[Editor's note: Dr. Harise Stein at Stanford University edits a web site — abuseresearch.info — that focuses on the effects of abuse, and includes research articles on PACEs. Every month, she posts the summaries of the abstracts and links to research articles that address only ACEs, PCEs and PACEs. Thank you, Harise!! — Rafael Maravilla]
Child Abuse
Rebbe R, Reddy J, Kuelbs CL, Huang J, Putnam-Hornstein E. The Impact of COVID-19 on Infant Maltreatment Emergency Department and Inpatient Medical Encounters. J Pediatr. 2023:113582. PMID: 37353150
Using data from all ED and inpatient visits to a large California children’s hospital system, “We found an increase in infant maltreatment medical encounters during a 21-month period following the onset of COVID-19.”
Farah R, Rege SV, Cole RJ, Holstege CP.
Suspected Suicide Attempts by Self-Poisoning Among Persons Aged 10-19 Years During the COVID-19 Pandemic - United States, 2020-2022. MMWR Morb Mortal Wkly Rep. 2023 Apr 21;72(16):426-430. PMID: 37079475
“Compared with 2019 (prepandemic), during 2021, the overall rate of suspected suicide attempts by self-poisoning increased by 30.0%, rates among children aged 10-12 years, adolescents aged 13-15 years, and females increased 73.0%, 48.8%, and 36.8%, respectively, and these trends continued into the third quarter of 2022. Substances most frequently involved in overdoses were acetaminophen, ibuprofen, sertraline, fluoxetine, and diphenhydramine. Acetaminophen-involved overdoses increased 71% in 2021 and 58.0% in 2022. Diphenhydramine-involved overdoses increased 24.2% in 2021 and 35.8% in 2022. A comprehensive public health approach to suicide prevention, focused on children and adolescents and involving a partnership between families, school teachers, mental health professionals, and public health leadership is needed.”
Bozer JJ, Gruber MD, Letson MM, et al.
Long-Term Functional Outcome Following Neurosurgical Intervention for Suspected Abusive Head Trauma. Pediatr Neurol. 2023;148:101-7. PMID: 37699270
“We performed a single-center retrospective review (2007-2019) of patients aged less than three years who had intracranial injury suspicious for abusive head trauma and received a neurosurgical procedure…77 patients were identified; 53 survived to discharge and had at least one-year follow-up. To examine long-term functional outcome, Pediatric Cerebral Performance Category at the last available visit was found to be 1 or 2 (normal to mild disability) for 64% of patients and 3 or 4 (moderate to severe disability) for 36%. The last available Mullen Scale of Early Learning composite score demonstrated that 13% of patients scored in the "average" range, 17% in the "below average" range, and 70% in the "very low" range.
Donnelly KA, Goyal MK.
The Epidemiology of Violence Exposure in Children. Pediatr Clin North Am. 2023;70(6):1057-68. PMID: 37865430
“Exposure to violence remains a significant issue for children in the United States. The COVID-19 pandemic exacerbated many of these exposures. Violence unequally impacts children of color and LGBTQ youth. Pediatricians can and must continue to advocate and intervene to decrease pediatric violence exposure and its effects.”
Kleinle S, Ngo H, Goldberg AP, Cohen RS.
A History of Child Abuse Pediatrics: Training, Research, and Clinical Diagnosis. Rhode Island medical journal (2013). 2023;106(10):10-4. PMID: 37890057
“This article provides an historical review of child maltreatment, focusing on the three most common subtypes: physical abuse, sexual abuse, and neglect. The evolution of recognizing, evaluating, and accurately diagnosing child maltreatment is described. Over time, the establishment of multidisciplinary teams, mandatory reporting, and Child Abuse Pediatrics as a subspecialty of pediatrics has improved the training, research, and clinical diagnosis for all forms of child maltreatment. These advancements have set clinical standards to ensure accurate diagnosis, prevent the misdiagnosis of child abuse and neglect, and continually improve the systems meant to protect children.”
Kemal S, Nwabuo A, Hoffmann J.
Mental Health and Violence in Children and Adolescents. Pediatr Clin North Am. 2023 Dec;70(6):1201-1215. PMID: 37865440
“This article examines the complex interplay between mental health and violence among children. Although children with mental illness are more likely to be victims of violence than perpetrators, this article describes the few mental health conditions associated with increased violent behavior among children. Next, the authors examine the spectrum of mental health sequelae among children following exposure to various forms of violence. Lastly, the authors discuss the underutilization of mental health services in this population and highlight screening and intervention tools available to pediatric clinicians caring for children exposed to violence.”
Joseph J, Buss C, Knop A, et al.
