[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!! — Jane Stevens]
Child Abuse
Liming KW, Akin B, Brook J.
Adverse Childhood Experiences and Foster Care Placement Stability. Pediatrics. 2021 Dec 1;148(6):e2021052700. PMID: 34851423
For 2998 children in the Kansas foster care system 2015-2019, “Children in foster care with greater cumulative ACE exposure were significantly more likely to experience placement instability…A child's race, biological sex, age at episode start, and whether they had siblings in foster care all significantly influenced placement instability.”
Freisthler B, Price Wolf J, Chadwick C, Renick K.
Daily Stress and Use of Aggressive Discipline by Parents during the COVID-19 Pandemic. J Fam Violence. 2021 Nov 27:1-9. PMID: 34866772
For 323 parents from Ohio April-May 2020, “For each higher level of stress, parents had 1.3 greater odds of using aggressive discipline. Having used aggressive discipline at baseline was related to three times greater odds of using it during the study period…this places children at risk for abuse and neglect that may go without detection and intervention for longer time periods…Well child visits, routine vaccinations, and problem-focused care are important opportunities to assess parents' stress and discipline practices that may be suggestive of abuse or neglect.”
Helton JJ, Vaughn MG, Schiff M.
The accrual of parent reported adverse childhood experiences following a child protective services investigation: A prospective approach. Child Abuse Negl. 2021 Dec 17;124:105447. PMID: 34923299
From a national survey, for children left in the home after a CPS investigation, the progression of ACEs was tracked over 3 years. “The average number of ACEs for in-home children increased precipitously, and higher ACE scores at baseline were associated with greater accumulation.”
Rettew DC, Pawlowski S.
Bullying: An Update. Child Adolesc Psychiatr Clin N Am. 2022 Jan;31(1):1-9. PMID: 34801148
“Bullying is a complex and widespread public health issue that affects children of all ages and adults. For decades, childhood bullying has been viewed as an unpleasant but generally harmless rite of passage that carries with it few long-term consequences. Research has increasingly documented the serious and long-term behavioral and health consequences of bullying. This article addresses several features of bullying including epidemiology, psychological and physical impact, and the role of health providers in bullying detection, intervention, and prevention.”
Adult Manifestations of Child Abuse
Byrne SP, McCarthy E, DeViva JC, Southwick SM, Pietrzak RH.
Prevalence, risk correlates, and health comorbidities of insomnia in US military veterans: results from the 2019-2020 National Health and Resilience in Veterans Study. J Clin Sleep Med. 2021 Jun 1;17(6):1267-1277. PMID: 33656983
Of 4069 veterans, 11.4% screened positive for clinical insomnia, and 26.0% for subthreshold insomnia. Adverse childhood experiences, traumatic life events, lower education and income were associated with greater risk for insomnia. A “dose-response” association was seen with increasing insomnia and mental health and medical conditions. Suicidal ideation was 3-5 times higher in veterans with clinical and subthreshold insomnia vs. no insomnia (23.0% vs. 13.6% vs. 4.5%).
Duan P, Wang Y, Lin R, et. al.
Impact of early life exposures on COPD in adulthood: A systematic review and meta-analysis. Respirology. 2021 Dec;26(12):1131-1151. PMID: 34541740
“Early life represents a critical period for the development and growth of the lungs. Adverse exposures in this stage may drive the development of chronic obstructive pulmonary disease (COPD).” From a research review, childhood respiratory disease, maltreatment, maternal smoking, and low birth weight each independently increased the risk of COPD, the third leading cause of disease-related death of adults in the US.
Yoon C, Emery RL, Mason SM, Neumark-Sztainer D.
Sexual and physical abuse and identity of the perpetrator: Associations with binge eating and overeating in Project EAT 2018. Eat Behav. 2021 Dec;43:101577. PMID: 34717249
From this survey of 1407 adults aged 18-30, and after controlling for sociodemographic variables, both familial and intimate partner sexual abuse and/or physical abuse were associated with binge eating (overeating with loss of control), but not overeating.
Testa A, Ganson KT, Jackson DB, et. al.
Adverse childhood experiences and maternal disability: Findings from the North Dakota and South Dakota PRAMS, 2019. Soc Sci Med. 2021 Dec 1;292:114616. PMID: 34864603
For 1775 pregnant women in North/South Dakota, “Mothers with exposure to a greater number of ACEs -- notably, 4 or more ACEs -- had elevated rates of several disabilities including difficulty communicating, difficulty remembering, difficulty seeing, and difficulty walking.”
