[Editor's note: Dr. Harise Stein at Stanford University edits a web site — abuseresearch.info — that focuses on the health effects of abuse, and includes research articles on ACEs. Every month, she posts the summaries of the abstracts and links to research articles that address only ACEs. Thank you, Harise!! — Jane Stevens]
Child abuse
Ghanem N.
The effect of violence in childhood on school success factors in US children. Child Abuse Negl. 2021 Oct;120:105217. PMID: 34293551
From a study of over 35,000 US non-institutionalized children aged 6-17 with data on violence-related ACEs, “violence in childhood increases the likelihood of grade repetition (Odds Ratio = 1.47), school-home contact (OR = 2.20), and school absence greater than one week (OR=1.4), controlling for socio-demographic and health status characteristics…Violence in childhood has a statistically significant negative impact on each of the school success factors included in this study.”
Adult manifestations
Jenkins NDM, Rogers EM, Banks NF, et. al.
Childhood psychosocial stress is linked with impaired vascular endothelial function, lower SIRT1, and oxidative stress in young adulthood. Am J Physiol Heart Circ Physiol. 2021 Sep 1;321(3):H532-H541. PMID: 34328346
For 42 otherwise healthy 21-year-old women, various tests on their blood vessels showed that those with ACE+ (vs. no ACEs) had certain kinds of impairment of blood vessel function that would increase susceptibility to the risk of high blood pressure and heart disease.
Ciciolla L, Shreffler KM, Tiemeyer S.
Maternal Childhood Adversity as a Risk for Perinatal Complications and NICU Hospitalization. J Pediatr Psychol. 2021 Jul 20:jsab027. PMID: 34304270
For 164 women followed during pregnancy, women with severe ACEs exposure (6+ ACEs) had 4 times the odds of reporting at least one adverse infant outcome, almost 9 times the odds of reporting a neonatal ICU admission, and 4 times the odds of reporting at least one maternal perinatal outcome.
Li Y, Herbell K, Bloom T, Sharps P, Bullock LFC.
Adverse Childhood Experiences and Mental Health among Women Experiencing Intimate Partner Violence. Issues Ment Health Nurs. 2020 Sep;41(9):785-791. PMID: 32401637
For a group of women with recent experience of IPV, “Over 70% of women reported parental separation or divorce, over 40% reported childhood sexual assault, and around 40% had a mother who was treated violently. Childhood physical abuse and sexual assault were associated with more severe posttraumatic stress disorder or depressive symptoms. Comprehensive interventions that address not only the effects of IPV but also the enduring effects of ACEs are needed to promote mental health for survivors of IPV.”
Nichter B, Stein MB, Norman SB, et. al.
Prevalence, Correlates, and Treatment of Suicidal Behavior in US Military Veterans: Results From the 2019-2020 National Health and Resilience in Veterans Study.
J Clin Psychiatry. 2021 Aug 10;82(5):20m13714. PMID: 34383391
Of 4,069 US veterans, “The prevalence of current suicidal ideation, lifetime suicide plans, and lifetime suicide attempts was 9.0%, 7.3%, and 3.9%, respectively. Suicidal behaviors were most prevalent among veterans aged 18-44 years, with 18.2%, 19.3%, and 11.1%, respectively, endorsing suicidal ideation, suicide plans, and suicide attempts. Major depressive disorder (MDD), age, posttraumatic stress disorder, and adverse childhood experiences (ACEs) emerged as the strongest correlates of suicidal ideation and suicide plans, while MDD, age, alcohol use disorder, and ACEs were the strongest correlates of suicide attempts. Only 35.5% of veterans with current suicidal ideation were engaged in mental health treatment.”
Cooke JE, Racine N, Pador P, Madigan S.
Maternal Adverse Childhood Experiences and Child Behavior Problems: A Systematic Review. Pediatrics. 2021 Aug 19:e2020044131. PMID: 34413250
From a research review, “Mothers' ACEs demonstrated largely consistent associations with children's behavior problems”, including externalizing problems such as inattention, hyperactivity, impulsivity and aggression; and internalizing problems such as anxiety and depression.
Dellor ED, Yoon S, Bunger AC, Himmeger M, Freishtler B.
Benchmarking Trauma in Child Welfare: A Brief Report.
J Interpers Violence. 2021 Aug 20:8862605211038324. PMID: 34416838
Using Ohio child welfare data from families with co-occurring maltreatment and substance use, adults were exposed to on average 4.2 ACEs, children 0-5 4.1 ACEs, and youth 6-18 years 5.6 ACEs. “Our findings related to the extensive trauma that parents with substance use experience suggests that caseworkers should help parents access addiction treatment services that are integrated or at least coordinated with trauma-informed practices.”
Rameckers SA, van Emmerik AAP, Bachrach N, et. al.
