[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!]
Child Abuse
Raz M, Gupta-Kagan J, Asnes AG.
Using Child Abuse Specialists to Reduce Unnecessary Child Protective Services Reports and Investigations.
JAMA Pediatr. 2023 Dec 1;177(12):1249-1250. PMID: 37812436
“Given the high rates of CPS investigations in the US, the disproportionate number of poor and Black families subjected to these investigations, and the intrusiveness of these investigations for families and communities, reducing unnecessary CPS referrals is an imperative…data suggest that many CPS referrals are avoidable if clinicians are empowered to consult a CAP [child abuse pediatrician] prior to making a CPS report. We therefore suggest that hospitals develop an internal pathway for clinicians who are concerned but uncertain about the likelihood of abuse to first consult their local CAP prior to submitting a CPS report.”
Martin NR, Claypool AL, Diyaolu M, et al.
SCAN for Abuse: Electronic Health Record-Based Universal Child Abuse Screening.
J Pediatr Surg. 2023 Oct 20:S0022-3468(23)00635-8. PMID: 37953157
“Following rollout of this EHR-based child abuse screening program, our center experienced increased detection of CPS-reportable cases of children who might have otherwise been missed, as well as an increase in overall CPS reporting rates of physical abuse. Furthermore, these results were accomplished without placing undue burden on nurses, social workers, or providers.” The protocol included an automatic referral for SCAN (suspected child abuse and neglect) team silent chart evaluation if a child under 5 was an injured/trauma patient, and depending upon initial evaluation the SCAN team could formally facilitate further actions.
Henderson TG, Graff AH, Thorvilson MJ.
The Role of Pediatric Palliative Care Following Nonaccidental Trauma.
J Palliat Med. 2023 Dec;26(12):1752-1754. PMID: 37433212
“All children experiencing child maltreatment/ neglect require child abuse experts to offer the complex care needed, and for the child with potential life-limiting injuries, both child abuse and palliative care experts are integral to the team…Here we describe a case of an infant who suffered injuries after nonaccidental trauma and the subsequent role of pediatric palliative care.”
Sarma A, Snyder EJ, Vankineni K, Williams HN, Pruthi S.
A Radiologist's Lexicon for Reporting in Child Abuse.
Radiographics. 2023 Jul;43(7):e220101. PMID: 37289645
“Optimal radiologic terminology for suspected abuse-associated injuries may differ from that used in other scenarios (e.g., older patients, accidental trauma). Varying word usage for the same finding may sometimes lead to confusion. Child abuse pediatricians’ expert evaluation of injury-mechanism correlation relies on precise, appropriately detailed, and consistent use of radiologic terminology.” Authors provide examples of appropriate and inappropriate wording.
Abraham-Bizot A, Greco C, Quartier P, et al.
Medical child abuse: Medical history and red flags in French adolescents.
Child Abuse Negl. 2023;146:106523. PMID: 37950944
Of 29 French adolescents seen in 5 tertiary care Paris hospitals and identified as suspected medical child abuse (MCA), “the mean age was 12.9 years at suspected diagnosis. Medical wandering [“doctor shopping’] was common, with a mean of 23 alleged symptoms and 33 specialized consultations in a mean of six different hospitals. The mean number of emergency visits was 11.8 and radiologic exams 24.3. The impact of MCA on quality of life was major, with a high rate of school dropout (96%). The mean delay to the suspected diagnosis was 5.8 years, and even when recognized, it was rarely the subject of a social or judiciary report (only 42%)…Adolescent MCA is poorly known among the medical profession. Increasing awareness, education and knowledge of risk factors could contribute to better care.”
Nasrazadani A, Ruda M, Girardet R, et al.
Gonorrheal and chlamydia yield for genital and extragenital testing in children evaluated for sexual abuse.
Child Abuse Negl. 2023 Nov 8;147:106525. PMID: 37948873
While Texas Forensic Nurse Examiners routinely test genital and non-genital sites for sexually transmitted infections (STI) in children being evaluated for sexual abuse, CDC guidelines recommend testing be based primarily on history of type of contact and other factors. In this study of 675 patients tested for STIs, with 11 positive, “10 patients' reported history of type of contact did not fully match sites that tested positive. Diagnosis of STI infection would have been missed for 5 patients if testing had been limited to the disclosed sites of sexual contact.”
Rockhold MN, Kautz-Turnbull C, Handley ED, Petrenko CLM.
The trauma experiences of children with fetal alcohol spectrum disorders: Developmental outcomes utilizing a threat/deprivation child adversity framework.
Alcohol Clin Exp Res (Hoboken). 2023 Sep;47(9):1722-1735. PMID: 37423769
Of 84 children aged 4-12 with fetal alcohol spectrum disorder, all in out-of-home placements, “87.5% of individuals experienced three or more subtypes of trauma. The average duration of all subtypes was 1.62 years, with a mean onset of 3.94 years. Biological parents were the most common perpetrator. There were significantly worse behavioral and caregiver-child relationship outcomes for children experiencing a combination of threat and deprivation trauma…longer duration of deprivation was associated with greater cognitive difficulties.”
Chiang CJ, Kim H, Jonson-Reid M, Yang M, Moon CK, Kohl P.
Risk factors and neglect subtypes: Findings from a nationally representative data set.
Am J Orthopsychiatry. 2023;93(6):532-542. PMID: 37561475
“Neglect is the most frequently reported type of maltreatment and has been shown to have a
significant impact on the long-term wellbeing of both children and families…This study identified five risk factors [child’s age, child’s biological sex, caregiver’s perceived social support level, caregiver’s parenting skills level, and caregiver’s stress level] that were able to discriminate between subtypes of neglect…interventions and policies should consider the heterogeneity in risk factors among neglect subtypes.”
Allard-Gaudreau N, Poirier S, Cyr M.
Factors associated with delayed disclosure of child sexual abuse: A focus on the victim's having been led to perform sexual acts on the perpetrator.
Child Abuse Negl. 2023;147:106537. PMID: 37956501
Results from a content analysis of 68 transcripts from investigative interviews with CSA victims aged 4 to 12 years old revealed that children were more likely to delay disclosure of sexual abuse if the perpetrator was a family member, the abuse was more frequent, and the child had been made to perform sexual acts on the perpetrator.
