Awareness of Toxic Stress and Adverse Childhood Experiences among Dutch Pediatric Health Care Providers: A National Survey

Introduction: Early recognition of adverse childhood experiences (ACEs) and adequate interventions are required to prevent negative effects on the child’s mental and physical health later in life caused by toxic stress. This study aimed to assess how familiar the concepts of ACEs and toxic stress are among Dutch pediatric health care providers (PHCPs) and whether screening for ACEs is standard practice in the Netherlands. Methods: From October 2018 until March 2019, a nation-wide questionnaire survey was held. Results: Of 548 participating PHCPs, 29% were familiar with toxic stress, 67% were familiar with ACEs, and 63% knew of the relationship between multiple ACEs and somatic diseases. Routine inquiries about ACEs were done always by 17% of the participants and sometimes by 65%. The ACEs which PHCPs asked about the most included divorce (n=288; 76.8%), bullying (n=265; 70.7%), physical domestic violence (n=184; 49.1%), parental psychiatric diseases (n=205; 54.7%) and sexual abuse (n=164; 43.7%). The ACEs asked about the least included deportation of a family member (n=22; 5.9%), gender discrimination (n=9; 2.4%) and racism (n=17; 4.5%). Conclusion: Even in 2019, there is limited awareness among Dutch PHCPs of ACEs and toxic stress. While most acknowledged to be aware of the role that toxic stress plays in the physical and mental health consequences of ACEs later in life, only 17% of the respondents performed standard ACE screening. Our findings underscore the need for standard ACE screening guidelines to support early recognition and adequate treatment of children suffering with toxic stress.