Protective hand shielding a child from dark clouds.

ACEs and Children: A Simple Guide to Screening and Supporting Kids

Lena Voss in Health & Wellness July 2025 • 5 min read.

"Learn how easy it is for family doctors to use Adverse Childhood Experiences (ACEs) screening to detect early childhood traumas and offer real help."

Adverse Childhood Experiences (ACEs) can have lasting effects on a child's well-being. ACEs are stressful or traumatic events, including abuse, neglect, and household challenges. These experiences can increase the risk of health problems, mental illness, and substance abuse later in life. That's why it’s super important to spot ACEs early, so we can help kids and families get the support they need.

The ACEs screening tool is a simple questionnaire that helps healthcare providers identify children who have experienced trauma. While modifications to the original adult questionnaire have been made to be more appropriate for children, the core ten ACE exposures remain the same across both versions. It’s quick, easy to use, and can provide valuable insights into a child's life. However, despite its benefits, many doctors don't use it regularly. This gap between what we know works and what we actually do in practice needs to be addressed.

This article will help you understand why ACEs screening is important and how to make it part of your regular checkups. We'll look at the common reasons doctors avoid screening and offer practical tips to make the process more efficient, sensitive, and effective. By the end, you'll see how ACEs screening can be a simple way to improve the health and well-being of your patients.

Why Aren't More Doctors Screening for ACEs?

Protective hand shielding a child from dark clouds.

Many doctors know that ACEs are harmful, but they often don't screen for them. Some doctors might think ACEs are only a mental health issue and outside their expertise. They might worry about opening a 'can of worms' without knowing how to handle it or feel they don't have the time or resources to address the issues that come up.

But, the good news is that ACEs screening doesn't have to be a big, scary process. Research shows that it can be done quickly and doesn't require extensive mental health training. Plus, parents are generally okay with ACEs screening and find it helpful for their children's care. By addressing ACEs in standard pediatric care, we can actually improve health outcomes for kids.

Here's how to make ACEs screening work in your practice:

Explain the Why: Tell parents and kids why you're asking these questions. Let them know that these stresses can increase the risk of illness and that you're asking everyone to identify these issues early and help reduce them.
Confidentiality Matters: Make it clear that their answers are confidential, except if the child is at risk of serious harm from abuse or neglect.
Get Everyone Involved: Have both the parent and child fill out the ACE questionnaire. For kids under 12, it might be easier for the doctor to ask the questions verbally to ensure clarity and accuracy.

It’s important to address any differences in how parents and children answer the questions. Sometimes, parents may not be aware of their child's perceptions, or they may under-report the stresses in the family. Watch videos to guide you on quick ACEs screening with parent and child at: www.porticonetwork.ca/web/childhood-trauma-toolkit/developmental-trauma/how-does-it-present

Turning Screening Into Action

Reviewing the ACE score with the child and family and discussing its significance is very important. Engage with them in a way that shows you care, emphasizing collaboration and support. Explain that early action can reduce these ACE stresses and that it’s an investment in the child's lifelong health. If the child has any current health issues, link them to the ACE score, explaining that addressing ACEs can improve their health by lowering stress hormones. Consider family therapy or parenting support for those with parental mental health or substance use issues.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1093/pch/pxy146, Alternate LINK

Title: How To Screen For Aces In An Efficient, Sensitive, And Effective Manner

Subject: Pediatrics, Perinatology and Child Health

Journal: Paediatrics & Child Health

Publisher: Oxford University Press (OUP)

Authors: Priya Watson

Published: 2018-12-11

Everything You Need To Know

What are Adverse Childhood Experiences (ACEs) and why are they so important to identify early in children?

Adverse Childhood Experiences (ACEs) are stressful or traumatic events that a child might experience, such as abuse, neglect, or household challenges. Identifying ACEs early is crucial because these experiences can have lasting effects on a child's well-being. Early identification allows healthcare providers to offer support and interventions that can reduce the risk of health problems, mental illness, and substance abuse later in life. It's about giving kids the chance to overcome the challenges they've faced and improving their overall health.

How does the ACEs screening tool work, and what are the key steps for healthcare providers when using it?

The ACEs screening tool is a simple questionnaire designed to help healthcare providers identify children who have experienced trauma. The core ten ACE exposures remain the same across both versions. When using the tool, it’s crucial to explain to parents and kids why you're asking these questions, emphasizing that these stresses can increase the risk of illness. Ensure confidentiality, except in cases where the child is at risk of serious harm. It’s often beneficial to have both the parent and child fill out the ACE questionnaire, and for younger children, the doctor may ask the questions verbally. Finally, review the ACE score with the child and family, discussing its significance, and offering support.

Why don't many doctors use ACEs screening regularly, and how can they overcome common barriers to implementation?

Many doctors are aware of the negative impact of ACEs but still don't screen for them regularly. Some doctors believe that ACEs are primarily a mental health issue, while others express concerns about a lack of time or resources. However, screening doesn't have to be a complex process. Doctors can integrate it into standard pediatric care, reassuring parents that their answers are confidential (except in cases of serious harm). Addressing differences in how parents and children answer the questions, and then turning the screening into action by discussing the ACE score and its implications, can make the process manageable and effective.

What is the significance of confidentiality in ACEs screening, and what are the exceptions to this rule?

Confidentiality is a critical aspect of ACEs screening to build trust with families and encourage open and honest responses. Healthcare providers must assure parents and children that their answers will be kept confidential. However, there's a crucial exception: if the child is at risk of serious harm from abuse or neglect, confidentiality cannot be maintained. In such cases, the provider must prioritize the child's safety and take appropriate action to protect them. This balance between privacy and protection is essential for responsible and effective ACEs screening.

Once an ACE score is obtained, what are the recommended steps for healthcare providers to take to support the child and family?

After obtaining an ACE score, healthcare providers should review the results with the child and family, emphasizing collaboration and support. It's important to discuss the significance of the score, explaining how early action can reduce ACE stresses and positively impact the child's lifelong health. If the child has current health issues, link them to the ACE score to illustrate the connection between ACEs and their health. Consider offering family therapy or parenting support, especially if there are parental mental health or substance use issues. The goal is to help the family understand the impact of ACEs and provide resources for improvement.