Greater maltreatment severity is associated with smaller brain volume with implication for intellectual ability in young children. Neurobiology of stress. 2023;27:100576. PMID: 37810429
Of 49 children aged 3-5 years with maltreatment exposure, “Higher maltreatment severity was significantly correlated with smaller intracranial volume…primarily due to smaller gray matter volume. Furthermore, smaller gray matter volume was associated with lower IQ at study entry and predicted IQ one year later. The observed associations were independent of potential confounding variables, including height, socioeconomic status, age and sex…likely setting a path for far-reaching long-term disadvantages. Insights into the molecular and neural processes that underlie the impact of maltreatment on brain structure and function are urgently needed to derive mechanism-driven targets for early intervention.”
Esernio-Jenssen D, Morrobel A, Hansen SE, Kincaid HM.
Exploring Associations Between Abnormal Weight Classifications and Child Maltreatment Diagnoses. Clin Pediatr (Phila). 2023:99228231204452. PMID: 37804149In a retrospective study of 855 pediatric patients diagnosed with maltreatment, “Neglect was most frequently diagnosed, and children with ≥2 diagnoses were more likely to be classified as underweight, overweight, or obese. Findings support abnormal pediatric weight as a biologic signal of adversity that warrants safety screening in the clinical setting.”
Rhodes CA, Thomas N, O'Hara KL, et al.
Enhancing the Focus: How Does Parental Incarceration Fit into the Overall Picture of Adverse Childhood Experiences (ACEs) and Positive Childhood Experiences (PCEs)? Res Child Adolesc Psychopathol. 2023 Dec;51(12):1933-1944. PMID: 37875642
Using data from a large national survey, “children with incarcerated parents had higher odds of experiencing other ACEs, higher odds of having mental health problems, and experienced fewer PCEs compared to children without incarcerated parents. Further, although PCEs were associated with a lower odds of mental health problems for both children with and without incarcerated parents, they did not mitigate the negative impact of parental incarceration on mental health outcomes…important implications for the development of multilevel intervention strategies that seek to promote resilience and reduce risk for this population.”
Adult Manifestations of Child Abuse
Rose H, Womick J, King LA.
Purpose maintained: ACEs and meaning in life. J Pers. 2023 Dec;91(6):1425-1441. PMID: 36748110
From a series of studies including college students and non-student adults, “Adverse childhood experiences consistently predict lower feelings of coherence [a sense of one's life making sense] and significance [a sense of life's inherent value and having a life worth living], but are unrelated to purpose [a sense of core goals, aims, and direction in life]. Purpose may represent a motivational strength emerging out of childhood adversity.”
Lyons-Ruth K, Li FH, Khoury JE, et al. Maternal Childhood Abuse Versus Neglect Associated with Differential Patterns of Infant Brain Development. Res Child Adolesc Psychopathol. 2023 Dec;51(12):1919-1932. PMID: 37160577
For 57 mother-infant pairs, with infant mean age 12.28 months completing MRIs under natural sleep, “Maternal childhood history of neglect, but not abuse, was associated with lower infant grey matter volume. Maternal history of abuse, but not neglect, was associated with smaller infant amygdala volume at older ages. Results are consistent with a threat versus deprivation framework, in which threat impacts regions central to the stress response, whereas deprivation impacts areas more central to cognitive function.”
Bränn E, Vaina A, Daníelsdóttir HB, et al.
Association between adverse childhood experiences and perinatal depressive symptoms: a cross-sectional analysis of 16,831 women in Iceland. Arch Womens Ment Health. 2023 Dec;26(6):839-849. PMID: 37726573
In this large study of Icelandic women, mean age 44 years, 36.8% had experienced probable perinatal depression (PND). Risk of PND increased in a dose-response manner with number of ACEs, with those who reported 5+ ACEs at 2.24 times increased risk. While all ACE types were associated with PND, with most pronounced association was for emotional neglect.
Hawes DJ, Allen JL.
A Developmental Psychopathology Perspective on Adverse Childhood Experiences (ACEs): Introduction to the Special Issue. Res Child Adolesc Psychopathol. 2023 Dec;51(12):1715-1723. PMID: 37421507
“This special issue of Research on Child and Adolescent Psychopathology focuses on the developmental science of ACEs and child psychopathology…This Introduction provides an overview of ACEs and child mental health from a developmental psychopathology perspective, with an emphasis on key concepts and recent progress spanning the prenatal period through to adolescence and intergenerational pathways… Methodological innovations in this work are highlighted, along with implications for prevention and intervention.” Table of Contents
Han YY, Chen W, Forno E, Celedón JC.
Adverse Events during Adulthood, Child Maltreatment, and Asthma among British Adults in the UK Biobank.
Ann Am Thorac Soc. 2023 Nov;20(11):1614-1623. PMID: 37668472
Using UK Biobank data, “In a cohort of British adults, child maltreatment was associated with current asthma in men and women, whereas adulthood adverse events were associated with current asthma in women only. This was independent of cigarette smoking.”