Stormer B, Chandler-Ofuya N, Baker AJL, et al.
Caregiver Psychological Maltreatment Behaviors Toward Children on TikTok.
Child Maltreat. 2023:10775595231211616. PMID: 37956869
“A significant number of parents engage in sharenting without considering its impact on their children and research shows that children, especially teens, can experience sharenting as a hostile act. Sharenting can compromise children’s online safety…as well as the potential for a child’s embarrassment, bullying, and reputational damage, both immediately and throughout the child’s life.” Authors note and discuss legal and policy issues as well as education/intervention for “behaviors related to posting negative content of their children to social media, such as videos capturing parents playing cruel pranks on their children designed to scare, embarrass, or upset them or videos capturing parents threatening and belittling their children or encouraging their child’s antisocial behavior (e.g., fighting between siblings, sexualized dancing).”
Islam MM.
The gradients of the relationship between child discipline practices at home and early childhood development of young children.
Child Abuse Negl. 2023;147:106536. PMID: 37944309
“This study examined the gradient of the relationship between the number and types of child
discipline practices at home and the ECD [early childhood development] of children aged 36-59 months…About 94% of children had experienced at least one of the eight violent disciplinary measures during the month preceding the survey…The probability that children were on track in ECD significantly increased with non-violent disciplinary practices and decreased with violent disciplinary
practices used. For one unit increase in the overall violent disciplinary index, the odds of children being on track in their ECD was reduced by 12%, and the reduction was significant.”
Hartill M, Rulofs B, Allroggen M, et al.
Prevalence of interpersonal violence against children in sport in six European countries.
Child Abuse Negl. 2023;146:106513. PMID: 37931542
Of 10,302 individuals aged 18-30 who had participated in organized sport prior to age 18 (50% female) from six European countries, prevalence of inside sport maltreatment included psychological violence (65%), physical violence (44%), neglect (37%), non-contact sexual violence (35%), and contact sexual violence (20%). Relatively small geographical differences were found. “Interpersonal violence against children in sport is widespread.”
Crouch E, Andersen TS, Smith HP.
Adverse Childhood Experiences and Positive Childhood Experiences Among United States Military Children.
Mil Med. 2023 Oct 28:usad416. PMID: 37897695
From a large national study, “There were no statistically significant differences in PCEs between military and civilian children. Compared to children with a civilian caregiver, children who had a caregiver who had ever served on active duty had higher odds of experiencing domestic violence (adjusted Odds Ratio 1.61), mental health issues or depression in the household (aOR 1.28), and substance use (aOR 1.28).”
Dubowitz H, Finkel M, Feigelman S, Lyon T.
Initial Medical Assessment of Possible Child Sexual Abuse: History, History, History.
Acad Pediatr. 2023 Nov 14:S1876-2859(23)00417-5. PMID: 37972726
“Primary care professionals (PCPs) can play a valuable role in the initial assessment of possible child sexual abuse (CSA)…PCPs, however, are often reluctant to conduct these assessments. The goal of this paper is to help PCPs be more competent and comfortable playing a limited but key role…This article focuses on practical guidance regarding history-taking when CSA is suspected, incorporating evidence from research on forensic interviewing. We have been mindful of the practical constraints of a busy practice and the role of the public agencies in fully investigating possible CSA.”
Caouette J, Cossette L, Hébert M.
Do You See What I See? Emotion Recognition Competencies in Sexually Abused School-Aged Children and Non-Abused Children.
J Child Sex Abus. 2023;32(7):813-28. PMID: 37545166
For 97 sexually abused (SA) children (65 girls) and 78 non-abused children (56 girls) aged between 6 and 12 years from the Montreal area, recognition of joy, anger, fear, sadness, and neutral expressions was assessed. Total scores of emotion recognition were significantly lower for those who experienced SA relative to non-abused children, especially for anger and joy. “Findings highlight the importance of assessing emotion recognition competencies to improve intervention programs provided to sexually abused children.”
Farkas BC, Jacquet PO.
Early life adversity jointly regulates body-mass index and working memory development.
Proceedings Biological sciences. 2023;290(2011):20231945. PMID: 37964530
Authors discuss the concept that a child, as a growing organism with a certain amount of energy to spend, balances energy expenditure towards body and brain development. “An important issue, largely overlooked so far, is the extent to which this energetic trade-off is influenced by early life environmental factors. In this study, we estimated the association between neurocognitive (measured by working memory ability) and somatic (measured by body-mass index) developmental trajectories, while taking into account multiple dimensions of early life adversity.”
Svendsen SS, Lewis T, Chiesa AE, Sirotnak AP, Lindberg DM.
The role of fellowship experience in decreasing burnout for child abuse pediatricians.
Child Abuse Negl. 2023;147:106532. PMID: 37956502
Of 133 pediatricians who had attended child abuse/neglect fellowships, with a 64% response rate, 53% scored in the high-risk range for at least 1 of the three subscales for burnout. “Activities perceived to be most useful in addressing burnout were: multidisciplinary team interactions, time spent with the team outside of work, and faculty/trainee one-on-one mentorship. Educational activities were only weakly associated with addressing burnout…Moderate or high levels of burnout are present in a large proportion of practicing CAPs [child abuse pediatricians] and more than one-third of participants felt that the quality of burnout training in fellowship did not meet their needs. These data support the need to more effectively address burnout education within the training experience of CAP fellows.”
Adult Manifestations of Child Abuse
Danese A, Widom CS.
Associations Between Objective and Subjective Experiences of Childhood Maltreatment and the Course of Emotional Disorders in Adulthood.
JAMA Psychiatry. 2023 Oct 1;80(10):1009-1016. PMID: 37405795
1196 midwestern individuals who had objective substantiated records of childhood physical and sexual abuse and/or neglect between 1967 and 1971 were compared to a demographically matched group of participants experiencing no abuse or neglect in childhood. Participants were followed up to age 40 years, including a measurement of subjective childhood maltreatment experience at mean age 29 years. Those who showed a poor course of emotional disorders (depression and anxiety) over the subsequent decade were largely attributable to the subjective experience of maltreatment. Participants with objective and not subjective experiences of maltreatment had minimal depression or anxiety. “Modification of the subjective experience of childhood maltreatment could improve the longitudinal course of emotional disorders.”
