Adverse childhood experiences (ACES) screening in pediatric primary care: Is "social drivers of health (SDOH) screening" sufficient?

Adverse childhood experiences (ACEs) are established predictors of long-term health risks. While pediatric practices increasingly screen for social drivers of health (SDOH) and other family psycho-social stressors, routine ACEs screening is not recommended due to lack of evidence for long-term benefit and concerns over stigmatization, re-traumatization, and non-standardized follow-up protocols. We piloted routine ACEs screening in Pediatric Primary Care practices that already routinely screen for SDOH, maternal depression and intimate partner violence (IPV). This retrospective chart review (2016-2020) explored the extent to which these family psycho-social screenings could serve as a relative proxy for ACEs identification. Among 1492 participants (738 children aged 0-5 and 690 caregivers mean age 30.3 ± 6.9), ACE and SDOH screening results were significantly associated (p < 0.002), particularly with housing insecurity (p < 0.014). However, 51.7% of individuals who reported a positive ACE screen were not flagged by the SDOH measure (false negatives), indicating relatively poor sensitivity. The negative predictive value for negative SDOH screens and negative ACEs was higher at 86%. These findings suggest that SDOH screening misses over half of true positives, and therefore reliance on SDOH screening alone may underestimate ACE exposure in pediatric primary care.