abuse (Turner et al., 2020). Both a child and his caregiver should undergo the screening process; then, the therapist evaluates the information and diagnoses the number of ACEs – the number of criteria present in the specific case. The more ACEs are in the diagnosis, the direr the need for intervention and therapy.
The framework’s predictability of possible health outcomes motivated numerous researchers to use the original ACEs item list or close variations as the starting point. Nevertheless, a study conducted by Turner et al. (2020) focused not on the framework’s success but the evaluation of its basis. The ten-item list was increased to almost 40; additionally, a more considerable emphasis was put on the independence of particular domains in their influence on predictability. First, the study revealed that the screening predictability of specific factors significantly varies depending on the children’s age (Turner et al., 2020). For example, with sexual assault being powerfully influential in both cases, sexual harassment proved to have a more significant impact on the older youth. Second, some criteria showed a little independent effect on overall predictability (Turner et al., 2020). Thus, they could be considered mere markers for the occurrence of traumatizing events or conditions. Such was the case with parental divorce because it implies the consequent child’s exposure to parental conflict, harsh discipline, or reduced supervision.
After considering certain items’ dependability, it becomes easier to highlight the flaws of the ACEs framework in specific examples. In the video provided by CAMH Professional Videos (2017), the ACEs framework was applied to screen a ten-year-old child. The diagnosis was estimated as three ACEs – parental divorce, physical neglect, and a sense of emotional deprivation (CAMH Professional Videos, 2017). The practitioner incorporated several therapeutic communication techniques into the process. She provided him with an explanation of an upcoming interview and started with an open question. She also provided examples of answers to make her questions more specific and summarized the received information. She showed little understanding and compassion for the child, however. (CAMH Professional Videos, 2017). In addition, she made an important discovery about divorce only in the second half of the video when she asked the child about his opinion on the issue (CAMH Professional Videos, 2017). If she had asked this open question earlier, it would have saved time in understanding the primary source of the problem. It also becomes plain that divorce by itself does not affect the child as much as its consequences.
Overall, the original ACEs ten-item list proved not to be universal enough for its reliable usage as a research starting point. Undoubtedly, it contains factors that possess solid independence in predicting possible health outcomes. After interviewing a child and his caregiver, a therapist can diagnose the severity of the child’s exposure to stressful circumstances and conditions. Nevertheless, the mentioned independence of specific factors signalizes the opposite in their counterparts, which implies the need for a more statistically and empirically oriented approach for their definition. For example, certain aspects serve as indicators for other, more significant stress sources or have a different impact depending on the children’s age. As was shown in the video session, the parental divorce – labeled as one of the ACEs in the final diagnosis – was actually a source of the child’s physical and emotional neglect. In the meantime, despite the right choices of therapeutic communication techniques, their lousy timing caused the interview to last longer and resulted in a greater child’s discomfort in general.
References
CAMH Professionals Videos. (2017). Conducting a quick screen for trauma – child interview. [Video] YouTube. Web.
Lang, J. M., Ake, G., Barto, B., Caringi, J., Little, C., Baldwin, M. J., Sullivan K., Tunno, A. M., Bodian, R., Stewart, C. J., Stevens, K. & Connell, C. M. (2017). Trauma screening in child welfare: Lessons learned from five states. Journal of Child & Adolescent Trauma, 10(4), 405–416. Web.
Turner, H. A., Finkelhor, D., Mitchell, K. J., Jones, L. M., & Henly, M. (2020). Strengthening the predictive power of screening for adverse childhood experiences (ACEs) in younger and older children.Child Abuse & Neglect, 107. Web.