[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
Lugo-Candelas C, Corbeil T, Wall M, et. al.
ADHD and risk for subsequent adverse childhood experiences: understanding the cycle of adversity. J Child Psychol Psychiatry. 2021 Aug;62(8):971-978. PMID: 33289088
From a long-term study of Puerto Rican children, and controlling for multiple factors, those with inattentive type of ADHD (vs. hyperactive/impulsive) predicted subsequent risk for ACEs. “The present study suggests a pathway for the perpetuation of adversity, where bidirectional relationships between ADHD and ACEs may ensnare children in developmental pathways predictive of poor outcomes.”
Nelson S, Borsook D, Bosquet Enlow M.
Targeting the stress response in pediatric pain: current evidence for psychosocial intervention and avenues for future investigation. Pain Rep. 2021 Sep 3;6(3):e953. PMID: 34514276
“Research indicates that youth with chronic pain report high rates of psychological stress, PTSS, and exposure to ACEs. In addition, a host of research has shown strong parallels between the neurobiology of pain processing and the neurobiology of stress exposure in both youth and adults.”
Malhi P, Bharti B.
School Bullying and Association with Somatic Complaints in Victimized Children. Indian J Pediatr. 2021 Oct;88(10):962-967. PMID: 33527337
Of 213 Indian schoolchildren with mean age 11.49 years, 42.7% were involved in bullying either as victims or as perpetrators. 26.8% reported victimization. A consistent positive association between victimization and bodily complaints was found. The most common physical symptoms reported by victims included headache (60.7%), chest pain (35.7%), stomach pain (33.9%), weakness (30.4%), and pain in arms and legs (19.6%). “Primary health care clinicians and pediatricians need to consider bullying as one of the potential risk factors when they encounter physical symptoms among pediatric patients.”
Zhang H, Li J, Sun B, Wei Q.
Effects of Childhood Maltreatment on Self-Compassion: A Systematic Review and Meta-Analysis. Trauma Violence Abuse. 2021 Sep 13:15248380211043825. PMID: 34510982
From a research review, emotional abuse and neglect were negatively related to self-compassion at a moderate level; and physical abuse, sexual abuse, and physical neglect were negatively related to self-compassion at a small level. Authors urge self-compassion training in child abuse intervention programs.
Adult Manifestations of Child Abuse
Binnie V, Le Brocque R, Jessup M, Johnston ANB.
Adult frequent presentation to emergency departments and adverse childhood experiences: a scoping review. Australas Emerg Care. 2021 Dec;24(4):264-279. PMID: 33358578
Studies in this review suggest childhood adversity is common among adults who frequently attend the emergency department. “and there is no standardized approach described to documenting childhood adversity, nor any consistent intervention reported by emergency departments to address its sequelae in adulthood…Screening frequent presenters for childhood adversity, while monitoring the outcomes of doing so through research, may provide a platform upon which to develop future directions.”
Merrill SM, Moore SR, Gladish N, et. al.
Paternal adverse childhood experiences: Associations with infant DNA methylation. Dev Psychobiol. 2021 Sep;63(6):e22174. PMID: 34333774
Stress experienced preconception by mothers can cause DNA changes in the next generation. This study of 45 3-month-old infants found that fathers’ exposure to ACEs were also associated with infant DNA changes. Analysis did not find any contribution to the infant’s DNA from fathers’ education, income, marital status, and postpartum depression, but did with smoking and body mass index. This same DNA association was found between paternal ACEs and offspring attention problems at 3 years.
Gordon JB.
The importance of child abuse and neglect in adult medicine. Pharmacol Biochem Behav. 2021 Sep 6:173268. PMID: 34499948
“At least one out of every ten USA adults has a significant history of childhood maltreatment…a past history of childhood abuse and neglect [CAN] makes substantial contributions to physical disease in adults, including asthma, chronic obstructive pulmonary disease, lung cancer, hypertension, stroke, kidney disease, hepatitis, obesity, diabetes, coronary artery disease, pelvic pain, endometriosis, chronic fatigue syndrome, irritable bowel syndrome, fibromyalgia, auto immune diseases, and shortened life expectancy. The contribution of CAN trauma to these many pathologies remains largely underappreciated…Recommendations are made for managing these patients.”
Herrenkohl TI, Fedina L, Hong SH, Lee JO, Saba S.
Associations between prospective and retrospective measures of child abuse and self-reported adult health at midlife. Child Abuse Negl. 2021 Oct;120:105203. PMID: 34280710
Of 457 children followed to adulthood, adults retrospectively reporting physical child abuse “were moderately related to reports of overall health, as well as…back and chest pain, hypertension, and certain forms of cancer. Associations were also observed for lifetime alcohol problems and past-year doctor and emergency room visits.” Retrospective reports correlated with child welfare records, but not with caregiver reports.
