[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
Ponton E, Courtemanche R, Singh TK, et. al.
Assessing the Social Determinants of Health and Adverse Childhood Experience in Patients Attending a Children's Hospital Cleft Palate-Craniofacial Program. Cleft Palate Craniofac J. 2021 Nov 3:10556656211048742. PMID: 34730452
Of 290 families seen at a Canadian Cleft Palate-Craniofacial program, 34% of families experienced significant barriers to accessing primary health care, 51% struggled financially, 47% reported not having adequate social support, and 11% scored 4+ ACEs. “Patients with cleft and craniofacial anomalies have complex needs that extend beyond medical care.”
Loos MHJ, Bakx R, Duijst WLJM, et. al.
High prevalence of non-accidental trauma among deceased children presenting at Level I trauma centers in the Netherlands. Forensic Sci Med Pathol. 2021 Dec;17(4):621-633. PMID: 34773580
Of all children who were seen at and died in Level 1 Pediatric trauma centers in the Netherlands over a 5-year period, 1 in 5 died from maltreatment – 9.7% from inflicted trauma and 10.3% from neglect. 44% of these children were under age 5 vs. 6% in the accidental trauma group. 78% of the deaths due to neglect were from drowning.
Palmer L, Prindle J, Putnam-Hornstein E.
A population-based case control study of suicide among youth reported for abuse and neglect. Child Abuse Negl. 2021 Jul;117:105060. PMID: 33845240
Of adolescents who died by suicide in California between 2010 and 2017 and who had a history of at least one report to CPS prior to death, “Recent CPS involvement, allegations of physical abuse, and allegations of sexual abuse emerged as significant risk factors for death by suicide. No differences in suicide risk were observed between youth with unsubstantiated or substantiated allegations.”
Greiner MV, Beal SJ, Nause K, Ehrhardt J.
Developmental Service Referrals and Utilization Among Young Children in Protective Custody. J Pediatr. 2021 Jul;234:260-264.e1. PMID: 33727112
In this study of children under age 3 seen at a foster care clinic, 75% failed developmental screening, and 77% were not receiving developmental services, whether in foster or kinship care. Of those potentially eligible, 60% were not referred for developmental services.
Tucker CJ, Finkelhor D, Turner H.
Exposure to parent assault on a sibling as a childhood adversity. Child Abuse Negl. 2021 Dec;122:105310. PMID: 34509926
From 3 combined national surveys on children’s exposure to violence, with 7,029 participants, “Lifetime EPAS [exposure to parent assault on a sibling] was 3.7%. Sibling assault was more common by fathers (70%) than by mothers (30%). Exposure was greatest for boys and adolescents, highest for those whose parents had some college education, and for those living with other non-parental adults, single parents, and stepfamilies. Rates did not differ by ethnicity. Most exposed youth felt afraid (83%)…Controlling for child maltreatment and exposure to inter-parental violence, those exposed to EPAS showed higher current levels of mental distress (anger, depression, and anxiety).”
Adult Manifestations of Child Abuse
Hughes K, Ford K, Bellis MA, Glendinning F, et. al.
Health and financial costs of adverse childhood experiences in 28 European countries: a systematic review and meta-analysis. Lancet Public Health. 2021 Nov;6(11):e848-e857. PMID: 34756168
“In most countries, interpersonal violence had the largest PAFs [population-attributable fraction] due to ACEs, followed by harmful alcohol use, illicit drug use, and anxiety. Harmful alcohol use, smoking, and cancer had the highest ACE-attributable costs in many countries. Total ACE-attributable costs ranged from $0·1 billion (Montenegro) to $129·4 billion (Germany) and were equivalent to between 1·1% (Sweden and Turkey) and 6·0% (Ukraine) of nations' gross domestic products.”
Whitaker RC, Dearth-Wesley T, Herman AN, et. al.
The interaction of adverse childhood experiences and gender as risk factors for depression and anxiety disorders in US adults: a cross-sectional study. BMC Public Health. 2021 Nov 12;21(1):2078. PMID: 34772386
From a US national study of 5834 respondents with mean age 54.1 years and 53.9% female, after adjusting for multiple variables, 26.9% of those with both female and 3-5 ACEs reported major depression, 10.2% higher than expected, and 21.9% reported an anxiety disorder, 11.4% higher than expected, due to an additive effect of experiencing both female gender and high ACEs.
Aquilina SR, Shrubsole MJ, Butt J, et. al.