Giampetruzzi E, Tan AC, LoPilato A, et al.
The impact of adverse childhood experiences on adult depression severity and treatment outcomes.
J Affect Disord. 2023 Jul 15;333:233-239. PMID: 37086798
Of 454 patients seen at a specialty clinic for treatment-resistant depression, those with 3+ ACEs had more severe symptoms and worse treatment outcomes. ACE subtypes of sexual trauma and physical violence were associated with more severe symptomatology, while childhood sexual trauma was associated with a history of suicide attempts and inpatient admissions.
Lee VM, Hargrave AS, Lisha NE, Huang AJ.
Adverse Childhood Experiences and Aging-Associated Functional Impairment in a National Sample of Older Community-Dwelling Adults.
J Gen Intern Med. 2023 Nov;38(15):3362-3371. PMID: 37532875
“Among the 3387 participants (aged 50 to 97 years; 54% female), 44% reported a history of one or more types of ACEs. After adjusting for age, gender, race, and ethnicity, participants reporting any ACE history were more likely to demonstrate physical mobility impairment (OR 1.30), cognitive impairment (OR 1.26) and report functional disability (OR 1.69)… Findings support the need for trauma-informed approaches to geriatric care that consider the potential role of early life trauma in shaping or complicating late-life functional challenges.”
Duka S, Rahman S, Hansen SE, Esernio-Jenssen D.
The Effect of Maternal Adverse Childhood Experiences (ACEs) on Substance Use During Pregnancy.
Matern Child Health J. 2023 Dec;27(Suppl 1):153-165. PMID: 37733152
Data from 222 infants who were referred to CPS for suspected substance exposure were analyzed. “Half (50.0%) the infants had withdrawal symptoms. Most (67.0%) women had positive toxicology screens, while 85.0% reported prenatal substance use…a higher prevalence of mothers referred to the child protection team had ≥ 4 ACEs than women in the general population (50.9% vs. 15.2%), and a large proportion had used substances while pregnant. Routine prenatal ACEs screening and universal, nonpunitive toxicology testing of infants and mothers at birth may provide opportunities for intervention while reducing the transgenerational impact of ACEs.”
Kristbergsdottir H, Valdimarsdottir HB, et al.
The role of childhood adversity and prenatal mental health as psychosocial risk factors for adverse delivery and neonatal outcomes.
Gen Hosp Psychiatry. 2023;85:229-35. PMID: 37995481
From a study of Icelandic pregnant women, “ACEs are strong predictors for mental health problems during pregnancy. Both ACEs and prenatal common mental disorder diagnosis are associated with operative delivery interventions and neonatal outcomes. Findings underscore the importance of identifying high-risk women.”
Keenan-Devlin LS, Borders AEB, Freedman A, et al.
Maternal exposure to childhood maltreatment and adverse birth outcomes.
Sci Rep. 2023 Jun 27;13(1):10380. PMID: 37369688
From a diverse US sample of 657 pregnant women, 32% reported any CM (childhood maltreatment) exposure. “Risk for SGA [small for gestational age] birth was 61% higher among those in the CM group compared to the non-CM group (14.1% vs. 7.6%), and each subsequent form of CM that an individual was exposed to corresponded with a 27% increased risk for SGA. There was no significant association between CM and preterm birth.”
Pryce P, Gangopadhyay M, Edwards JD.
Parental Adverse Childhood Experiences and Post-PICU Stress in Children and Parents.
Pediatr Crit Care Med. 2023 Dec 1;24(12):1022-1032. PMID: 37615404
Of 145 parents of children cared for at one urban academic pediatric ICU, with a 95% response rate, 58% of parents reported 1+ ACE and 14% reported 4+ ACEs. At one month follow-up (79% response rate), 16% of parents had provisional PTSD, and risk for PTSD was 10.2 times greater in parents with 4+ ACEs. 56% of children screened at risk for PTSD, but there was no correlation with parental ACEs or parental PTSD. “Family-centered care that seeks to mitigate post-PICU stress should be mindful of the potential relevance of parental ACEs.”
Copeland WE, Halvorson-Phelan J, McGinnis E, Shanahan L.
Adult Mental Health, Substance Use Disorders, and Functional Outcomes of Children Resilient to Early Adversity.
Am J Psychiatry. 2023:appiajp20230038. PMID: 37941330
The analysis was based on the prospective, representative Great Smoky Mountains Study (N=1,420). Participants were assessed for psychiatric disorders and exposure to adversity up to eight times in childhood, and 86.3% followed up to ages 25-30. 75% of the group met criteria for a psychiatric disorder or displayed subthreshold psychiatric problems by age 16. The number of ACEs was strongly associated with childhood psychiatric status. Of children exposed to multiple adversities, 12.2% did not display psychiatric problems, meeting common definitions of childhood resilience. However, “in adulthood these individuals showing childhood resilience had greater risk of anxiety (risk ratio=2.9) and depressive (risk ratio=4.5) disorders, as well as worse physical health (means ratio=0.7) and financial or educational functioning (means ratio=0.6), compared with individuals exposed to fewer childhood adversities. These individuals showing childhood resilience did not have elevated risk for substance use disorders…Individuals who appeared resilient in childhood were at risk for delayed poorer outcomes in adulthood. Public health efforts should prioritize minimizing early adversity exposure over promoting resilience.”
Ee JS, Culp PA, Bevis ZJ, Dogbey GY, Agnello RN, Chang MH.
Chronic Pain and Childhood Adversity Experiences Among U.S. Military Personnel.
Mil Med. 2023;188(Supplement_6):561-6. PMID: 37948239
Of 40 soldiers seen at an interdisciplinary pain management center, 20 with a history of childhood maltreatment and 20 without childhood maltreatment and matched for age, gender, pain history duration, and pain problem, there were no significant differences in current, worst, or average pain ratings. However, the maltreatment group reported significantly greater effect of pain on mood, more serious depression and anxiety symptoms, and more tendency to catastrophize.
