[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
Sterling S, Chi F, Lin J, et. al.
Physical, Mental Health and Developmental Conditions, and Sociodemographic Characteristics Associated With Adverse Childhood Experiences Among Young Children in Pediatric Primary Care. J Pediatr Health Care. 2021 Jul 2:S0891-5245(21)00088-2. PMID: 34226089
Of 13,370 Northern California children aged 1-5 years screened for ACEs at routine well-child visits in three pediatric clinics, “Older age, Medicaid insurance, epilepsy/seizure disorder, sleeping disorders, adjustment disorders, and feeding disorders were associated with higher odds of ACEs exposure.”
Adult Manifestations of Child Abuse
Soares ALG, Hammerton G, Howe LD, et. al.
Sex differences in the association between childhood maltreatment and cardiovascular disease in the UK Biobank. Heart. 2020 Sep;106(17):1310-1316. PMID: 32665362
From a large UK study, all types of childhood maltreatment were associated with increased risk of cardiovascular disease (high blood pressure, heart attack and stroke) for both men and women, however with a stronger association for women.
Yuan M, Qin F, Zhou Z, Fang Y.
Gender-specific effects of adverse childhood experiences on incidence of activities of daily life disability in middle-age and elderly Chinese population. Child Abuse Negl. 2021 Jul;117:105079. PMID: 33945896
From a national Chinese midlife and retirement survey, approximately 10% had 3+ ACEs. Of those with 3+ ACEs compared to those with 0 ACEs, males were 45% and females 28% more likely to have an Activity of Daily Living disability.
Baiden P, Panisch LS, Onyeaka HK, LaBrenz CA, Kim Y.
Association of childhood physical and sexual abuse with arthritis in adulthood. Prev Med Rep. 2021 Jun 24;23:101463. PMID: 34258175
From a national survey of over 75,000 adults aged 18-75, 49.7% female, and after adjusting for multiple factors, the 25.5% who reported childhood physical abuse were 1.36 times more likely to have a diagnosis of arthritis. The 5.6% who reported childhood sexual abuse were 1.74 times more likely to have this diagnosis.
Humphreys KL, LeMoult J, Wear JG, et. al.
Child maltreatment and depression: A meta-analysis. Child Abuse Negl. 2020 Apr;102:104361. PMID: 32062423
From 192 research studies consisting of 68,830 individuals, higher child maltreatment scores and each type of child maltreatment were associated with a diagnosis of depression and with higher depression symptom scores. The strongest association was for emotional abuse/neglect.
Williams K, Moehler E, Kaess M, Resch F, Fuchs A.
Dissociation Links Maternal History Of Childhood Abuse To Impaired parenting. J Trauma Dissociation. 2021 Jun 29:1-15. PMID: 34185634
Comparing 58 mothers who had experienced childhood maltreatment to a control mother group, higher dissociation scores significantly predicted more parental bonding impairment, higher physical abuse risk, and less observed maternal sensitivity. “Maternal dissociative symptoms play a distinct role in the intergenerational transmission of adverse childhood experiences and should therefore be targeted in therapeutic interventions.”
Damian AJ, Oo M, Bryant D, Gallo JJ.
Evaluating the association of adverse childhood experiences, mood and anxiety disorders, and suicidal ideation among behavioral health patients at a large federally qualified health center. PLoS One. 2021 Jul 12;16(7):e0254385. PMID: 34252139
Of 4392 patients in behavioral healthcare services of a large federally qualified health center, “emotional neglect was the strongest predictor of SI [suicidal ideation] among Millennials (Odds Ratio = 1.59), Generation X (OR = 1.81), and Baby Boomers (OR = 1.88) after controlling for mood and anxiety disorders, race/ethnicity, and gender…ACEs should be considered as a risk factor and incorporated into screening assessments for suicidal ideation.”
Loxton D, Forder PM, Cavenagh D, et. al.
The impact of adverse childhood experiences on the health and health behaviors of young Australian women. Child Abuse Negl. 2021 Jan;111:104771. PMID: 33160649
From a long-term study of 8609 Australian women, 59% reported 1 ACE, and 10% 4+ ACEs. Women reporting 4+ ACEs had higher rates of poor physical health, poor mental health, severe obesity, and smoking.