Testa A, Jackson DB, Boccio C, Ganson KT, Nagata JM.
Adverse childhood experiences and marijuana use during pregnancy: Findings from the North Dakota and South Dakota PRAMS, 2017-2019. Drug Alcohol Depend. 2021 Nov 26;230:109197. PMID: 34861494
For 5399 pregnant women in North/South Dakota, “Only 0.9% of women with zero ACEs reported marijuana use during pregnancy, compared to 11.7% of women with four or more ACEs.”
Kalia V, Knauft K, Hayatbini N.
Adverse childhood experiences (ACEs) associated with reduced cognitive flexibility in both college and community samples. PLoS One. 2021 Dec 2;16(12):e0260822. PMID: 34855895
Cognitive flexibility, a brain executive function, is the ability to adapt our behaviour and thinking in response to the environment, such as finding different ways to solve a problem. Cognitive flexibility is associated with positive outcomes in adulthood. From testing of 510 college students and adults, those with higher number of ACEs were more likely to report higher levels of perceived chronic stress, and exhibited reduced cognitive flexibility.
Mian O, Anderson LN, Belsky DW, et. al.
Associations of Adverse Childhood Experiences with Frailty in Older Adults: A Cross-Sectional Analysis of Data from the Canadian Longitudinal Study on Aging. Gerontology. 2021 Dec 7:1-10. PMID: 34875667
From a Canadian study of 27,748 adults aged 45-85 years, and after adjusting for income, education, smoking, and alcohol consumption, individuals exposed to ACEs had elevated levels of frailty in a graded manner, especially for women, and especially for those who experienced neglect.
Milbocker KA, Campbell TS, Collins N, et. al.
Glia-Driven Brain Circuit Refinement Is Altered by Early-Life Adversity: Behavioral Outcomes. Front Behav Neurosci. 2021 Dec 2;15:786234. PMID: 34924972
Detailed, technical article on how early life adversity negatively impacts the growth, maturation, and connectivity of brain cells, leading to mental health and behavior problems.
Kate MA, Jamieson G, Middleton W.
Childhood Sexual, Emotional, and Physical Abuse as Predictors of Dissociation in Adulthood. J Child Sex Abus. 2021 Nov-Dec;30(8):953-976. PMID: 34353238
Of 303 participants, including inpatients and outpatients receiving treatment for a dissociative disorder (DD), and university participants with elevated levels of dissociation or PTSD, plus with a control group, “clinical levels of dissociation and DDs occur in individuals reporting a history of childhood abuse, particularly sexual abuse and experiences that are potentially life-threatening to a child, such as choking, smothering, and physical injury that breaks bones or teeth, or that compromise the child's survival needs, including threats of abandonment and deprivation of basic needs. Females who disclosed sexual abuse in addition to being choked or smothered had a 106-fold increased risk of clinical levels of dissociation.”
Afifi TO, Sareen J, Taillieu T, et. al.
Association of Child Maltreatment and Deployment-related Traumatic Experiences with Mental Disorders in Active Duty Service Members and Veterans of the Canadian Armed Forces. Can J Psychiatry. 2021 Nov;66(11):961-970. PMID: 33472392
Of 2941 Canadian Armed Forces members and veterans, 62.5% reported childhood maltreatment, and 68.6% deployment-related traumatic experiences (DRTEs). “Cumulative effects of having experienced both child maltreatment and DRTEs increased the odds of past 12-month PTSD symptoms, general anxiety disorder, social phobia, and major depression…Understanding these relationships may provide insight into developing effective interventions for military personnel and veteran mental health outcomes.”
Wan A, Bernstein CN, Graff LA, et. al.
Childhood Maltreatment and Psychiatric Comorbidity in Immune-Mediated Inflammatory Disorders. Psychosom Med. 2022 Jan 1;84(1):10-19. PMID: 34654023
For 681 adults with immune-mediated inflammatory disorders (IMID) of multiple sclerosis, inflammatory bowel disease, and rheumatoid arthritis, plus a healthy control group, the prevalence of 1+ ACEs was higher in the inflammatory group (MS, 63.8%; IBD, 61.6%; RA, 62.3%; healthy controls, 45.6%). For women only, emotional abuse was 2.37 times more likely in those with IMID. A history of ACEs was 2.24 times more likely to be found in IMID, which did not differ across types of disorders. “Childhood maltreatment is more common in IMID than in a healthy population and is associated with psychiatric comorbidity.”
