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Updated: Dec 24, 2025
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Use of the Whole Child Assessment to identify children at risk of poor outcomes
Ariane Marie-Mitchell1, Heather B R Watkins2, Ivan A Copado1
1Loma Linda University Preventive Medicine & Pediatrics Departments, Loma Linda, CA, United States.
Insights
Screening for Adverse Childhood Experiences (ACEs) in children using the Whole Child Assessment is valid. This tool effectively identifies children at risk for poor health and psychosocial outcomes, aiding early intervention.
Area of Science:
- Pediatric Health
- Psychosocial Outcomes
- Adverse Childhood Experiences Research
Background:
- Screening for Adverse Childhood Experiences (ACEs) in pediatric patients is crucial for preventing associated poor health outcomes.
- Existing tools often fail to screen for all ten ACEs across all pediatric age groups and lack demonstrated validity.
- There is a need for validated screening tools to assess ACEs in children.
Purpose of the Study:
- To evaluate the validity of the Whole Child Assessment (WCA) in identifying Adverse Childhood Experiences (ACEs).
- To examine the associations between WCA responses regarding ACEs and poor health outcomes in pediatric patients.
- To determine if WCA is a reliable tool for screening ACEs in children aged 5-11.
Main Methods:
- A cross-sectional study involving 499 children aged 5-11 years old from two university-affiliated clinics in California.
- Caregivers completed the Whole Child Assessment, including all Child-ACE measures, during well-child visits.
- Medical records were reviewed for diagnoses, developmental delays, and healthcare utilization to assess outcomes.
Main Results:
- Patients with two or more reported ACE exposures showed significantly higher rates of sadness, anger, sleep problems, bullying, school problems, and enuresis compared to those with 0-1 exposures.
- Including questions about the risk of ACEs in the total Child-ACE score improved the directionality and number of statistically significant associations.
- The Whole Child Assessment demonstrated strong relationships between reported ACEs and adverse child health and psychosocial outcomes.
Conclusions:
- The Whole Child Assessment demonstrates strong validity for screening Adverse Childhood Experiences (ACEs) in pediatric patients aged 5-11.
- The findings support the use of the Whole Child Assessment during routine well-child visits for early identification of ACEs.
- This validated screening approach can facilitate timely interventions to mitigate the long-term health impacts of ACEs.
Background:
Screening for Adverse Childhood Experiences (ACEs) in pediatric patients has the potential to prevent poor health outcomes associated with ACEs. Only a limited number of tools screen for all ten ACEs in all pediatric age groups, and none of these have demonstrated robust validity to date.
Objective:
In order to evaluate the validity of the Whole Child Assessment, we examined associations between poor outcomes in pediatric patients and responses to questions about exposure to and risk of ACEs.
Methods:
This cross-sectional study used medical record data from 499 children ages 5-11 years old who received care at one of two university-affiliated clinics in California. All Child-ACE measures were included on the Whole Child Assessment, which caregivers completed when they brought their child to a well-child visit. Medical charts were reviewed for current diagnoses and problems, current or past history of any developmental delay, and health care utilization.
Results:
Compared to lower risk patients (0-1 reported ACE exposure), patients with 2 or more reported exposures were statistically significantly more likely to experience sadness, anger, sleep problems, bullying, school problems, and enuresis. The directionality of effects and the number of statistically significant associations improved when adding questions about risk of ACEs to the total Child-ACE score.
Conclusion:
We found strong relationships between Child-ACEs reported on the Whole Child Assessment and odds of poor child health and psychosocial outcomes in pediatric patients age 5-11 years old, which supports the validity of using the Whole Child Assessment at well-child visits.
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