Adolescents
Myers B, Bantjes J, Lochner C, Mortier P, Kessler RC, Stein DJ.
Maltreatment during childhood and risk for common mental disorders among first year university students in South Africa. Soc Psychiatry Psychiatr Epidemiol. 2021 Jul;56(7):1175-1187. PMID: 33394071
Of 1290 first year South African university students, “48.4% of participants reported childhood maltreatment, the most common type being emotional abuse (26.7%)…emotional abuse was the only type of maltreatment independently associated with 12-month diagnoses of major depressive disorder, generalised anxiety disorder or drug use disorder.”
Rogers CJ, Forster M, Grigsby TJ, et. al.
The impact of childhood trauma on substance use trajectories from adolescence to adulthood: Findings from a longitudinal Hispanic cohort study.
Child Abuse Negl. 2021 Jul 9;120:105200. PMID: 34252647
From a long-term survey of 1399 Hispanic adolescents in Southern California starting in 9th grade, ACEs were a significant predictor at 9thgrade of significant cigarette, marijuana and alcohol use. Those with more ACEs experienced significantly steeper inclining use over time than those with fewer ACEs. “ACE continue to have an impact on substance use trends through emerging adulthood.”
LGBTQ
Thoma BC, Rezeppa TL, Choukas-Bradley S, et. al.
Disparities in Childhood Abuse Between Transgender and Cisgender Adolescents. Pediatrics. 2021 Jul 5:e2020016907. PMID: 34226247
In a nationwide online sample of US adolescents, trans-gender adolescents (TGAs) had elevated rates of childhood psychological (73%), physical (39%) , and sexual abuse (19%) compared with heterosexual cis-gender adolescents, at almost twice the rate.
Race/Cultural
Loe IM, Froehlich TE, Edrees HH, et. al.
Racism as an Adverse Childhood Experience: An Interactive Workshop to Train Pediatricians to Address Racism in Clinical Care. J Dev Behav Pediatr. 2021 Aug 1;42(6):502-511. PMID: 34191762
“An interactive educational workshop on racism as an ACE was effective in improving pediatric professionals' comfort level and self-rated skills…A variety of educational strategies (e.g., audience polls, videos, didactic presentations, experiential activities, and peer-guided case-based discussion and practice) were used to appeal to varied learning styles.”
Ayodeji E, Dubicka B, Abuah O, Odebiyi B, Sultana R, Ani C.
Editorial Perspective: Mental health needs of children and young people of Black ethnicity: Is it time to reconceptualise racism as a traumatic experience? Child Adolesc Ment Health. 2021 Sep;26(3):265-266. PMID: 34240554
“We argue that the experience of racism should be universally considered an Adverse Childhood Experience (ACE)…This should include: the impact of racism in staff training, improving the cultural competence of staff, and supporting Black children and young people to articulate their experiences of racism and related traumas whilst facilitating their development of coping strategies to manage these experiences.”
Claypool N, Moore de Peralta A.
The Influence of Adverse Childhood Experiences (ACEs), Including the COVID-19 Pandemic, and Toxic Stress onDevelopment and Health Outcomes of Latinx Children in the USA: a Review of the Literature. Int J Child Maltreat. 2021 Jul 11:1-22. PMID: 34278229
“In applying the ACE framework to US-Latinx populations, relevant findings concerning a potential failure of ACEs to accurately capture Latinx experiences of adversity were highlighted, as well as the need to classify the COVID-19 pandemic as an ACE. Research suggests that first-generation Latinx immigrants report lower-than-average rates of ACEs despite the various disparities ethnic minorities face in the USA. A discussion on whether this health paradox arises because of the failure of ACEs to properly identify adverse experiences unique to immigrants or if it is related with immigrant families' protective cultural factors. The compounding experiences of discrimination, immigration anxieties, and now also pandemic-related hardship have the potential to harm Latinx children's cognitive, emotional, and physical development.” Evidence-based interventions are discussed.