Adverse childhood experiences and adult diet quality. J Nutr Sci. 2021 Oct 29;10:e95. PMID: 34804516
From a survey of 30,854 adults aged 40-79 from the Southeastern US, “ACEs are associated with poor adult diet quality, independent of race, sex and adult income. Research is needed to explore whether trauma intervention strategies can impact adult diet quality.”
Shamblaw AL, Sommer JL, Reynolds K, et. al.
Pregnancy and obstetric complications in women with a history of childhood maltreatment: Results from a nationally representative sample. Gen Hosp Psychiatry. 2021 May-Jun;70:109-115. PMID: 33799106
From a survey of 1279 US pregnant and post-partum women, 45% reported at least one form of childhood maltreatment, and 24.6% of these women experienced a perinatal complication compared to 13.5% of women without a history of childhood maltreatment. “Exposure to any childhood maltreatment, childhood sexual abuse and intimate partner violence (IPV) during childhood were significantly associated with increased odds of perinatal complications after adjusting for sociodemographic characteristics and lifetime psychiatric disorders. This association may be explained by vulnerability to physical diseases/complications due to persistent changes in biological stress systems, physical injuries from abuse, or as a result of traumatic memories triggered by pregnancy and childbirth.”
Niebauer E, Fry N, Auster-Gussman LA, Wahbeh H.
Patient perspectives on the causes of breast cancer: a qualitative study on the relationship between stress, trauma, and breast cancer development. Int J Qual Stud Health Well-being. 2021 Dec;16(1):1983949. PMID: 34694978
For 50 women with breast cancer, “Participants frequently discussed how childhood trauma and adult interpersonal stress significantly impacts their lives and breast cancer experiences. There was an overall idea from the participants that these events may have contributed to their developing breast cancer, specifically regarding lifetime stress’ cumulative effect on the body or stress making the body more vulnerable in some way.” Authors recommend trauma-informed therapies addressing these beliefs.
Dodson TS, Beck JG.
Does Using Social Support Matter in the Association of Post-Traumatic Cognitions and Perceived Social Support? Comparison of Female Survivors of Intimate Partner Violence With and Without a History of Child Abuse. J Interpers Violence. 2021 Nov;36(21-22):NP11674-NP11694. PMID: 31771401
For two groups of IPV survivors, one of whom had also experienced childhood abuse while the other did not, those with a childhood abuse history “had higher levels of negative post-traumatic cognitions about the world and self, greater negative attitudes about using social support, and lower perceived social support from family. These results…highlight the impact that negative attitudes about using social support can have on the trauma survivor's functioning.”
Testa A, Jackson DB, Ganson KT, Nagata JM.
Adverse Childhood Experiences and Criminal Justice Contact in Adulthood: ACEs and Adult Criminal Justice Contact. Acad Pediatr. 2021 Nov 6:S1876-2859(21)00532-5. PMID: 34752957
Of 8,531 participants in the national Longitudinal Study of Adolescent to Adult Health, “Accumulating ACEs - especially 4+ ACEs - was significantly associated with various forms of criminal justice contact, including having been arrested, experiencing a greater number of arrests, having been incarcerated in adulthood, having been incarcerated multiple times, and having spent longer periods of time incarcerated.”
Teicher MH, Gordon JB, Nemeroff CB.
Recognizing the importance of childhood maltreatment as a critical factor in psychiatric diagnoses, treatment, research, prevention, and education. Mol Psychiatry. 2021 Nov 4:1–8. PMID: 34737457
“Childhood maltreatment is the most important preventable risk factor for psychiatric disorders. Maltreated individuals typically develop psychiatric disorders at an earlier age, have a more pernicious course, more comorbidities, greater symptom severity, and respond less favorably to treatments than non-maltreated individuals with the same primary DSM-5 diagnosis. Furthermore, maltreated individuals have alterations in stress-susceptible brain regions, hypothalamic-pituitary-adrenal response [stress hormones], and inflammatory marker levels not discernible in their non-maltreated counterparts. Hence, maltreated and non-maltreated individuals with the same primary DSM-5 diagnoses appear to be clinically and neurobiologically distinct. The failure to embody this distinction in DSM-5 has interfered with our ability to discover novel treatments, to recommend currently available treatments most likely to be efficacious, and has been a largely unrecognized confound that has thwarted our ability to identify the biological basis for major psychiatric disorders.”
Verbist IL, Allsopp K, Huey D, Varese F.