The impact of childhood maltreatment on the severity of childhood-related posttraumatic stress disorder in adults. Child Abuse Negl. 2021 Oct;120:105208. PMID: 34332332
For 147 adults with childhood-related PTSD (Ch-PTSD), “emotional abuse was the only trauma type that was significantly related to severity of PTSD and to the severity of specific PTSD symptom clusters…emotional abuse plays a more important role in Ch-PTSD than hitherto assumed, and treatment should not neglect processing of childhood emotional abuse.”
Chen H, Fan Q, Nicholas S, Maitland E.
The long arm of childhood: The prolonged influence of adverse childhood experiences on depression during middle and old age in China.
J Health Psychol. 2021 Aug 16:13591053211037727. PMID: 34397302
From a study of Chinese adults, “The results showed a significant dose-response relationship between adverse childhood experiences and adult depression. The elevated health risks of chronic diseases, disabilities, and physical pain, as well as the disadvantages in education, employment, and economic status caused by the adverse childhood experiences indirectly worsen adult depression.
Holochwost SJ, Wang G, Kolacz J, et. al.
The neurophysiological embedding of child maltreatment. Dev Psychopathol. 2021 Aug;33(3):1107-1137. PMID: 32624073
This extremely detailed review looks at research regarding the effects of child maltreatment on bodily response from the stress hormone system, and the autonomic nervous system which encompasses parasympathetic activity related to conserving and storing energy or allowing organs to rest and repair, and sympathetic activity to support active defense behaviors for fight or flight.
Adolescents
Forster M, Rogers CJ, Rainisch B, et. al.
Adverse Childhood Experiences and Intimate Partner Violence; Findings From a Community Sample of Hispanic Young Adults. J Interpers Violence. 2021 Aug 3:8862605211035881. PMID: 34344225
For 1273 Southern California Hispanic youths, “At age 22, participants with 1-3 and ≥4 ACE were overrepresented in all IPV behaviors and had higher risk of verbal and physical victimization and perpetration compared to their peers with no ACE. By age 24, respondents with a history of ≥4 ACE were at significantly greater risk for escalating IPV behaviors…These findings highlight the importance of investing in coordinated efforts to develop strategies that help young people cope with the downstream effects of early life adversity.”
Schafer ES.
Adverse childhood experiences and risky behaviors in male college students. J Am Coll Health. 2021 Aug 27:1-9. PMID: 34448681
For 795 male college students attending a large southern university, sexual abuse in particular, and exposure to interparental violence and household mental illness were variously associated with high-risk drinking, increased number of sexual partners, and impulsivity. For each additional ACE, risky behaviors increased.
LGBTQ
Biedermann SV, Asmuth J, Schröder J, et. al. Childhood adversities are common among trans people and associated with adult depression and suicidality. J Psychiatr Res. 2021 Sep;141:318-324. PMID: 34304035
From a survey of trans individuals from four German health-care centers, 93% reported childhood adversities, with over 30% reporting severe to extreme childhood adversities. 70% reported bullying by peers. Adversities were associated with increased risk for adult depression and suicidality.
Race/Culture
Bell S, Deen JF, Fuentes M, et. al.
Caring for American Indian and Alaska Native Children and Adolescents. Pediatrics. 2021 Apr;147(4):e2021050498. PMID: 33753539
“This policy statement examines the inequitable disease burden observed in AI/AN youth, with a focus on toxic stress, mental health, and issues related to suicide and substance use disorder, risk of and exposure to injury and violence in childhood, obesity and obesity-related cardiovascular risk factors and disease, foster care, and the intersection of lesbian, gay, bisexual, transgender, queer, and Two-Spirit and AI/AN youth.”
Volpe VV, Schorpp KM, Cacace SC, Benson GP, Banos NC.
State- and Provider-Level Racism and Health Care in the U.S. Am J Prev Med. 2021 Sep;61(3):338-347. PMID: 34419231
“Among White individuals, more state-level racism was associated with 5% higher odds of being able to get care and 6% higher odds of sufficient time with provider. Among Black individuals, more state-level racism was associated with 8% lower odds of being able to get care. Provider racial discrimination was also associated with 80% lower odds of provider explaining care, 77% lower odds of provider answering questions, and 68% lower odds of sufficient time with provider.”
Rizzo MT, Green ER, Dunham Y, Bruneau E, Rhodes M.
Beliefs about social norms and racial inequalities predict variation in the early development of racial bias. Dev Sci. 2021 Aug 23:e13170. PMID: 34423885
In a study of 116 4-year-olds, “In a 6-month, three-wave, longitudinal study, we found that 4-year-old children's beliefs that their parents and peers do not value interracial friendships predicted increased racial bias in and across time…These findings suggest that children's foundational beliefs about the social world developmentally predict the emergence of racial bias in early childhood and speak to the importance of early and persistent intervention efforts targeting children's normative beliefs about interracial friendships and explanatory beliefs about racial inequalities.”
Richards TN, Schwartz JA, Wright E.