Providers
Barnett ML, Kia-Keating M, Ruth A, Garcia M. Promoting Equity and Resilience: Wellness Navigators' Role in Addressing Adverse Childhood Experiences. Clin Pract Pediatr Psychol. 2020 Jun;8(2):176-188. PMID: 34194889
Description of a Wellness Navigator program in a pediatric clinic, in which bilingual and bicultural wellness navigators (WN) helped to deliver ACEs screening, addressed social determinants of health, and made referrals to community resources in over half of the cases. Insurance, childcare, and housing were the most frequent referral sources, and WNs supported caregivers in initiating 94% of services.
Millar HC, Lorber S, Vandermorris A, et. al.
"No, You Need to Explain What You Are Doing": Obstetric Care Experiences and Preferences of Adolescent Mothers With a History of Childhood Trauma. J Pediatr Adolesc Gynecol. 2021 Aug;34(4):538-545. PMID: 33535100
For 29 adolescent mothers with average age 17.9 years, the mean ACE score was 5.1. 65.5% reported being triggered during pregnancy or postpartum. Trauma memories were elicited during vaginal examinations in the clinic (27.6%) and in the hospital (27.6%), abdominal examinations (13.8%), measurement of vital signs (17.2%), and labor (17.2%). Ten participants (34.5%) felt that the providers delivering their baby knew how to help them cope with trauma memories. Themes that emerged included the following: acknowledgment of trauma by provider, avoiding re-telling of story, building a relationship with provider, choice and control in care, and providing coping strategies.
Gupta RC, Randell KA, Dowd MD.
Addressing Parental Adverse Childhood Experiences in the Pediatric Setting. Adv Pediatr. 2021 Aug;68:71-88. PMID: 34243860
“Parents’ own adverse childhood experiences (ACEs) impact their children’s physical and emotional health. Causal mechanisms are not fully understood but are likely multifactorial, affecting parent resiliency and attachment behaviors, with possible intergenerational transmission. Although universal screening for parental ACEs is controversial, they may be identified during pediatric care. Providers can address parental ACEs by consistently using trauma-informed, healing-centered approaches that acknowledge the impact of trauma and the presence of resilience, promote positive parenting skills, and provide compassionate support universally. When necessary, more targeted interventions may include referral to community social support services and parenting programming. Incorporating a two-generation approach in pediatrics may enhance and support child health and well-being more robustly.”
Prevention
McKeen H, Hook M, Podduturi P, Beitzell E, Jones A, Liss M.
Mindfulness as a mediator and moderator in the relationship between adverse childhood experiences and depression. Curr Psychol. 2021 Jun 21:1-11. PMID: 34177211
Of 279 university students, several aspects of mindfulness both mediated (explains how items are related) and moderated (explains the strength of that relationship) between ACEs and depression, such that individuals with high levels of mindful awareness had no increase in depression even as the number of ACEs increased.
Ashton K, Davies AR, Hughes K, et. al.
Adult support during childhood: a retrospective study of trusted adult relationships, sources of personal adult support and their association with childhood resilience resources. BMC Psychol. 2021 Jun 27;9(1):101. PMID: 34176519
From a Welsh national survey, “Prevalence of access to an always-available trusted adult decreased with increasing number of ACEs from 86.6% of individuals with no ACEs, to 44.4% of those with four or more ACEs (≥ 4)…For individuals with ≥ 4 ACEs, those with access to an always-available trusted adult were 5.6 times more likely to have had supportive friends and 5.7 times more likely to have been given opportunities to develop skills to succeed in life, compared to those with no access to a trusted adult.”
Tani Y, Fujiwara T, Kondo K.
Adverse Childhood Experiences and Dementia: Interactions With Social Capital in the Japan Gerontological Evaluation Study Cohort. Am J Prev Med. 2021 Aug;61(2):225-234. PMID: 33985835
Social capital = the network of relationships among people in a given society. From a large Japanese elder study, at 3-year follow-up of new dementia cases, those with 3+ ACEs and low social capital were 3.25 times more likely to develop dementia, 3+ ACEs with middle social capital 1.19 times more likely, and in those with 3+ ACEs with high social capital no new dementia cases were observed.