Minjoz S, Sinniger V, Hot P, Bonaz B, Pellissier S.
The burden of early life stress in chronic inflammatory bowel diseases.
J Health Psychol. 2023;28(13):1204-16. PMID: 37203800
Of 93 French adults with inflammatory bowel disease (IBD), the prevalence of patients with IBD who were exposed to at least one childhood abuse was 53%. Those exposed reported significantly poorer mental health and quality of life as well as more digestive perturbations and fatigue. “These results suggest that early abuse should be considered a component of IBD care.”
O'Connor DB, Branley-Bell D, Green JA, et al.
Effects of childhood trauma on sleep quality and stress-related variables in adulthood: evidence from two multilevel studies.
Psychology & health. 2023:1-22. PMID: 37975565
From two UK adult studies, higher levels of childhood neglect and abuse were variously associated with poorer daily sleep quality, shorter sleep duration, longer sleep onset latency, greater morning tiredness, and higher daily stress, rumination and worry levels. “Interventions aimed at mitigating the negative effects of childhood trauma should also incorporate components that target modifiable risk factors, such as sleep, stress, worry, and rumination.”
Regmi S, Kedia SK, Ahuja NA, Lee G, Entwistle C, Dillon PJ.
Association Between Adverse Childhood Experiences and Opioid Use-Related Behaviors: A Systematic Review.
Trauma Violence Abuse. 2023:15248380231205821. PMID: 37920999
From a research review, “All studies found statistical associations between ACEs and lifetime or current opioid use-related behaviors…as the number of ACEs increased, the risk of opioid use-related behaviors also increased. Hence, it is essential for clinicians to screen for ACEs before prescribing opioid medications, for opioid treatment to incorporate trauma-informed methods, and for messaging around opioid use interventions to include information about ACEs. The current review points to a critical need to implement standardized ACE screening instruments in clinical and research settings.”
Souama C, Milaneschi Y, Lamers F, et al.
Metabolic syndrome after childhood trauma: a 9-year longitudinal analysis.
Psychol Med. 2023:1-9. PMID: 37981868
Participants (N = 2958) from a Netherlands Study were assessed four times across 9 years in adulthood. Childhood trauma (CT) was reported by 49% of participants, and was consistently associated with increased waist size, blood sugar level, systolic blood pressure, and decreased HDL (“good”) cholesterol. “These associations were mainly driven by severe CT and unaffected by lifestyle…Individuals with CT have an increased risk for cardiometabolic disease and may benefit from monitoring and early interventions targeting metabolism.”
Wakuta M, Nishimura T, Osuka Y, et al.
Adverse childhood experiences: impacts on adult mental health and social withdrawal.
Frontiers in public health. 2023;11:1277766. PMID: 37954050
“A total of 4,000 Japanese adults, aged 20-34, were recruited through an Internet survey form in October 2021. Participants answered questions regarding their ACEs in the family (10 items), school ACEs (five teacher-related items and two bullying-related items), depressive/anxiety symptoms, and Hikikomori (remaining at home for more than 6 months). A significant association with depressive/anxiety symptoms was shown in both ACEs and school ACEs…As for Hikikomori, a significant association was shown in the school ACEs only: a 29% increased risk of Hikikomori for every one-point increase in school ACE scores.”
Adolescents
Lussier AA, Zhu Y, Smith BJ, et al.
Association between the timing of childhood adversity and epigenetic patterns across childhood and adolescence: findings from the Avon Longitudinal Study of Parents and Children (ALSPAC) prospective cohort.
Lancet Child Adolesc Health. 2023 Aug;7(8):532-543. PMID: 37327798
Using data from a large long-term national study, researchers analyzed DNA methylation (changes to DNA caused by external circumstances) at 41 different DNA locations. “Exposure to one-adult households was associated with differences in DNA methylation at 20 [49%] of 41 loci, exposure to financial hardship was associated with changes at nine (22%) loci, and physical or sexual abuse was associated with changes at four (10%) loci… Differences in DNA methylation at 15 years were not present at 7 years and differences identified at 7 years were no longer apparent by 15 years…These findings highlight the time-varying effect of childhood adversity on DNA methylation profiles across development…these epigenetic signatures could ultimately serve as biological indicators or early warning signs of initiated disease processes.”
Lee K, McMorris BJ, Chi CL, et al.
Using data-driven analytics and ecological systems theory to identify risk and protective factors for school absenteeism among secondary students.
J Sch Psychol. 2023 Jun;98:148-180. PMID: 37253577
Using data for 121,008 students, 18 risk and protective factors for chronic school absenteeism were noted.
Williams PG, Yogman M.
Addressing Early Education and Child Care Expulsion.
Pediatrics. 2023;152(5). PMID: 37899732
“Expulsion of young children ignores underlying emotional and behavioral concerns, disproportionately affects children of color (Black or Hispanic), males, children with disabilities, and socioeconomically disadvantaged populations, and has long-term consequences on educational and life success. Addressing implicit bias and providing child mental health consultation (psychologists, social workers, developmental behavioral pediatricians, child psychiatrists, and child neurologists) to child care providers can prevent expulsion. Pediatricians and other providers within the medical home play an important part in preventing expulsion…By identifying children at risk for expulsion…the pediatrician can connect families with community resources that may ameliorate these effects.”
Astridge B, Li WW, McDermott B, Longhitano C.
A systematic review and meta-analysis on adverse childhood experiences: Prevalence in youth offenders and their effects on youth recidivism.
Child Abuse Negl. 2023 Jun;140:106055. PMID: 37142357
From a research review of youth offenders aged 10-19 years, “Cumulative ACEs and neglect were positively associated with youth recidivism [re-offending], with OR = 1.966 and OR = 1.328, respectively. Physical and sexual abuse were not significantly associated with youth recidivism. Regarding the mechanisms underlying the relationship between ACEs and recidivism; moderators [influencing the strength of the association] included gender, positive childhood experiences, strong social bonds, and empathy. Mediators [influencing whether there is an association or not] included child welfare placement, emotional and behavioural problems, drug use, mental health problems, and negative emotionality…Developing programs for youth offenders aiming to address the impact of cumulative and individual ACE exposure, strengthen the protective factors and weaken the risk factors, would be useful to reduce youth recidivism.”