Clephane K, Wilson MC, Heiman JR, Craig AN, Lorenz T.
Sexual violence history predicts changes in vaginal immune parameters during sexual arousal. Brain Behav Immun. 2022;104:171-80. PMID: 35697156
91 healthy premenopausal women in a laboratory setting provided vaginal samples before and after viewing one neutral and one erotic film. “Relative to women without assault histories, women with a history of early life sexual trauma showed significantly altered vaginal immune responses following sexual arousal. If replicated, these findings may help explain the increased risk for sexually transmitted infections observed among women with sexual assault histories.”
Alberry B, Silveira PP.
Brain insulin signaling as a potential mediator of early life adversity effects on physical and mental health. Neurosci Biobehav Rev. 2023;153:105350. PMID: 37544390
“In this review, we describe the consequences of early life adversity in the brain where insulin signaling is a key factor and how insulin may moderate the effects of adversity on psychiatric and cardio-metabolic health outcomes.”
Racine N, Deneault AA, Thiemann R, et al.
Intergenerational transmission of parent adverse childhood experiences to child outcomes: A systematic review and meta-analysis. Child Abuse Negl. 2023:106479. PMID: 37821290
In this research review, parental ACEs were associated with child mental health problems, and internalizing and externalizing difficulties, but not cognitive or language skills.
Brandford AA, Williams EN, Han G, Weston C, Downing NR.
Adverse Childhood Experiences and Preventive Cervical Cancer Screening Behavior. Oncol Nurs Forum. 2023;50(6):679-91. PMID: 37874753
From a large Texas community survey, women with increased ACEs, and those with a history of childhood physical abuse, were less likely to have received recommended cervical cancer screening (PAP smears).
Yilgör A, Kurhan F.
Is Childhood Trauma a Risk Factor for Resistant Epilepsy? J Interpers Violence. 2023:8862605231203964. PMID: 37815052
85 patients being treated for epilepsy, 45 female and 40 male, “were divided into refractory epilepsy and treatment-responsive epilepsy groups. There was no significant difference between the groups in sociodemographic characteristics. On the other hand, total CTQ [Childhood Trauma Questionnaire] and all CTQ subscale scores and HAM-D [Hamilton Depression] scores were significantly higher in the refractory epilepsy group than in the treatment-responsive epilepsy group. This study demonstrates that childhood traumas may contribute to treatment resistance in epilepsy patients. Therefore, it is recommended that a history of childhood traumas be routinely queried in the treatment of epilepsy patients.”
Sikorski C, Mavromanoli AC, Manji K, et al.
Adverse Childhood Experiences and Primary Headache Disorders: A Systematic Review, Meta-analysis, and Application of a Biological Theory. Neurology. 2023 Nov 21;101(21):e2151-e2161. PMID: 37879940
From a research review encompassing 154,739 participants from 19 countries, as the number of ACEs increased, the odds of primary headache increased with 1 ACE odds ratio 1.24 and 4+ ACEs OR 2.09. “A neurodevelopmental theory that categorizes ACEs into threat or deprivation was tested, and both were independently associated with primary headaches (threat OR = 1.46 and deprivation OR = 1.35, respectively).”
Hagemann CT, Spetalen S, Saga S, et al.
Symptoms of complex pelvic pain: A survey in three cohorts of women. Acta Obstet Gynecol Scand. 2023;102(10):1396-408. PMID: 37698177
From a comparison of Norwegian women from gynecologic outpatient clinics, members of chronic pelvic pain organizations, and healthy volunteers, women with high scores on a complex pelvic pain symptom scale were more likely to report a history of sexual assault as a child or adult, poor sexual function, and low mental health.
Adolescents
Beal SJ, Greiner MV, Ammerman RT, et al. Patterns of substance use among adolescents in and out of foster care: An analysis of linked health and child welfare administrative data. Child Abuse Negl. 2023;146:106473. PMID: 37801757
After controlling for multiple factors, 2787 youth in foster care had higher odds of engaging in substance use and at an earlier age than those not in care. “Placement stability and family care settings reduced odds of lifetime substance use.”
Koçtürk N.
Psychological symptoms of adolescent survivors of sexual abuse and characteristics of survivors displaying suicidal and/or self-harming behaviors. Health Care Women Int. 2023;44(9):1136-54. PMID: 35133950
Of 80 Turkish adolescent survivors of childhood sexual abuse, survivors with high psychological symptom scores were more likely to indicate that the perpetrator was a family member and that penetration occurred. For survivors who had previously attempted suicide, “the perpetrators in these cases were mostly reliable/loved people, while these survivors generally hid the events and were exposed to penetration more often.”
