PEdiatric ACEs Screening and Resiliency Study (PEARLS)

ACEs are a root cause of many of the greatest public health challenges we face today - increasing the risk of serious conditions ranging from asthma, diabetes, and obesity, to school failure, teen pregnancy, and substance dependence.

Nadine Burke Harris, MD

First California Surgeon General


The Pediatric Early Adversity and Related Life Effect Screen (PEARLS) is a tool developed by UCSF Benioff Children's Hospital Oakland and the UCSF School of Medicine to identify and measure toxic stress and remediate it in the primary care setting. The 17-item screen includes the traditional 10 ACEs questions, along with other questions that assess exposure to bullying, community violence, discrimination, family separation, low family cohesion, caregiver death or physical illness, food insecurity, and housing instability. The PEARLS tool was developed with patient families and providers to ensure high face validity, acceptability, and usability. Please see this link for more information:

The PEARLS tool is one of several products of the Pediatric ACEs and Resiliency Study. To accompany the PEARLS tool, the study team worked with clinical providers to develop an anticipatory guidance script on ACEs that focuses on family and resilience. The script focuses on the biological effects of toxic stress and provides practical recommendations on how parents can build resilience in their children. The study aimed to advance the field's ability to identify and measure toxic stress and remediate it in the primary care setting. The study introduced two novel, low-cost interventions and to those who reported one or more ACE: the Resilience Clinic, which supports caregivers and their children (jointly referred to as “dyads”) in acquiring greater self- and co-regulation skills, and Care Coordination, which offers care coordination visits for unmet social needs. The study successfully recruited 555 patients ages 0-12 and collected a rich set of measurements, including demographic, medical, mental/behavioral health, and biomarker data. Preliminary results pointed to significant differences in health and well-being among children with high versus low ACEs, including higher rates of asthma, obesity, and school absenteeism, and an overall lower quality of life.


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