Dadi D, Bonilla Z, Beckstrand MJ, et al.
Emerging adult college students' descriptions of exposure to childhood emotional abuse and associated factors.
Child Abuse Negl. 2023;146:106516. PMID: 37922619
From interviews with 58 college students, themes were reported about their experiences with childhood emotional abuse, and the context surrounding that abuse: inability to meet parent expectations, parent attacks on the child's character, parent negative comparisons to siblings and others, parent invalidation of the child's emotions and mental health needs, and evolution over time in the parent-child relationship. Aspects of childhood family environments contemporaneous with the childhood emotional abuse included: financial stress; parent mental illness; parent divorce, separation, or volatile relationship; parent adversity or trauma; physical abuse; and young parent age.”
Al-Shoaibi AAA, Iyra P, Raney JH, et al.
Associations between adverse childhood experiences and early adolescent physical activity in the United States.
Acad Pediatr. 2023 Oct 26:S1876-2859(23)00395-9. PMID: 37898383
Using data from a large national adolescent study that included Fitbit daily step assessment, “Adjusted models suggest an inverse association between number of ACEs and Fitbit daily steps, with ≥4 (compared to 0) ACEs associated with 526 fewer daily steps. Of the ACEs subtypes, emotional abuse, physical neglect, household mental illness, and household divorce or separation, were inversely and statistically significant associated with Fitbit daily steps after adjusting for confounders…This work highlights the importance of screening for ACEs among young people at an early age to help identify those who could benefit from interventions or community programs that support increased physical activity.”
Langevin R, Pennestri MH, Hershon M, Pirro T, Hébert M.
The association between child sexual abuse and self-reported sleep in adolescent girls.
Journal of clinical sleep medicine. 2023;19(11):1933-9. PMID: 37469189
Of 707 adolescent girls aged 14-18 years, child sexual abuse had a significant and moderate association with negative overall sleep scores, with varying degrees of increased difficulties for different sleep dimensions. Authors support continued study of sleep issues in this population.
Lucas R, Talih M, Soares S, Fraga S.
Bullying Involvement and Physical Pain Between Ages 10 and 13 Years: Reported History and Quantitative Sensory Testing in a Population-Based Cohort.
J Pain. 2023 Oct 31:S1526-5900(23)00594-1. PMID: 37914095
From a national study of Portuguese adolescents, those classified as a bullying victim only, or as both a victim and aggressor at age 10 “had higher risk of pain with psychosocial triggers, pain that led to skipping leisure activities, multisite pain, pain of higher intensity, and pain of longer duration.” In addition, those classified as victim only at age 10 were more sensitive to pain at age 13. “Bullying victimization in youth: 1) is more likely to lead to negative reported pain experiences than the reverse, 2) may have long-term influence on adverse pain experiences, and 3) may contribute to pain phenotypes partly by interfering with somatosensory responses to painful stimuli.”
Schmidt F, Varese F, Bucci S.
Understanding the prolonged impact of online sexual abuse occurring in childhood.
Frontiers in psychology. 2023;14:1281996. PMID: 37941760
From interviews with 8 female UK young adults who had experience online sexual abuse (OSA) in childhood, “Results showed that the longer-term impact of OSA was multi-fold, including negative impact on sense of self and broader interpersonal relationships, and significant impact on the participants' mental health, including experiences of self-harm, anxiety, and low mood. Likewise, participants discussed long-term apprehension to taking images and the added fear and worry that their sexual images were distributed online. Seven participants had received mental health support but only two recounted a positive experience when receiving support for OSA.”
Lansing AE, Park J, Beck AN.
Cumulative trauma, adversity, and loss among juvenile justice-involved girls: Implications for health disparities.
J Trauma Stress. 2023 Dec;36(6):1015-1030. PMID: 37937661
This study of juvenile-justice involved girls notes how they variously related to stress – their emotional, physical, and dissociative reactions, and their maladaptive coping strategies such as risk taking, substance use, and suicidality.
DV – Effects on Children
Ayhan F.
The Association Between Witnessing Interparental Violence and Adolescents' Anger Expression Styles.
J Interpers Violence. 2023:8862605231209993. PMID: 37919952
From a national online survey of 1,000 adolescents aged 15-19 years, trait, externalized, and internalized anger scores were higher among the 44.6% of adolescents who had witnessed interparental violence compared to those who had not…has significant effects on the individual's trait anger and anger expression styles. We recommend that witnessing violence in different cultural environments be evaluated in future studies.”
Wilson RF, Xu L, Betz CJ, et al.
Firearm Homicides of US Children Precipitated by Intimate Partner Violence: 2003-2020.
Pediatrics. 2023 Dec 1;152(6):e2023063004. PMID: 37927118
“From 2003-2020, a total of 11,594 child homicides were captured in the National Violent Death Reporting System, of which 49.3% (n = 5716) were firearm homicides; 12.0% (n = 686) of child firearm homicides were IPV-related. Among IPV-related child firearm homicides, 86.0% (n = 590) were child corollary victims (i.e., children whose death was connected to IPV between others); 14.0% (n = 96) were teens killed by a current or former dating partner…Over half of IPV-related firearm homicides of child corollary victims included homicide of the adult intimate partner, of which 94.1% were the child victim's mother.”
Ragavan MI, Culyba AJ.
Intimate Partner Violence-Related Firearm Child Homicides: An Urgent Call to Action.
Pediatrics. 2023 Dec 1;152(6):e2023063805. PMID: 37927100
In this editorial regarding the above article, authors review the statistics and impact on children of IPV and homicide as well as adolescent relationship abuse and homicide, and emphasize how a pediatric medical home can be a source of support and resources for women, children, and dating adolescents against family and partner violence.
Kim JY, Zhang L, Gruber AM, Kim SK, Holmes MR, Brevda A.
Prenatal Exposure to Intimate Partner Violence and Child Developmental Outcomes: A Scoping Review Study.