Frequency and impact of childhood sexual and physical abuse on people using IAPT services. Br J Clin Psychol. 2021 Nov;60(4):504-512. PMID: 34080717
From a dataset of 1315 clients receiving psychological therapies, 14% (likely underestimated) were identified with a record of childhood sexual and/or physical abuse. A history of childhood abuse was associated with longer duration and earlier age of onset of conditions, greater number of presenting problems, PTSD, higher intensity treatment delivery, and lower recovery rates.
Hashemi L, Fanslow J, Gulliver P, McIntosh T.
Exploring the health burden of cumulative and specific adverse childhood experiences in New Zealand: Results from a population-based study. Child Abuse Negl. 2021 Oct 28;122:105372. PMID: 34717153
From a large study of New Zealand adults, and after controlling for socio-demographic factors, “respondents with higher ACE scores…had the strongest association with poor mental health followed by disability and chronic physical health conditions…Exposure to ACEs was detrimental to health even in the presence of PCEs [positive childhood experiences].”
Racine N, McDonald S, Chaput K, Tough S, Madigan S.
Pathways from Maternal Adverse Childhood Experiences to Substance Use in Pregnancy: Findings from the All Our Families Cohort. J Womens Health (Larchmt). 2021 Dec;30(12):1795-1803. PMID: 33524303
For 1994 Canadian pregnant women, there were significant direct and indirect associations between maternal ACEs and maternal substance use in pregnancy…Exposure to adversity in childhood can lead to socioeconomic and mental health difficulties that increase risk for substance use in pregnancy. Addressing these difficulties before pregnancy may help to reduce the potential for substance use in pregnancy.”
Adolescents
Lawler S, Stapinski L, Teesson M, et. al.
Unpacking Violent Behavior in Young Adulthood: The Relative Importance of Hazardous Alcohol Use. J Interpers Violence. 2021 Oct 29:8862605211044103. PMID: 34715761
From an online survey of 507 Australian young adults aged 18-20 years in the general community, 13% reported at least one act of violent behavior in the past year, primarily assault perpetrated against another person. “After controlling for other risk factors, the number of ACEs reported and hazardous alcohol use were independently and positively associated with increased odds of reporting violent behavior in young adulthood.”
Gnanamanickam ES, Nguyen H, Armfield JM, et. al.
Child maltreatment and emergency department visits: a longitudinal birth cohort study from infancy to early adulthood. Child Abuse Negl. 2022 Jan;123:105397. PMID: 34823123
For 443,754 Australian individuals followed since birth to early adulthood, those with any child maltreatment concerns had significantly higher rates for ED visits, especially for self-harm, substance use, and mental health, during adolescence and early adulthood.
Domestic Violence – Effects on Children
Riggs JL, Janisse H, Huth-Bocks A.
Parenting Mediates Associations Between Intimate Partner Violence at Different Life Stages and Toddler Social-Emotional Problems. Child Maltreat. 2021 Nov;26(4):398-408. PMID: 33783267
For 120 diverse women with toddlers, both maternal childhood exposure to IPV and adult experience of IPV predicted observed and self-reported parenting problems, which in turn predicted greater toddler social-emotional problems. “Exposure to IPV at different time points may influence parenting in different ways.”
Beltrán-Arzate K, Hodson K, Tes HK, et. al.
Contextual risk and psychosocial profiles of opioid-using mothers: A mixed-methods study. Womens Health (Lond). 2021 Jan-Dec;17:17455065211060624. PMID: 34818934
Of 50 opioid-using biological mothers of infants diagnosed with neonatal opioid withdrawal syndrome, psychosocial risk factors included: (1) barriers to communication and mistrust of health professionals, (2) limitations of access to health care and the amplification of disadvantages related to COVID-19, (3) lifelong consequences of adverse childhood experiences (ACEs), and (4) intimate partner violence and its influence on drug use…Efforts to reduce opioid usage in mothers need to consider psychosocial and contextual risks.
Race/Cultural Concerns
Raz M, Dettlaff A, Edwards F.
The Perils of Child "Protection" for Children of Color: Lessons From History. Pediatrics. 2021 Jul;148(1):e2021050237. PMID: 34112658
“The history of the child welfare system demonstrates how a focus on surveillance and reporting shifted the mission of child welfare agencies from service provision to investigations. This has resulted in disproportionate harm to Black children and families through disproportionate rates of removal and its negative sequalae, culminating in the termination of parental rights…Recognizing the history of our current child welfare system and the consequences of coercive family interventions is a crucial first step in envisioning alternative responses that offer services and support, including material resources, to help ensure children and families can thrive.
Johnson LM, Green HD Jr, Koch B, Harding R, et. al.