Downing NR, Akinlotan M, Thornhill CW.
The impact of childhood sexual abuse and adverse childhood experiences on adult health related quality of life. Child Abuse Negl. 2021 Oct;120:105181. PMID: 34247038
From a large adult survey in Texas, “The prevalence of self-reported CSA [childhood sexual abuse] in the sample was 10.3%. Compared to the non-exposed group, individuals exposed to CSA were more likely to report their general health as poor (Adjusted Odds Ratio 1.51), report 14 or more physical unhealthy days (AOR 1.46), 14 or more mental unhealthy days (AOR 1.86), and 14 or more activity limitation days (AOR 2.22) in a month. Health-related quality of life outcomes were worse for respondents who reported being forced to have sex as a child compared with those who reported being touched or forced to touch someone.”
Maunder RG, Wiesenfeld L, Lawson A, Hunter JJ.
The Relationship Between Childhood Adversity and Other Aspects of Clinical Complexity in Psychiatric Outpatients. J Interpers Violence. 2021 Oct;36(19-20):9060-9076. PMID: 31339443
Of 1315 mental health outpatients, 36.0% reported childhood abuse or neglect. After controlling for multiple factors, those with a history of childhood maltreatment were noted to have greater overall complexity, distress and disability. “Childhood abuse and neglect were associated with many characteristics that contribute to clinical complexity, and thus to suboptimal outcomes to standard, guideline-based care. Screening may alert psychiatrists to the need for intensive, patient-centered, and trauma-informed treatments.”
Wilson-Genderson M, Heid AR, Cartwright F, Pruchno R.
Adverse childhood experiences, adult trauma, and depressive symptom trajectories. Aging Ment Health. 2021 Sep 20:1-9. PMID: 34541986
From a survey of 5688 community adults aged 50-74, those with ACEs were more likely to have depressive symptoms in later life, and those with 2+ ACEs were significantly more likely to experience fear and distress from Hurricane Sandy. “Adverse childhood experiences can alter the way traumatic events in adulthood are experienced.”
Sulaiman S, Premji SS, Tavangar F, Yim IS, Lebold M; MiGHT.
Total Adverse Childhood Experiences and Preterm Birth. Matern Child Health J. 2021 Oct;25(10):1581-1594. PMID: 34036452
From a research review, “nine studies report on birth outcomes for 6,087 women from a range of sociodemographic and ethnic backgrounds. Despite a wide range of study designs, measurement tools, and timings of ACEs exposure across studies, seven of the nine included studies showed significant relationships between ACEs and preterm birth.”
Osofsky JD, Osofsky HJ, Frazer AL, et. al.
The importance of adverse childhood experiences during the perinatal period. Am Psychol. 2021 Feb-Mar;76(2):350-363. PMID: 33734800
For 303 pregnant women in a psychosocial obstetrics support program, almost ¼ reported 4+ ACEs. “Those reporting more overall ACEs also reported more symptoms of depression, posttraumatic stress, and increased tobacco use.”
Testa A, Jackson DB, Ganson KT, Nagata JM.
Maternal Adverse Childhood Experiences and Pregnancy Intentions. Ann Epidemiol. 2021 Sep 18:S1047-2797(21)00299-4. PMID: 34547446
Using data from a North and South Dakota Pregnancy registry, women with 3+ ACEs were more than twice as likely to have an unwanted pregnancy (vs. an intended pregnancy) than those with 0 ACEs.
Adolescents
McNiss C, Kalarchian M, Laurent J.
Factors associated with childhood sexual abuse and adolescent pregnancy. Child Abuse Negl. 2021 Oct;120:105183. PMID: 34245975
From a research review, “Studies suggest that people who are abused in childhood through adolescence and are not believed when they report abuse may be at greater risk for pregnancy in adolescence.” Childhood sexual abuse was associated with a range of sexual risk-taking behavior (e.g., ineffectual contraception use, drug and alcohol use prior to sex, multiple partners) which could lead to adolescent pregnancy.
Labuhn M, LaBore K, Ahmed T, Ahmed R.
Trends and instigators among young adolescent suicide in the United States. Public Health. 2021 Sep 18;199:51-56. PMID: 34547557
From a large national survey of US high school students, “The factor most associated with suicide ideation was bullying (either electronic or physical), whereas the factor most associated with suicide attempt was sexual violence followed closely by physical bullying.
Race/Cultural Concerns
Butler A, Covington K, Parsh B.
Identifying and tackling racial disparities in healthcare. Nursing. 2021 Sep 1;51(9):40-43. PMID: 34463653
“The US healthcare system is plagued with inequities that disproportionately impact people of color and other marginalized communities. This article discusses some of the key reasons behind these historic and current health disparities, identifies key terms, and discusses strategies…to tackle inequity and racism in American healthcare.