Trauma Violence Abuse. 2023:15248380231209434. PMID: 37997428
A research review “showed adverse effects of prenatal IPV exposure on psychological, behavioral, physical health, and physiological outcomes [on children], either directly or indirectly via mechanisms such as maternal behavioral health. Due to inconsistency in results and a lack of empirical evidence, however, social and cognitive outcomes were identified as needing further research…Incorporating strengths/asset-focused outcomes and examining contextual factors and sex/gender specific effects may advance the knowledge in this area.”
Girgla JK, Mahadeva S, Srivastava M, et al.
Exploring the Connection Between Domestic Violence and Masticatory Outcomes in the Pediatric Population: A Systematic Review.
Cureus. 2023;15(10):e46764. PMID: 37954731
In this research review, there was a significant association between domestic violence in the home and chewing issues in children aged 6-19 years, including bite problems, jaw pain, and teeth clenching.
Andoh JE, Miguez S, Andoh SE, et al.
Epidemiologic trends of domestic violence-related ocular injuries among pediatric patients.
J AAPOS. 2023 Dec;27(6):335.e1-335.e8. PMID: 37931837
From a national ED data set 2008-2017, there were 4,125 ED encounters for children with eye injuries due to domestic violence, 50.0% male and mean age 9.2 years. “The most common known perpetrator was a family member (29.4%). Most ED encounters took place at southern regional (28.6%), metropolitan teaching (67.1%) and designated trauma hospitals (57.8%). Contusion [bruising] of the eye/adnexa and being struck by or against an object were the most common ocular diagnosis and known mechanism of injury, respectively. An estimated 12.4% of patients were admitted with a median hospital stay of 4 days. Median charges during the study period were $27,415.10 ($13,142.70-$54,454.90).”
Leppäkoski T, Vuorenmaa M, Paavilainen E.
Combinations of Parent-Related Risk Factors Explaining Family Violence Toward Children and Spouse.
J Interpers Violence. 2023 Nov 8:8862605231208421. PMID: 37937746
A Finnish national study of parents with 4-year-old children looked at risk factor clusters of parental well-being, parent's childhood adversities, and parent's health, and family violence (FV). Results showed that even a single risk factor predicted the likelihood of FV, and risk increased with increasing additive different risk factors. “As a result, we emphasize the importance of identifying families with concurrent risk factors…parents must be supported in coping with their everyday life.”
Human trafficking
Scaggs SJA, Starseed SC, Kluckman M, Tueller S, Yu L.
A state-wide analysis of characteristics and predictors of dual system involvement among child victims of human trafficking.
Child Abuse Negl. 2023;147:106530. PMID: 37979486
Of 9300 Florida children with a first human trafficking allegation, nearly half, and especially females, were already involved in the child protection system. Black trafficked children were more likely to already be involved in child protection as well as juvenile justice systems, and children with labor trafficking as opposed to sex trafficking were less likely to be involved in either.
LGBTQ Concerns
Jones MS, Worthen MGF.
Measuring the prevalence and impact of adverse childhood experiences in the lives of LGBTQ individuals: A much-needed expansion.
Child Abuse Negl. 2023:106560. PMID: 38001009
“In the current article, we develop and present a more comprehensive ACE measurement strategy for understanding the cumulative and deleterious impacts of ACEs in the lives of LGBTQ individuals…we offer three expansions to the current ACE framework: (1) the inclusion of an LGBTQ-specific ACE in addition to the standard ACE measures, (2) the addition of LGBTQ qualifiers for current ACE items (when applicable, [such as asking if something happened due to LGBTQ identity]), and (3) the expansion of ACE measures to capture the unique ACE experiences of LGBTQ individuals in family life, schools, and faith communities [such as being dismissed or rejected].”
Solberg MA, Blair LM, Schlegel EC, Kurzer J.
Health Disparities Among Sexual and Gender Minorities With Adverse Childhood Experiences: Insights From the 2021 Behavioral Risk Factor Surveillance System Data.
Am J Public Health. 2023;113(12):1343-51. PMID: 37939340
Of 38,483 eligible respondents, 2329 (6.1%) identified as an SGM (sexual and gender minority). SGMs reported higher ACE prevalence than did their non-SGM counterparts. ACEs partially attenuated relationships between SGMs and a higher risk for depression, cardiovascular disease, chronic kidney disease, electronic nicotine delivery system use, and cannabis use…Targeted interventions are needed to mitigate the impact of ACE-associated aftereffects in this population.”
Race/Cultural Issues
White RS, Tangel VE, Lui B, Jiang SY, Pryor KO, Abramovitz SE.
Racial and Ethnic Disparities in Delivery In-Hospital Mortality or Maternal End-Organ Injury: A Multistate Analysis, 2007-2020.
J Womens Health (Larchmt). 2023 Dec;32(12):1292-1307. PMID: 37819719
“We performed a retrospective multistate analysis of adult inpatient delivery hospitalizations (Florida, Kentucky, Maryland, New Jersey, New York, North Carolina, and Washington) between 2007 and 2020…Black and Hispanic patients had higher adjusted odds of in-patient mortality and end-organ damage after birth than White patients. Race and ethnicity serve as strong predictors of health care inequality, and differences in outcomes may reflect broader structural racism and individual implicit bias. Proposed solutions require immense and multifaceted active efforts to restructure how obstetrical care is provided on the societal, hospital, and patient level.”
Sheehy S, Aparicio HJ, Palmer JR, et al.
Perceived Interpersonal Racism and Incident Stroke Among US Black Women.
JAMA Netw Open. 2023 Nov 1;6(11):e2343203. PMID: 37948073
Using extensive data from the Black Women’s Health Study, Black women who reported experiences of interpersonal racism in all 3 situations involving employment, housing, and interactions with police appeared to have a 38% increased risk of stroke, even after accounting for demographic and vascular risk factors.
Cuevas AG, Krobath DM, Rhodes-Bratton B, et al.
Association of Racial Discrimination With Adiposity in Children and Adolescents.
JAMA Netw Open. 2023 Jul 3;6(7):e2322839. PMID: 37432683
In this diverse national study of 6463 children, mean age 9.95 years, children’s perceived racial discrimination was associated with increased body mass and waist circumference. “Interventions to reduce exposure to racial discrimination in early life may help reduce the risk of excess weight gain across throughout life.”