Correlates of Medical Mistrust Among Minority Women at Risk for HIV and Their Networks. Health Educ Behav. 2021 Dec;48(6):860-872. PMID: 33622086
“Individual-level and network-level variables were significantly associated with medical mistrust. Health interventions may benefit from conceiving of medical mistrust as a complex, rational response to cumulative discriminatory life experiences and a reflection of the networks within which individuals are embedded.”
Sexual Abuse
Basile KC, Smith SG, Chen J, Zwald M.
Chronic Diseases, Health Conditions, and Other Impacts Associated With Rape Victimization of U.S. Women. J Interpers Violence. 2021 Dec;36(23-24):NP12504-NP12520. PMID: 31971055
From a national sample of women with any lifetime experience of rape, “About two in five rape victims (39.1%) reported injury (e.g., bruises, vaginal tears), and 12.3% reported a sexually transmitted disease as a result of the rape victimization. Approximately 71.3% of rape victims (an estimated 16.4 million women) experienced some form of impact as a result of violence by a rape perpetrator…the adjusted odds of experiencing asthma, irritable bowel syndrome, frequent headaches, chronic pain, difficulty sleeping, activity limitations, poor physical or mental health, and use of special equipment (e.g., wheelchair) were significantly higher for lifetime rape victims compared with non-victims.”
Human Trafficking
Franchino-Olsen H.
Vulnerabilities Relevant for Commercial Sexual Exploitation of Children/Domestic Minor Sex Trafficking: A Systematic Review of Risk Factors. Trauma Violence Abuse. 2021 Jan;22(1):99-111. PMID: 30712473
From a research review of domestic minor sex trafficking, “Relevant risk factors and vulnerabilities include child abuse and maltreatment, caregiver strain, running away or being thrown away, substance use, peer influence, witnessing family violence or criminality, poverty or material need, difficulty in school, conflict with parents, poor mental health or view of self, involvement in child protective services, involvement in juvenile detention or delinquency, early substance use, and prior rape or adolescent sexual victimization.”
Providers
Baker AJL, LeBlanc S, Adebayo T, Mathews B.
Training for mandated reporters of child abuse and neglect: Content analysis of state-sponsored curricula. Child Abuse Negl. 2021 Mar;113:104932. PMID: 33484982
From a review of US state-sponsored online mandated reporter training, “Numerous gaps were identified in the curricula including: few trainings identified reasons why reports should be made, only about one fourth included a definition, indicators, and examples of each type of maltreatment, the average number of suggestions for responding to a disclosure made by a child was 3, and few curricula addressed barriers to reporting or the impact of reporting on the reporter.”
Lloyd MC, Ratner J, La Charite J, et. al.
Addressing Trauma and Building Resilience in Children and Families: Standardized Patient Cases for Pediatric Residents. MedEdPORTAL. 2021 Nov 8;17:11193. PMID: 34820511
“With content experts, we developed three standardized patient cases based on common clinical encounters, as well as didactic and debriefing materials. Case 1 focused on somatic [physical] symptoms in an adolescent with ACEs, case 2 focused on an ACE disclosure by a parent, and case 3 focused on de-escalation.” After the training, participants felt more comfortable with inquiring about and discussing ACEs, explaining the health impacts of trauma, identifying protective factors, resilience counseling, and de-escalation. Training materials
Goddard A, Janicek E, Etcher L.
Trauma-informed care for the pediatric nurse. J Pediatr Nurs. 2021 Nov 16;62:1-9. PMID: 34798581
“Awareness of trauma, assessment of trauma in pediatrics, and health and resiliency promotion are critical in moving forward post-pandemic. The overview of trauma-informed care provides a guide for the pediatric nurse.”
Prevention
Khetarpal SK, Szoko N, Ragavan MI, Culyba AJ.
Future Orientation as a Cross-Cutting Protective Factor Against Multiple Forms of Violence. J Pediatr. 2021 Aug;235:288-291. PMID: 33991542
Of 2346 9th- to 12th-grade students who completed an anonymous survey, positive future orientation was significantly and inversely associated with multiple forms of interpersonal violence including youth, community, and sexual/relationship violence. Designing interventions to promote future orientation holds promise.”
Halpin AB, MacAulay RK, Boeve AR, D'Errico LM, Michaud S.
Are Adverse Childhood Experiences Associated with Worse Cognitive Function in Older Adults? J Int Neuropsychol Soc. 2021 Nov 19:1-10. PMID: 34794526
Of 121 Maine elders, “Over 56% of older adults reported an adverse childhood event. ACE scores were negatively associated with income and years of education and positively associated with depressive symptoms and subjective cognitive concerns…however, these relationships were no longer significant after adjusting for education.”