Vasilenko SA, Wang X, Liu Q.
Longitudinal Patterns of Multidimensional Violence Exposure and Adolescent Early Sexual Initiation. Arch Sex Behav. 2023 May 8:10.1007/s10508-023-02607-5. PMID: 37154880
“Early sexual intercourse is associated with sexually transmitted infections, pregnancy, and depressive symptoms, and delay of intercourse allows adolescents opportunities to practice relationship skills. Thus, understanding predictors of early sexual intercourse is crucial.” Using data from a national study of children aged 3 to 15, “Findings suggest that experiencing persistent physical and emotional abuse across childhood was associated with the greatest prevalence of early sexual initiation…early abuse was more strongly associated with sexual initiation for boys, while late childhood abuse was more strongly associated for girls…gender-sensitive programs are highly needed to address unique risk factors for boys' and girls' sexual behaviors.”
Clarke V, Goddard A, Wellings K, et al. Medium-term health and social outcomes in adolescents following sexual assault. Soc Psychiatry Psychiatr Epidemiol. 2023 Dec;58(12):1777-1793. PMID: 34370051
This study of 75 adolescents followed after sexual assault showed high levels of vulnerability over a year post-assault, including persistent depression, anxiety and PTSD despite accessing support services; physical symptoms; and doubling of persistent absence from school. “Interview data suggested inter-relationships between mental ill-health, physical health problems and disengagement from school, and poor understanding from schools regarding how to support young people post-assault.”
Espinoza CN, Goering M, Mrug S. Disclosure of Exposure to Violence in Urban Adolescents. J Interpers Violence. 2023:8862605231202979. PMID: 37799041
Of 81 urban adolescents from the Southeastern US, “Across three time points, 90% to 91% witnessed violence and 64% to 81% were victimized in the last year. Of these youth, 40% to 53% disclosed experiences of witnessing violence and 29% to 52% disclosed experiences of victimization…disclosure of violence most often involved parents and friends, with fewer youth disclosing to teachers and counselors. Experiences of dating violence victimization were less likely to be disclosed by adolescents, especially among males. These findings support the need for more research on adolescents' disclosure of violence exposure.”
Myran L, Sen A, Willumsen T, et al.
Associations of adverse childhood experiences with caries and toothbrushing in adolescents. The Young-HUNT4 Survey. BMC oral health. 2023;23(1):760. PMID: 37838651
In a large study of Norwegian adolescents aged 13-17 years, “Adolescents exposed to physical abuse by others, sexual abuse by peers, parental separation/divorce, bullying, or who had witnessed violence, were more likely to report non-daily toothbrushing compared with those with no exposure to the given ACEs.” Each cumulative increase in ACE exposure was associated with a 30% higher likelihood of non-daily toothbrushing, and increased risk of dental caries (cavities). Particularly for 16-17 year-olds, bully victimization was associated with a 2.59 times higher likelihood of non-daily and higher dental caries experienced.
Schuler BR, Gardenhire RA, Jones SD, et al.
Exploring the Association Between Trauma, Instability, and Youth Cardiometabolic Health Outcomes Over Three Years. J Adolesc Health. 2023 Oct 15:S1054-139X(23)00476-7. PMID: 37843478
For 360 Cleveland 6th graders followed for 3 years, while trauma (e.g., badly hurt, victim of crime, loss of close person) was not associated with statistically significant cardiometabolic markers, instability (e.g., moving, change of schools, change in household structure) was significantly associated with increased body mass index, decreased high-density lipoprotein, and increased C-reactive protein slopes, all markers for adverse cardiometabolic health.
Rasmussen EF, Barnard S, Athey A, Gorovoy S, Grandner MA.
Adverse childhood experiences associated with sleep health in collegiate athletes. Sleep Health. 2023 Oct 2:S2352-7218(23)00175-4. PMID: 37793972
189 National Collegiate Athletic Association (NCAA) Division-I male (n = 102) and female (n = 87) student-athletes were recruited by flyers on one campus. “We found a statistically significant dose-response relationship between adverse childhood experience score and increased insomnia levels, poor sleep quality and decreased sleep duration…When adjusted for other adverse childhood experience categories, emotional neglect had the strongest association with sleep outcomes.”
Flannery DJ, Scholer SJ, Noriega I.
Bullying and School Violence. Pediatr Clin North Am. 2023 Dec;70(6):1153-1170. PMID: 37865437
“Rates of traditional bullying have remained stable (30%) but rates of cyberbullying are increasing rapidly (46% of youth). There are significant long-term physical and mental health consequences of bullying, especially for vulnerable youth. Multi-component school-based prevention programs that include caring adults, positive school climate, and supportive services for involved youth can effectively reduce bullying…Pediatricians play a critical role in identification, intervention, awareness, and advocacy.”
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