Jowell AR, James AK, Jasrasaria R, et al.
DARE Training: Teaching Educators How to Revise Internal Medicine Residency Lectures by Using an Anti-racism Framework.
MedEdPORTAL. 2023;19:11351. PMID: 37941996
Authors created a Department of Medicine Anti-Racism and Equity Educational Initiative (DARE) to promote anti-racism in internal medicine education. After 34 faculty completed DARE training, “their sample slides were significantly improved with respect to diversity of graphics, discussion of research participant demographics, and discussion of the impact of racism/bias on health disparities. After DARE training, 23 of 24 participants (96%) endorsed feeling more prepared to bring an anti-racist framework to lectures and to support colleagues in doing the same.” Training materials.
Simmons A, Ferry M, Christopher M.
Relative Impact of Mindfulness, Self-Compassion, and Psychological Resilience on Mental Health Outcomes in Racially Minoritized Adults.
Psychol Rep. 2023:332941231213646. PMID: 37970811
Of 169 racial minority adults aged 18-64, the evaluated qualities of self-compassion, resilience, acting with awareness, non-judging of inner experience, and non-reactivity of inner experience, differentially predicted depression, anxiety, stress, and life satisfaction; however, only self-compassion consistently predicted all outcomes…Enhanced self-compassion, and by proxy reduced self-judgement, may also provide a unique buffer in the context of racialized stress.”
Perpetrators
Gewirtz-Meydan A, Afnan AN, Lassri D, Katz C.
"I Know It's Hard to Believe, But the Monster Who Abused Me is My Mother:" Experiences of Being Sexually Abused as a Child by a Female.
Sex Abuse. 2023;35(8):927-52. PMID: 36524788
Of 28 adults who had experienced childhood sexual abuse by a female, half reported that their mother was the offender, usually in the shower/bathroom. Participants described how the abuse had serious consequences for their lives, and how perceived gender and social roles cast doubt on the existence and reliability of their experiences. Authors “suggest social mechanisms that may help explain why perpetration by females is understood and treated differently than perpetration by males”.
Police and Court Systems
Denne E, Stolzenberg SN.
Exploring how attorneys address grooming in criminal trials of child sexual abuse.
Behav Sci Law. 2023;41(6):488-503. PMID: 37996976
“It is important that grooming is addressed in court to explain the unintuitive ways a child may act when they have been victims of abuse. The present study draws upon 134 transcripts of CSA [child sexual abuse] criminal trials…Only 1.8% of attorney's questions addressed grooming behaviors. The majority of these focused on exposure to pornography (27%) or boundary pushing (19%)…We suggest that attorneys consider devoting proportionally more time to addressing grooming in court, to help jurors demystify common myths surrounding CSA.”
Barron CE, Fitzgerald M, Coleman M, Moore JL, Iacone MD.
A Unique Canine Comfort Therapy Program for Child Maltreatment Cases.
Rhode Island medical journal (2013). 2023;106(10):46-9. PMID: 37890064
This article describes a Rhode Island canine comfort therapy program established specifically to support children who experience maltreatment, by implementing a collaborative program within both a children’s hospital and a police department. “This provides a longitudinal experience that supports children and their families by fostering a sense of familiarity and trust throughout all the difficult components of a child maltreatment case (e.g., evaluation, treatment, investigation and prosecution)”.
Providers
Dubowitz H, Kressly SJ.
Documenting Psychosocial Problems in Children's Electronic Health Records.
JAMA Pediatr. 2023 Sep 1;177(9):881-882. PMID: 37486683
Authors note the importance of understanding and documenting a child’s home environment for their health care, as well as the many barriers to doing so. “Ultimately, health information technology interoperability standards should include ways to segment sensitive data at a granular level and allow for limited disclosures that are both patient-consented and appropriately shared, reasonably balancing potential benefit and harm. Pediatricians can advocate for functionality that promotes safe and equitable data sharing while protecting sensitive data that are important to high-quality care and valuable to other stakeholders.”
Williams DR, Chaves E, Karp SM, Browne NT.
Clinical review: Implementation of trauma informed care to optimally impact the treatment of childhood obesity.
Obes Pillars. 2023;5:100052. PMID: 37990746
“Combining the pillars of obesity treatment (i.e., nutrition, physical activity, behavior therapy, medical management) with the tenets of TIC (realize, recognize, respond, resist re-traumatization) affords patients holistic, intentional care and family support. The desired outcomes of TIC align with goals of obesity treatment in children, namely improvement of health and quality of life, sense of self (e.g., body image and self-esteem), and prevention of negative health outcomes.
Prevention
Ostrosky F, Decety J, Lozano A, et al.
Can psychopathy be prevented? Clinical, neuroimaging, and genetic data: an exploratory study.
Child Neuropsychol. 2023:1-21. PMID: 37947201
In this small study of 14 maltreated children, mean age 8.77 years, from a shelter in Mexico City, and compared to a control group of 10 children from the general population, brain scans showed amygdala hyperactivation during exposure to fear and anger stimuli in the maltreated children. After trauma-focused cognitive behavioral therapy, the maltreated group showed decreased activation in this brain area as well as decreased clinical symptoms. “Trauma-Focused Behavioral Therapy may help reorganize the brain's processing of emotional stimuli. These observations reveal the importance of an early intervention when the mechanisms of neuroplasticity [the brain’s ability to change and heal] may be still recruited.”
Campbell KA, Wood JN, Berger RP.
Child Abuse Prevention in a Pandemic-A Natural Experiment in Social Welfare Policy.
JAMA Pediatr. 2023 Dec 1;177(12):1263-1265. PMID: 37870864
“The COVID-19 pandemic was a unique natural experiment in child abuse prevention through social welfare policy. Paid parental leave, universal basic income, and housing and health care security provided stability to the most vulnerable households in our communities…The decrease in abusive head trauma rates at the height of the pandemic and the gradual return to prepandemic levels as the pandemic era social welfare policies were lifted strongly support an association between public policy and child abuse prevention.”