Examining adverse childhood experiences among Native American persons in a nationally representative sample: Differences among racial/ethnic groups and race/ethnicity-sex dyads. Child Abuse Negl. 2021 Jan;111:104812. PMID: 33220946
From a national survey, “Native American persons reported the greatest average number and variety of ACEs than persons from any other racial/ethnic group, and reported the highest rates of physical abuse, sexual abuse, parental substance abuse, and witnessing violence than members of any other racial/ethnic category.” Native American females reported the greatest rates of emotional abuse and sexual violence, while Native American males reported the greatest rates of physical neglect.
Providers
Forkey H, Szilagyi M, Kelly ET, et. al.
Trauma-Informed Care. Pediatrics. 2021 Jul 26:e2021052580. PMID: 34312292
Thorough review article. “Research in genetics, neuroscience, and epidemiology all provide evidence that these traumatic experiences have effects at the molecular, cellular, and organ level, with consequences on physical, emotional, developmental, and behavioral health across the life span. Trauma-informed care translates that science to inform and improve pediatric care and outcomes.”
Duffee J, Szilagyi M, Forkey H, et. al.
Trauma-Informed Care in Child Health Systems. Pediatrics. 2021 Jul 26:e2021052579. PMID: 34312294
“This policy statement summarizes what policy makers, legislators, and health care organizations need to consider in terms of infrastructure, resources, and financial support to facilitate the integration of TIC principles into all pediatric points of care. The accompanying clinical report describes the elements of TIC in the direct care of children, adolescents, and families and covers the spectrum from prevention to treatment.”
American College of Obstetricians and Gynecologists’ Committee on Health Care for Underserved Women.
Caring for Patients Who Have Experienced Trauma: ACOG Committee Opinion, Number 825. Obstet Gynecol. 2021 Apr 1;137(4):e94-e99. PMID: 33759830
“It is important for obstetrician-gynecologists and other health care practitioners to recognize the prevalence and effect of trauma on patients and the health care team and incorporate trauma-informed approaches to delivery of care…A number of health effects that may be associated with trauma are seen frequently in obstetrics and gynecology, including chronic pelvic pain, sexually transmitted infections, unintended pregnancy, conflicted feelings about pregnancy and sexuality, and difficulty with infant attachment postpartum. Obstetrician-gynecologists should become familiar with the trauma-informed model of care and strive to universally implement a trauma-informed approach across all levels of their practice with close attention to avoiding stigmatization and prioritizing resilience.”
Goddard A.
Adverse Childhood Experiences and Trauma-Informed Care. J Pediatr Health Care. 2021 Mar-Apr;35(2):145-155. PMID: 33129624
“The trauma-informed care approach includes the realization of how ACEs affect health, the recognition of pediatric clinical symptom presentation and screening protocols for ACEs, and the health care provider's ability to respond and not re-traumatize patients when delivering evidence-based care.” Article includes an extensive list of ACEs; and summaries of ways to provide care, promote resiliency with topics for anticipatory guidance, and institute trauma therapy modalities.
Reed-Ashcraft K, Hege A, Fiske E, et. al.
Addressing adverse childhood experiences, trauma and resilience through interprofessional course development. J Interprof Care. 2020 Nov 21:1-7. PMID: 33222588
“Faculty of nursing, public health, and social work collaborated to develop an interprofessional course at the undergraduate and graduate levels that focus on ACEs, trauma, and resiliency literature as well as interprofessional collaboration and evidence-based prevention and treatment. In this paper, the faculty detail the approach undertaken to develop this interprofessional course, lessons learnt and key resources.”
Prevention
Hustedde C.
Adverse Childhood Experiences. Prim Care. 2021 Sep;48(3):493-504. PMID: 34311853
General review article.
Bentovim A, Chorpita BF, Daleiden EL, et. al.
The value of a modular, multi-focal, therapeutic approach to addressing child maltreatment: Hope for Children and Families Intervention Resources – a discussion article. Child Abuse Negl. 2021 Sep;119(Pt 1):104703. PMID: 32951866
“The paper introduces an innovative strategy to help the field better organise and prevent the extensive sequelae of polyvictimization and ACEs.”
Researchers
Alhowaymel F, Kalmakis K, Jacelon C.
Developing the Concept of Adverse Childhood Experiences: A Global Perspective. J Pediatr Nurs. 2021 Jan-Feb;56:18-23. PMID: 33181368
“The concept has evolved from the original ACE study, in which ACEs included abuse, neglect, and household disfunction, to a concept that encompasses family, community, social context, and cultural environment. Recognizing the context in which childhood adversity occurs, renders it more applicable in countries around the globe in which it is being studied.”
Krinner LM, Warren-Findlow J, Bowling J, et. al.
The dimensionality of adverse childhood experiences: A scoping review of ACE dimensions measurement. Child Abuse Negl. 2021 Aug 19;121:105270. PMID: 34419902
“More research is needed on ACE domains not included in the original ACE-Study Questionnaire, such as bullying or experiencing poverty, and their dimensionality. The inclusion of ACE dimensions in research may increase the accuracy of models estimating the association between ACEs and health outcomes. Better models and screening tools will provide for more tailored treatment plans for people who have experienced ACEs.”
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