Dhurjati R, Main E, Profit J.
Institutional Racism: A Key Contributor to Perinatal Health Inequity. Pediatrics. 2021 Sep;148(3):e2021050768. PMID: 34429337
In this commentary on an article showing that in New York City, compared with white infants, Black and Hispanic term infants had increased risk of complications, authors note that “infants born to mothers from vulnerable populations are being sorted into lower-performing hospitals. Barriers that prevent racial and ethnic minority and vulnerable populations from accessing high-quality care are a form of institutional racism that perpetuates disadvantage.” Authors discuss remedies, including supporting hospitals that predominantly care for vulnerable populations with quality improvement programs, directing patients to better-performing hospitals, or models of co-ownership and joint ventures to strengthen available resources throughout a region.
Bird CM, Webb EK, Schramm AT, et. al.
Racial Discrimination is Associated with Acute Posttraumatic Stress Symptoms and Predicts Future Posttraumatic Stress Disorder Symptom Severity. J Trauma Stress. 2021 Oct;34(5):995-1004. PMID: 33715212
For 113 African American and/or Black patients recruited from a Wisconsin emergency department after a traumatic injury, pre-trauma exposure to racial discrimination significantly predicted PTSD symptoms at follow-up, even after controlling for multiple factors. “Experiences of racial discrimination add significant additional risk for PTSD symptom development following traumatic injury.”
Eichstaedt JC, Sherman GT, Giorgi S, et. al.
The emotional and mental health impact of the murder of George Floyd on the US population. Proc Natl Acad Sci U S A. 2021 Sep 28;118(39):e2109139118. PMID: 34544875
Using data from 2 very large US population surveys, “According to the Gallup data, in the week following Floyd's death, anger and sadness increased to unprecedented levels in the US population. During this period, more than a third of the US population reported these emotions. These increases were more pronounced for Black Americans, nearly half of whom reported these emotions. According to the US Census Household Pulse data, in the week following Floyd's death, depression and anxiety severity increased among Black Americans at significantly higher rates than that of White Americans. Our estimates suggest that this increase corresponds to an additional 900,000 Black Americans who would have screened positive for depression, associated with a burden of roughly 2.7 million to 6.3 million mentally unhealthy days.”
Hunter EA, Spears EC, Martz CD, et. al.
Racism-related stress and psychological distress: Black Women's Experiences Living with Lupus study. J Health Psychol. 2021 Nov;26(13):2374-2389. PMID: 32228184
From a study of 430 African American Women with Lupus, racism-related stress influenced general psychological distress, which in turn increased lupus disease activity.
Giurgescu C , Misra D P , Slaughter-Acey J C, et. al.
Neighborhoods, Racism, Stress, and Preterm Birth Among African American Women: A Review. West J Nurs Res. 2021 Aug 28:1939459211041165. PMID: 34455864
“This review focuses on potential stress-related pathways by which neighborhood disadvantage and racial discrimination increase the risk for PTB [pre-term birth] among African American women. Specifically, we propose cortisol, systemic inflammation, proteome and lipidome profiles, and telomere shortening [a measure of premature cell aging] as potential mediators linking these social determinants of health with PTB among African American women.
Human Trafficking
Diaz A, Arden M, Blaustein S, et. al.
Using School-Based Health Programs to Prevent Human Trafficking: The Mount Sinai Experience. Ann Glob Health. 2021 Jun 8;87(1):47. PMID: 34164260
“School-based health centers are available to all students attending a school and are often located in schools whose students have risk factors associated with human trafficking: those with a history of running away from home; unstable housing or homelessness; a history of childhood maltreatment or substance use; LGBTQ-identification; physical or developmental disabilities, including students who have Individualized Education Programs and need special education; gang involvement; and/or a history of involvement in child welfare or the juvenile justice system. The Mount Sinai Adolescent Health Center provides a model of the types of service school clinics can offer, including integrated medical, sexual, and reproductive health, health education, and behavioral and mental health.”
Perpetrators
Leiding D, Kaiser F, Steffens M, Puiu AA, Habel U.
What determines violent behavior in men? Predicting physical, psychological, and sexual violent offending based on classification and regression tree analysis. Aggress Behav. 2021 Sep;47(5):570-582. PMID: 34096633
From a survey of 5385 German men, “Results indicate that violence is best predicted by previous exposure to violence and polyvictimization. Physical violence is best predicted by prior exposure to physical violence and this is further influenced by the frequency of and the age at which violence was experienced. Drug use was a strong predictor of physical and psychological violence. The latter is best predicted by a history of polyvictimization, the severity and the originator of violence. Sexual violence is strongly predicted by one's sexual violence experience. Other factors such as demographic characteristics are less predictive.”
