328 - Adverse and Positive Childhood Experiences: A Scoping Review

Poster Number: 328
Publication Number: 328.447

Robert Sege, Tufts Medicine, Boston, MA, United States; Dina Burstein, Tufts University School of Medicine, Boston, MA, United States

Background: The original Adverse Childhood Experience (ACE) study was published in 1998, and has been the basis of many studies. More recently, several shortcomings have become apparent: the list of 10 experiences could be updated and expanded, and Positive Childhood Experiences (PCEs) that mitigate the effects of ACEs are not included.

Objective: Describe the body of literature on the topics of the original ACEs, expanded ACEs (ExACEs), and positive childhood experiences (PCEs), in order to identify gaps in evidence and to prepare for systematic evidence review(s).

Design/Methods: We conducted a systematic scoping review according to PRISMA standards: bibliographic review across multiple databases, screening of titles and abstracts to eliminate irrelevant articles, full text screening to identify relevant articles, data abstraction, and analysis and reporting. Scoping reviews do not include an assessment of data quality. This study included only English language reports of studies conducted in the US that reported associations between exposures and outcomes.  Studies of people from other countries and prevalence studies were not included.

Results:

	Identified	Full Text screen	Included in report
ACEs	4,048	187	19
Expanded ACEs	6,617	368	51
PCEs	8,919	759	220

As shown in the table, over 23,000 articles were screened.

Only systematic reviews were considered for the original ACEs, 19 studies were included, and these reported 33 associations with abuse, 11 with family factors, and 7 with neglect. Few studies looked at physical health outcomes, 

51 original reports related to expanded ACEs were included.  Exposures included bullying, discrimination, exposure to violence, and harsh parenting.  Mental health outcomes were most commonly reported for ACEs and exACEs. 

220 original articles concerning PCEs were included. Analytic categories were based on the HOPE - Healthy Outcomes from Positive Experience framework, categorized as relating to environment, relationship, and social engagement. The largest volume of literature related to caregiver relationships, school environment, and opportunities for community and spiritual engagement. Much of the data was derived from a small number of surveys.  PCEs were inconsistently defined.

Conclusion(s): Physical health outcomes of ACEs, ExACEs and PCEs were understudied.  Available data would support exploration of revised ACEs tools and concepts, including both an expanded list of possible ACEs and measurement of mitigating positive childhood experiences.