Trivedi M, Dumkrieger G, Chong CD, Dodick DW, Schwedt TJ.
Impact of abuse on migraine-related sensory hypersensitivity symptoms: Results from the American Registry for Migraine Research. Headache. 2021 May;61(5):740-754. PMID: 33779989
Of 588 adults in a registry for migraine patients, 38% reported a history of abuse. Those with an abuse history reported greater migraine-related sensory hypersensitivity symptoms, such as sensitivity to light or sound.
Brown MJ, Kaur A, James T, et. al.
Adverse Childhood Experiences and Subjective Cognitive Decline in the US. J Appl Gerontol. 2021 Dec 13:7334648211058718. PMID: 34898321
From a large national survey of US adults >45 years, various ACEs were associated with 2-3 times increased subjective cognitive decline over the prior year. There was also a dose-response relationship between ACEs score and subjective cognitive decline.
Adolescents
Clements-Nolle K, Lensch T, Yang Y, et. al.
Attempted Suicide Among Adolescents in Military Families: The Mediating Role of Adverse Childhood Experiences. J Interpers Violence. 2021 Dec;36(23-24):11743-11754. PMID: 31976794
From a random sample of 5,336 students from 98 high schools, compared to their peers, students in military families had higher exposure to ACEs (1 ACE: adjusted odds ratio aOR= 1.4, 2 ACEs: aOR = 2.07, and 3-6 ACEs: aOR = 2.57) and twice the odds of attempting suicide in the past 12 months (aOR = 2.16). “Cumulative exposure to ACEs was mainly responsible for the relationship between military family involvement and attempted suicide.”
Donnelly KA, Rucker A, Boyle MD, et. al.
Experiencing Bullying Is Associated With Firearm Access, Weapon Carriage, Depression, Marijuana Use, and Justice Involvement in Adolescents. Pediatr Emerg Care. 2022 Feb 1;38(2):e918-e923. PMID: 34116552
Of 369 adolescents seen in a pediatric ED, 40.5% reported experiencing bullying. Bullied teenagers had higher odds of a gun in the home (adjusted odds ratio 3.0), weapon carriage (aOR 5.6), witnessing an assault (aOR 3.0), negative experience with law enforcement (aOR 4.5), mental health diagnosis (aOR 3.9), and marijuana use (aOR 2.7).
Pierce H, Jones MS, Gibbs BG.
Early adverse childhood experiences and exclusionary discipline in high school. Soc Sci Res. 2022 Jan;101:102621. PMID: 34823667
Using data from a Fragile Families study, “We find that a child with a cumulative ACE score is almost four times more likely to have been suspended or expelled [from high school] …and suggests the importance of trauma-informed interventions in the American education system.”
Goncalves Soares A, Zimmerman A, et. al.
Abuse in Childhood and Cardiometabolic Health in Early Adulthood: Evidence From the Avon Longitudinal Study of Parents and Children. J Am Heart Assoc. 2021 Dec 7:e021701. PMID: 34873916
Of 3223 participants evaluated at age 18 and 25, at 18 years, childhood physical, sexual and psychological abuse were associated with higher body mass index. Physical abuse was also associated with lower high-density lipoprotein cholesterol (“good” cholesterol) and higher C-reactive protein (marker of inflammation), and sexual abuse was associated with higher heart rate. At age 25, all 3 types of abuse were additionally associated with higher insulin. “The age at which abuse occurred (<11 or 11-17 years) had little influence on the associations…Childhood abuse is associated with negative cardiometabolic outcomes even by young adulthood. Further follow-up will determine whether associations strengthen across the life course.”
Espeleta HC, Taylor DL, Kraft JD, Grant DM.
Child maltreatment and cognitive vulnerabilities: Examining the link to posttraumatic stress symptoms. J Am Coll Health. 2021 Oct;69(7):759-766. PMID: 31944931
From surveys of 376 college students, childhood maltreatment severity was related to decreased ability to control attention and increased repetitive negative thinking (RNT), which were then both related to increased post-traumatic stress symptoms. “Interventions for increasing attentional control and decreasing RNT should be implemented and evaluated for young adults with early adversity currently experiencing PTSS.”
Joyner B, Beaver KM.
Examining the potential link between child maltreatment and callous-unemotional traits in children and adolescents: A multilevel analysis. Child Abuse Negl. 2021 Dec;122:105327. PMID: 34534846
“For 4579 male and female youths from a national study, there was a significant association between child maltreatment and callous-unemotional traits, moreso for males than females.