Researchers
Gentry SV, Paterson BA.
Does screening or routine enquiry for adverse childhood experiences (ACEs) meet criteria for a screening programme? A rapid evidence summary. J Public Health (Oxf). 2021 Jul 7:fdab238. PMID: 34231848
Using United Kingdom National Screening Committee (UKNSC) programme criteria, authors conclude that “Good quality evidence was identified from meta-analyses for associations between ACEs and a wide range of adverse outcomes. There was no consistent evidence on the most suitable screening tool, setting of administration, and time or frequency of use. Routine enquiry among adults was feasible and acceptable to service users and professionals in various settings. A wide range of potentially effective interventions was identified. Limited evidence was available on the potential for screening or routine enquiry to reduce morbidity and mortality or possible harms of screening. Based on the application of available evidence to UKNSC screening criteria, there is currently insufficient evidence to recommend the implementation of a screening programme for ACEs. Further research is needed to determine whether routine enquiry can improve morbidity, mortality, health and wellbeing.”
Powell KM, Rahm-Knigge RL, Conner BT.
Resilience Protective Factors Checklist (RPFC): Buffering Childhood Adversity and Promoting Positive Outcomes. Psychol Rep. 2021 Aug;124(4):1437-1461. PMID: 32799743
Using the Resilience Protective Factors Checklist (RPFC) with 1256 undergrads, “factor analysis supported the resilience structural model of three interrelated areas of protective factors - Individual, Family, and Community influences. All three areas of protection were positively correlated with all four domains of positive life outcomes (physical health, psychological health, social relationships, and a healthy environment) and negatively correlated with adverse childhood experiences.”
Fortier J, Stewart-Tufescu A, Salmon S, et. al.
What type of survey research questions are identified by adults as upsetting? A focus on child maltreatment. Child Abuse Negl. 2020 Nov;109:104764. PMID: 33038722
Of 1000 Canadian adults being asking about reactions to potentially upsetting survey questions, 4% identified maltreatment-related questions as upsetting, with 15.1% identifying abuse or other questions as upsetting. However, 92.7-97.5% of the upset group felt that the questions were important to ask and should not be removed.
Carmel T, Widom CS.
Development and validation of a retrospective self-report measure of childhood neglect. Child Abuse Negl. 2020 Aug;106:104555. PMID: 32497939
Authors describe a new, validated 10-item childhood neglect instrument.
Related of Interest
Merz MP, Turner JD.
Is early life adversity a trigger towards inflammageing? Exp Gerontol. 2021 Jul 15;150:111377. PMID: 33905877
“We propose that early life adversity [ELA] shapes the developing immune, endocrine and nervous system in a non-reversible way…might act as an accelerator for inflammageing and age-related diseases.”
Nguyen LH.
Calculating the impact of COVID-19 pandemic on child abuse and neglect in the U.S. Child Abuse Negl. 2021 Aug;118:105136. PMID: 34098378
From an extrapolation of child welfare data from NY City, Florida, New Jersey and Wisconsin to the US nationally, historically as well as focusing on the March – December 2020 interval, an estimated 85,993 children were missed for prevention services and about 104,040 children were missed for child abuse and neglect, with a potential lifetime economic impact of up to $48.1 billion in the U.S.
Katz C, Tsur N, Nicolet R, Klebanov B, Carmel N.
No way to run or hide: Children's perceptions of their responses during intrafamilial child sexual abuse. Child Abuse Negl. 2020 Aug;106:104541. PMID: 32474116
From interviews with 40 Israeli children aged 4-14 who had been sexually abused by their fathers, children related how “fight, flight, or disclosure were not relevant options for them…The children quickly understood the consequences and implications of their responses, and on the basis of their assessments, made the best and most pragmatic decisions they could, with two main guidelines in mind: one was simply to survive the abuse and the second was to protect their younger siblings.”
Ibrahim P, Almeida D, Nagy C, Turecki G.