Homan KJ, Hollenberger JC.
Religious Support Moderates the Long Reach of Adverse Childhood Events on Physical Health in Middle to Late Adulthood. J Relig Health. 2021 Dec;60(6):4186-4208. PMID: 33860403
Of 4041 adults from a national midlife survey, religious support (such as from a clergyperson or group) but not religious identification, private religious practice, or religious service attendance “buffered the effect of childhood adversity on physical health”.
Liu X, Xiao R, Tang W.
The Impact of School-Based Mindfulness Intervention on Bullying Behaviors Among Teenagers: Mediating Effect of Self-Control. J Interpers Violence. 2021 Nov 22:8862605211052047. PMID: 34802328
Compared to a control group, for 92 teenagers who received a mindfulness intervention, post-test scores of trait mindfulness and self-control in the experimental group significantly increased, while scores of bullying behavior significantly decreased. Half of the effect of trait mindfulness on bullying behavior was through increased self-control.
Keding TJ, Heyn SA, Russell JD, et. al.
Differential Patterns of Delayed Emotion Circuit Maturation in Abused Girls With and Without Internalizing Psychopathology. Am J Psychiatry. 2021 Nov;178(11):1026-1036. PMID: 34407623
“Brain age” was calculated from brain scans using gray matter volume in whole-brain, emotion, and language centers. Of 234 girls aged 8-18 years, childhood abuse was related to reduced emotion circuits BrainAGE (delayed maturation), while childhood physical neglect was associated with increased whole-brain BrainAGE (advanced maturation). Resilient girls showed emotion circuit maturity and increased BrainAGE. “The BrainAGE maturity index have the potential to allow researchers to test treatment strategies targeting specific circuits and help clinicians monitor the neurodevelopmental trajectories of their patients, with the aim of helping guide them back into healthy ranges.”
Researchers
Suglia SF, Appleton AA, Bleil ME, et. al.
Timing, duration, and differential susceptibility to early life adversities and cardiovascular disease risk across the lifespan: Implications for future research. Prev Med. 2021 Dec;153:106736. PMID: 34293381
Authors “focus specifically on the roles of: 1) susceptibility and resilience, 2) timing and developmental context; and 3) variation in risk exposure. We propose to expand current conceptual models to incorporate these factors to better guide research that examines early life abuse and cardiovascular disease risk across the lifespan.”
Guo S, O'Connor M, Mensah F, et. al.
Measuring Positive Childhood Experiences: Testing the Structural and Predictive Validity of the Health Outcomes From Positive Experiences (HOPE) Framework. Acad Pediatr. 2021 Nov 18:S1876-2859(21)00539-8. PMID: 34801761
Authors show that a 4 factor structure from the Health Outcomes from Positive Experiences (HOPE) framework - 1) positive parenting, 2) trusting and supportive relationships, 3) supportive neighborhood and home learning environments, and 4) social engagement and enjoyment had “sufficient internal coherence and predictive validity to offer a potentially useful way of conceptualizing and measuring PCEs in future cohort studies and intervention trials aiming to enhance the understanding of, and mitigate the negative impacts of, adverse childhood experiences.”
Other of Interest
Purtle J, Nelson KL, Srivastav A, Gollust SE.
Perceived Persuasiveness of Evidence About Adverse Childhood Experiences: Results From a National Survey. Acad Pediatr. 2021 Apr;21(3):529-533. PMID: 32553780
From an online survey of 503 US adults, evidence about ACEs as risk factors for mental health, substance use conditions, suicide and the macro-economic impact of ACEs may be most compelling to the US general public, while evidence about epigenetics and ACEs as risk factors for physical health conditions may be least compelling. Communications research is important to the next era of ACE-related research and accelerating the translation of ACE evidence into public policy.
Ellis W, Dietz WH, Chen KD.
Community Resilience: A Dynamic Model for Public Health 3.0. J Public Health Manag Pract. 2022 Jan-Feb 01;28(Suppl 1):S18-S26. PMID: 34797257
“The CR [community resilience] model focuses on community and population health outcomes associated with the policies and practices of the housing, public education, law enforcement, and criminal justice sectors as CR measures. The model demonstrates how behaviors of these systems interact and produce outcome measures such as employment, homelessness, educational attainment, incarceration, and mental and physical health…The CR model is being used by local public health departments to develop equity measures and monitor change over time.”
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