Islam MI, Yunus FM, Kabir E, Khanam R.
Evaluating Risk and Protective Factors for Suicidality and Self-Harm in Australian Adolescents With Traditional Bullying and Cyberbullying Victimizations. Am J Health Promot. 2022 Jan;36(1):73-83. PMID: 34308672
Of 2145 Australian adolescents aged 14-17 years, “25.6% of adolescents were traditional bullying victims and 12% were cyberbullying victims. The percentages of suicidality (34.4% vs 21.6%) and self-harm (32.8% vs 22.3%) were higher in cyberbullying victims than in traditional bullying victims. Girls were more often bullied and more likely to experience suicidal and self-harming behavior than boys…Positive mental health/resilience and adequate sleep were found be significantly associated with decreased suicidality and self-harm in both types of bullying victims.”
Couture MC, Kang JE, Hemenway D, Grinshteyn E.
Associations between having been threatened or injured with a weapon and substance use and mental health among high school students in the United States. Int J Inj Contr Saf Promot. 2021 Dec 19:1-10. PMID: 34923925
“Being threatened or injured with a weapon is a serious form of physical bullying…from a national 2017 youth survey, approximately 6.0% of students reported having been threatened/injured with a weapon.” After adjusting for multiple variables, having been threatened/injured with a weapon was associated with binge drinking (adjusted odds ratio aOR = 2.5), marijuana use (aOR = 2.1), tobacco use (aOR = 2.6), misuse of prescription medication (aOR = 2.2), feeling sad/hopeless (aOR = 1.6) and considering suicide (AOR 1.7) compared with students who had not been threatened/injured.
Race/Cultural Concerns
Rosenthal CM, Parker DM, Thompson LA. Racial Disparities in Child Abuse Medicine. JAMA Pediatr. 2022 Feb 1;176(2):119-120. PMID: 34661605
“Overrepresentation of children from minoritized racial and ethnic groups in screening and reporting of child abuse will result in a cascade effect, causing continued overrepresentation at all later decision points in the child welfare system. It is imperative that health care professionals and mandatory reporters make efforts to minimize bias and disparity in making reports of abuse. This is no small task.”
Perpetrators
Potter MH, Kennedy RS, Font SA.
Rates and predictors of child maltreatment re-perpetration against new victims and prior victims. Child Abuse Negl. 2021 Nov 29;123:105419. PMID: 34856446
Using a sample of 285,245 first-time perpetrators of a substantiated maltreatment incident in 2010, “Fifteen percent of perpetrators re-maltreated one or more of their original victims ("same victim re-perpetration"); 12% maltreated a new victim. Overall, re-perpetration was more common among younger, female, and White perpetrators. Perpetrators who were the biological or adoptive parent of their initial victim(s) had higher rates of same victim re-perpetration; new victim re-perpetration was more common among perpetrators who initially victimized an adoptive or stepchild…Child welfare agencies should track re-perpetration in addition to revictimization as part of agency evaluations and risk assessments.”
Providers
Okeson K, Reid C, Mashayekh S, et. al.
Adverse Childhood Experiences and Healthcare Utilization of Children in Pediatric Emergency Departments. J Pediatr. 2022 Jan;240:206-212. PMID: 34547336
Of 1000 children presenting to 2 pediatric Eds (PEDs), those with ACEs were more likely to not have a primary care provider, and to be seen more frequently, especially for sick visits. “Over 85% of caregivers reported never discussing ACEs with their primary care provider. Most caregivers felt comfortable addressing ACEs in PEDs (84.4%) and would use referral resources (90.4%)…Given higher PED utilization in children with more ACEs and caregiver acceptance of PED-based screening and intervention, PEDs may represent a strategic and opportune setting to both assess and respond to ACEs among vulnerable populations.”
Prevention
Hazzard VM, Yoon C, Emery RL, et. al.
Adverse childhood experiences in relation to mood-, weight-, and eating-related outcomes in emerging adulthood: Does self-compassion play a buffering role? Child Abuse Negl. 2021 Dec;122:105307. PMID: 34492573
From a diverse sample of 1440 emerging adults, self-compassion acted as a buffer against adverse mood-, weight-, and eating-related outcomes in the face of ACEs, and “therefore may be an important intervention target.”
Researchers
Herrenkohl TI, Fedina L, Roberto KA, et. al.