Molecular impacts of childhood abuse on the human brain. Neurobiol Stress. 2021 May 20;15:100343. PMID: 34141833
This article reviews research evidence for the effects of childhood abuse on epigenetics (changes to DNA), HPA axis (stress hormone system), myelination (the health of nerve cells), plasticity (the ability for the brain to change in response to various factors), and signaling (the communication components between parts of the brain).
Carr A, Duff H, Craddock F.
A Systematic Review of Reviews of the Outcome of Noninstitutional Child Maltreatment. Trauma Violence Abuse. 2020 Oct;21(4):828-843. PMID: 30249161
In this extensive research review involving over 30 million individuals, 518,022 of whom were maltreated in childhood, childhood maltreatment was associated with an exceptionally wide range of physical health problems and a pro-inflammatory state; an exceptionally wide range of mental health problems; significant abnormalities in the structure and functioning of the brain and hormone system; and a wide range of negative psychosocial outcomes across the life span including difficulties in making and maintaining relationships, managing sexual and aggressive impulses, adjustment in school and at work, and maintaining a satisfying quality of life.
Hantsoo L, Zemel BS.
Stress Gets into the Belly: Early Life Stress and the Gut Microbiome. Behav Brain Res. 2021 Jul 16:113474. PMID: 34280457
“Our review suggests strong evidence that acute laboratory stress, chronic stress, and ELS [early life stress] affect the gut microbiota in rodents, and growing evidence that perceived stress and ELS may impact the gut microbiota in humans… We also review data on dietary interventions to moderate impact of stress on the gut microbiome.”
Cénat JM, Kogan C, Noorishad PG, et. al.
Prevalence and correlates of depression among Black individuals in Canada: The major role of everyday racial discrimination. Depress Anxiety. 2021 Sep;38(9):886-895. PMID: 33949750
From a survey of 845 Black Canadian adults, many of whom were college students, 65.87% reported severe depressive symptoms, with higher rates for women and those unemployed. This rate is nearly six times the reported prevalence rate for the general population of Canada. Everyday racial discrimination was the best predictor of depressive symptoms, with those experiencing the highest levels of discrimination 36.4 times more likely to report severe depressive symptoms than those with low levels of discrimination.
Wildeman C, Edwards FR, Wakefield S.
The Cumulative Prevalence of Termination of Parental Rights for U.S. Children, 2000-2016. Child Maltreat. 2020 Feb;25(1):32-42. PMID: 31113210
Per author analysis, 1 in 100 U.S. children will experience the termination of parental rights by age 18, with risk highest in the first few years of life. Risks are highest for Native American (3.0%) and African American children (1.5%). In addition, there is dramatic variation across states in the risk of experiencing this event as well as racial/ethnic inequality in this risk.
MacNeill EC.
What's Notable is our Absence. Acad Emerg Med. 2021 Aug;28(8):934-935. PMID: 34245629
“As emergency medicine providers, we bear witness to the incredible burden that violence, including gun violence, has on individuals, families, and communities. We see it in ways we do not often think about; increased psychiatric illness, increased ED visits for asthma, higher Adverse Childhood Events scores, cancer, cardiovascular disease and resultant lower life expectancy. All of these have been associated with exposure to violence. Of any medical specialty, emergency medicine as a field must embrace the idea that the ED is a medical home for the disease of violence. Emergency care providers are among the few healthcare professionals who care for acute violent injuries as well as the downstream effects. We need to develop expertise not only in the acute treatment of violence victims; we need to be experts in screening people for risk and intervening with evidence based supported programs.”
Lane WG, Dubowitz H.
Social determinants of health, personalized medicine, and child maltreatment. Pediatr Res. 2021 Jan;89(2):368-376. PMID: 33288877
“This paper synthesizes knowledge on social determinants of health [economic stability, education, health and healthcare, neighborhood environment, and social context] and advances in genetics and genomics [how a person’s genetics interact with the person’s environment] related to the prevention of child maltreatment. It provides examples of model approaches to addressing the prevention of child maltreatment in primary care practices.” Authors also address the role of personalized medicine (tailoring of medical treatment to the individual characteristics of each patient) in addressing child maltreatment.
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