Childhood trauma evaluations now used to gauge health of adults, expectant mothers

Intuition would tell you that bad experiences in childhood could lead to more bad things down the road, but doctors in Alberta are now finding new ways of integrating the research on childhood adversity into their day-to-day care. 

The medical term is adverse childhood experiences, or ACEs, and they include everything from childhood abuse to moving often, or having a family member with mental illness.  

Julie McManus remembers the years she spent coming to terms with what happened to her as a child. She went through a lot, from her parents' divorce, to sexual abuse and being sold to perform sexual acts. 

McManus, now a mother herself, has a four-month-old son and three daughters. But when the doctor she was seeing for prenatal care initiated a conversation about McManus's childhood, it changed the dynamic of their doctor-patient relationship. 

"I'm a huge advocate for mental health awareness and especially with postpartum. I experienced terrible postpartum with one of my pregnancies. And so, I was all for it." 

'It's a blessing'

Dr. Teresa Killam is a family physician and works with low-risk obstetrical patients at Calgary's Riley Park Maternity Clinic. She began using the clinically-recognized ACEs questionnaires with her patients as a part of a pilot project.

Ten questions give you a score between one and 10, which Killam calls "a history taking tool."

Killam doesn't ask her patients to discuss the events of their childhood but only to reveal the overall score. And so far the feedback from patients has been great.

It makes it feel like those experiences weren't for nothing. You can take those things and turn them around.- Julie McManus, a patient of Dr. Teresa Killam 

"Somebody asking about it to learn how they can better help or treat people who have been through these things, it makes it feel like those experiences weren't for nothing. You can take those things and turn them around," McManus told CBC News. 

"There's a level of trust with [Dr. Killam] that I've never experienced with any other doctor or even psychologist because she doesn't have to ask that, she doesn't have to be involved. Her job is the physical side, her job is the baby side.

"It's a blessing."

​'Your ACE score is not your destiny'

High ACE scores can be an indicator for a number of medical issues. The one of most concern to new moms is postpartum depression, Killam explained in an interview.

She said evaluating ACEs scores allows her and her team to prepare for care to address that higher risk, or even possible prevention.

But Killam has also seen that the questionnaire allows patients to feel comfortable discussing some parenting resources they might not feel they have access to.

"So I think it's opening a door for that conversation," Killam said. 

​"Your ACE score is not your destiny, it's not deterministic. It is a risk factor that may help us better understand what you might be at risk for in terms of your health over the long run. It also is only one piece of that puzzle," Killam said.

High score indicator for digestive problems, headaches, higher medical costs

Keith Dobson is a clinical psychologist and professor at the University of Calgary and he's been focusing his research on ACEs and their health impacts.

"Ideally, of course, people would not experience ACEs in the first instance. But when they do experience them, we know that there's a relationship between those experiences and long-term health," said Dobson.

​"They take three main forms: child abuse, child neglect and what we call general adverse experiences — households kinds of dysfunction. There are actually specifically 10 different types of ACEs that we assess in most of our research, which go across those three domains." 

The relationship between ACEs and long-term health impacts has been studied before, but Dobson's new, still unpublished research shows the trends hold true for Albertans.

More than 4,000 Calgarians participated in the study.

Those who had higher ACEs scores showed increased instances of a number of long-term health effects, including: gastrointestinal problems such as irritable bowel syndrome, frequent headaches and fatigue, anxiety, substance abuse and depression. 

The research shows an individual with a score on the ACEs survey of 4 or higher has healthcare costs roughly 25 per cent higher than those with scores between 0 and 3. 

Additionally, Dobson said individuals with high ACEs scores tend to have different relationships to their emotions and different kinds of interpersonal relationships and experiences. The traumatic experiences and higher stress as a young person can change the brain's chemistry and how it functions into adulthood, Dobson explained. 

"Previous research has even looked at the risk of early death. And there's an estimate that people with a high score actually will have a shortened life by 15 to 20 years, compared to people with reduced numbers of ACEs," Dobson said. 

"So the question is: What do you do?"

Treatment options 'a bit of a challenge'

​The treatment options that healthcare practitioners generally consider are complete prevention of childhood trauma, treating long-term chronic health problems, or secondary prevention — intervening in an identified population to modify behaviour before treatment of an illness is needed. Dobson's research is looking at that last option. 

"It's a bit of a challenge, I have to say. Family physicians are extremely busy ... so they're not going to have the time to do a lifestyle assessment or to look at the long-term impact of ACEs. We're hoping that physicians can become ACE informed, or trauma informed, and be able to sensitively ask the questions about childhood adversity."

The science is compelling.- Dr. Teresa Killam, a family physician 

Dobson is working with his team to set up a clinical trial to demonstrate the effectiveness of a referral system from there, where patients would receive care from what he calls a behaviour health consultant.

He believes the clinical trial will show improved self-reported well-being, but also decreases to associated healthcare costs long term. 

Dobson hopes the research will lead to online resources being developed for patients who don't have access to a behavioural training consultant. 

It's research like Dobson's that convinced Killam to make a change in her care for expectant moms. She says she hopes to see more and more doctors doing it. 

"The science is compelling, so it's kind of calling us to action to integrate it into our practice."