Child Maltreatment, Youth Violence, Intimate Partner Violence, and Elder Mistreatment: A Review and Theoretical Analysis of Research on Violence Across the Life Course. Trauma Violence Abuse. 2022 Jan;23(1):314-328. PMID: 32723166
“To eradicate violence in all its forms, considerably more must be done to increase awareness of the repetition of violence; to connect research to actionable steps for prevention and intervention across the life course; and to better integrate systems that serve vulnerable children, youth, and adults. Primary prevention is essential to breaking the cycle of violence within families.”
Manning SE, Blinn AM, Selk SC, et. al.
The Massachusetts Racial Equity Data Road Map: Data as a Tool Toward Ending Structural Racism. J Public Health Manag Pract. 2022 Jan-Feb 01;28(Suppl 1):S58-S65. PMID: 34797262
“Key informants highlighted the need to consider structural factors and historical and community contexts when interpreting data…the team identified potential solutions and prioritized development and piloting of the MDPH [Mass. Dept. Public Health] Racial Equity Data Road Map…The Road Map is a resource to support programs to authentically engage communities; frame data in the broader contexts that impact health; and design solutions that address root causes.” https://www.mass.gov/service-d...equity-data-road-map
Reid M, Snyder C.
Feasibility of Using Child Maltreatment Measurement Instruments in the Primary Care Setting: A Systematic Review. J Pediatr Nurs. 2021 Nov-Dec;61:e1-e14. PMID: 33926746
Authors evaluated 111 child maltreatment measurement instruments, and recommend 6 for use by primary care providers “dependent on the needs of their individual practice…there is not a single superior instrument nor any instrument with a complete psychometric profile.” The six instruments are: ACE – Adverse Childhood Experiences Questionnaire, BCAPI – Brief Child Abuse Potential Inventory, CTQ – Childhood Trauma Questionnaire, CTQSF – Childhood Trauma Questionnaire Short Form, PSNA – Parenting Support Needs Assessment, STRESS - Structured Trauma-Related Experiences and Symptom Screener. The pros and cons of each are discussed.
Ross MC, Heilicher M, Cisler JM.
Functional imaging correlates of childhood trauma: A qualitative review of past research and emerging trends. Pharmacol Biochem Behav. 2021 Dec;211:173297. PMID: 34780877
“In this review, we discuss three popular approaches for discerning functional neural correlates to early life trauma, including regional activation [activation of a specific area of the brain], bivariate functional connectivity [activating multiple related areas of the brain at the same time to form a circuit], and network-based connectivity [how different circuits influence each other]. The breadth of research in each method is discussed, followed by important limitations and considerations for future research.” Very technically detailed.
Bethell C, Blackwell CK, Gombojav N, et. al.
Toward measurement for a whole child health policy: Validity and national and state prevalence of the Integrated Child Risk Index. Acad Pediatr. 2021 Dec 8:S1876-2859(21)00616-1. PMID: 34896272
Authors developed and validated an Integrated Child Risk Index (ICRI), which includes medical health risk (MHR), social health risk (SHR) and relational health risk (RHR) domains. It can be used to “estimate national and state prevalence on a multi-dimensional index that assesses the complex medical, social and relational health risks experienced by US children.”
Mathews B, MacMillan HL, Meinck F, et. al.
The ethics of child maltreatment surveys in relation to participant distress: Implications of social science evidence, ethical guidelines, and law. Child Abuse Negl. 2021 Dec 6;123:105424. PMID: 34883421
“We provide an updated overview of scientific evidence of the frequency and severity of distress in studies of child maltreatment, a review of ethical requirements including a focus on beneficence and participant welfare, and a new analysis of researchers' legal duties towards participants…we distil key principles of good epidemiological practice …which both fulfil ethical requirements to participants, and demonstrate trauma-informed practice.”
Other
Levine GN, Cohen BE, Commodore-Mensah Y, Fleury J, et. al.
Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association. Circulation. 2021 Mar 9;143(10):e763-e783. PMID: 33486973
“Based on current study data, the following statements can be made: There are good data showing clear associations between psychological health and CVD [cardiovascular disease] risk; there is increasing evidence that psychological health may be causally linked to biological processes and behaviors that contribute to and cause CVD; the preponderance of data suggest that interventions to improve psychological health can have a beneficial impact on cardiovascular health; simple screening measures can be used by health care providers for patients with or at risk for CVD to assess psychological health status; and consideration of psychological health is advisable in the evaluation and management of patients with or at risk for CVD.
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