Sanders MR.
The Triple P System of Evidence-Based Parenting Support: Past, Present, and Future Directions.
Clin Child Fam Psychol Rev. 2023;26(4):880-903. PMID: 37432507
“The Triple P system is used as a case example to discuss the past, present and future challenges, and opportunities involved in developing, evaluating, adapting, scaling and maintaining a sustainable system of evidence-based parenting intervention.”
Frankowski BL.
Encouraging Strengths in Parents and Youth to Promote Positive Childhood Experiences.
Pediatrics. 2023 Jul 1;152(1):e2023061264. PMID: 37337840
“The Strengthening Families Approach and Protective Factors Framework is an initiative developed for preventing child abuse and neglect of children aged birth to 5 years, focusing on supporting those families to build 5 strengths or protective factors: Parental resilience, Social connections, Knowledge of parenting and child development, Social and emotional competence of children, and Concrete support in times of need. Pediatricians already focus on many of these strengths when interacting with families… Pediatricians have an opportunity to identify and encourage strengths in their adolescent patients…an image conceptualizing youth strengths: Belonging (connection), Mastery (competence, confidence, coping), Independence (control, confidence), and Generosity (contribution, character). The goal is not just to ask about strengths in an intake questionnaire or interview, but to make parents and youth aware of them; many do not feel they have any strengths until someone points them out…Explaining the protective role of strengths and resilience…can foster hope and motivation…Think about a strengths framework that makes sense to you. Practice pointing out 1 strength you observe in each of your clinical encounters.”
Kogan SM, Kwon E, Brody GH, et al.
Family-Centered Prevention to Reduce Discrimination-Related Depressive Symptoms Among Black Adolescents: Secondary Analysis of a Randomized Clinical Trial.
JAMA network open. 2023;6(11):e2340567. PMID: 37910105
“SAAF [Strong African American Families] is a 7-session (14 hours) family skills training intervention that occurs over 7 weeks. Small groups of caregivers and their adolescents participate in a structured curriculum targeting effective parenting behavior, adolescent self-regulation, and Black pride.” For 240 rural Georgia adolescents enrolled in this program, compared to a control group, the intervention significantly decreased depressive symptoms associated with racial discrimination.
Researchers
Chen A, Demaestri S, Schweiberger K, et al.
Inclusion of Non-English-Speaking Participants in Pediatric Health Research: A Review.
JAMA Pediatr. 2023 Jan 1;177(1):81-88. PMID: 36315130
“This review of 3 pediatric journals provides preliminary evidence suggesting exclusion of NES [non-English speaking] communities from pediatric research from 2012 to 2021 and highlights an opportunity to provide more methodological detail about communication with NES participants. Best practices for improving inclusivity of NES participants are needed to guide researchers toward improved methods and more relevant results.”
Gonzalez C, Morawska A, Higgins DJ, Haslam DM.
Psychometric properties of the parenting belief scale in a multi-country sample of parents from high-income countries.
Child Abuse Negl. 2023;147:106565. PMID: 38000351
Authors discuss the validity and consistency of the Parenting Belief Scale, to evaluate parents' perceived privacy in their parental role and acceptability of corporal punishment.
Hietamäki J, Laajasalo T, Lindgren M, Therman S.
Development and initial validation of the THL Adverse Childhood Experiences Questionnaire (ACE-THL).
Child Abuse Negl. 2023;146:106483. PMID: 37922617
“Based on the initial validation, the 14-item ACE-THL [THL = Finnish Institute for Health and Welfare] questionnaire is a reliable and valid instrument to measure adverse childhood experiences, as well as protective experiences…The final 14-item questionnaire, including 12 ACE items and two items measuring protective experiences, was highly acceptable to the respondents…The ACE-THL covers the same domains as the original ACE questionnaire (physical, sexual, and emotional abuse, domestic violence and neglect, substance abuse or mental health problems in the family, and the loss of a parent), and additionally includes items such as bullying during childhood and financial difficulties, which were deemed to be important based on recent literature. The questionnaire also included two items related to positive experiences (having an adult to speak to and the feeling of being valued at home) that are infrequently measured simultaneously with ACEs and that can also improve the response experience.”
Xu H, Li M, Cai J, Yuan Y, He L, Liu J, et al.
Comparison of ACE-IQ and CTQ-SF for child maltreatment assessment: Reliability, prevalence, and risk prediction.
Child Abuse Negl. 2023;146:106529. PMID: 37931543
“1484 college students from northern China were recruited, assessing demographic characteristics and outcomes related to traumatic experiences, including post-traumatic stress disorder, complex post-traumatic stress disorder, borderline personality disorder, anxiety, and depression.” Authors compared results using the Childhood Trauma Questionnaire Short Form (CTQ-SF) and the Adverse Childhood Experiences International Questionnaire (ACE-IQ), and concluded that the ACE-IQ indicated “a superior model fit for elucidating outcomes”.
Other of Interest
Salter M, Woodlock D, Wong T.
The sexual politics of technology industry responses to online child sexual exploitation during COVID-19: "This pernicious elitism".
Child Abuse Negl. 2023:106559. PMID: 37993364
“The analysis of the views of anti-exploitation professionals highlights the alignment between the economic interests of the technology sector and the sexual interests of online child abusers in the absence of government oversight…emphasises the need for regulatory intervention, harm minimisation and the restructuring of the online environment and technology sector in the interests of child safety.”
Rubini E, Valente M, Trentin M, Facci G, Ragazzoni L, Gino S.
Negative consequences of conflict-related sexual violence on survivors: a systematic review of qualitative evidence. International journal for equity in health. 2023;22(1):227. PMID: 37891663
“Conflict-related sexual violence: a specific type of gender-based violence that includes rape, sexual slavery, forced prostitution, forced pregnancy, forced abortion, enforced sterilization, forced marriage, forced nudity, forced witnessing, exposure to acts, and any other form of SV that is directly or indirectly (temporally, geographically, or causally) linked to a conflict…This review provides an analysis of the negative consequences of conflict-related sexual violence on survivors…Gender-inclusive protocols and services need to be implemented to address the specific needs of all victims.”
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