Cheng P, Jaffe P.
Examining Depression Among Perpetrators of Intimate Partner Homicide. J Interpers Violence. 2021 Oct;36(19-20):9277-9298. PMID: 31370737
From an analysis of 135 homicide cases from a Canadian coroner’s homicide review committee, “depressed perpetrators were significantly older, more likely to commit homicide-suicide than homicide only, more likely to have prior threats or attempts of suicide, more likely to have been abused or witnessed domestic violence as a child than nondepressed perpetrators, and more likely to exhibit sexual jealousy.”
Sitney MH, Kaufman KL.
A Chip Off the Old Block: The Impact of Fathers on Sexual Offending Behavior. Trauma Violence Abuse. 2021 Oct;22(4):961-975. PMID: 31910735
From a research review, “the strongest impacts occur when sons are witness to their fathers engaging in acts of sexual abuse or domestic violence, in accordance with social learning theory. Father-son attachment or relationship quality also appears to have a measurable impact on the son's engagement in sexual violence.”
Providers
Kulkarni SJ, Kohl PL, Edmond T.
From "Stop Family Violence" to "Build Healthy Relationships to End Violence": The Journey to Reenvision a Grand Challenge. Soc Work. 2020 Oct 10;65(4):401-405. PMID: 32974679
Combining attention to child maltreatment, IPV, and gender-based violence, “’Build healthy relationships to end violence’ represents an inclusive framework that invites scholars who study violence, oppression, prevention, intervention, relationships, and health across a range of theoretical perspectives, developmental stages, social contexts, funding mechanisms, and service systems.”
Gordinier ME, Shields LBE, Davis MH, Cagata S, Lorenz DJ.
Impact of Screening for Sexual Trauma in a Gynecologic Oncology Setting. Gynecol Obstet Invest. 2021 Sep 2:1-7. PMID: 34515127
Of 1423 consecutive patients screened for sexual abuse at a gynecologic cancer clinic, 12% disclosed a history of sexual abuse, the majority as a young child or early teen, which was lower than expected. 92% of those identified declined counseling. “The screening questions were normalized by the statement ‘we ask this because we recognize that patients with a history of sexual abuse may have difficulties with examinations’…Identification of an undisclosed sexual trauma history allows for an opportunity to offer counseling and minimize the emotional distress that may be precipitated by treatment and exams.” (Wonder if disclosure and counseling uptake would be greater at a subsequent visit, as people may be scared, overwhelmed and only focused on cancer diagnosis at first visit.)
McElvaney R, Nixon E.
Parents' Experiences of Their Child's Disclosure of Child Sexual Abuse. Fam Process. 2020 Dec;59(4):1773-1788. PMID: 31715020
From interviews with 10 mothers and fathers whose children had experienced sexual abuse, “The first theme-making sense of the abuse in retrospect-captured the process through which parents sought to make sense of their child's disclosure, focusing on why their child had not disclosed the abuse to them earlier, and how they had noticed something was wrong but misattributed their child's behavior to other factors. The second theme-negotiating parental identity as protector-reflected how parents' identity as a protector was challenged, their perception of their world had been forever altered, and they now experienced themselves as hypervigilant and overprotective. The final theme-navigating the services-pertained to parents' struggle in navigating child protection and police services, and feelings of being isolated and alone. These findings highlight the need for empathy and parental support following child disclosure of sexual victimization.”
Welfare-Wilson A, Adley L, Bell Z, Luby R.
COVID-19 and how the wearing of face coverings can affect those with an experience of trauma. J Psychiatr Ment Health Nurs. 2021 Oct;28(5):777-782. PMID: 33587790
“This paper provides an awareness of the link between trauma and the wearing of face coverings, and how their use could be re-traumatizing for those accessing services…and be able to offer suggestions to alleviate distress.”
DeJong M, Wilkinson S, Apostu C, Glaser D.
Emotional abuse and neglect in a clinical setting: challenges for mental health professionals. BJPsych Bull. 2021 Sep 21:1-6. PMID: 34544522
Practical and useful article, with Q&A “How to”. “Emotional abuse or neglect [EAN] is a very common form of child maltreatment often considered difficult to recognise or define…We have attempted to highlight here dilemmas encountered by both adult and child mental health workers in this complex area and to suggest possible ways of resolving them.”
Prevention
Anderson KM, Bernhardt C.
Resilient Adult Daughters of Abused Women: Turning Pain Into Purpose. Violence Against Women. 2020 May;26(6-7):750-770. PMID: 31053052
From interviews with 29 resilient adult daughters of abused women, “Coping processes included distancing from the family, seeking understanding and acceptance, and finding meaning and purpose. Motivating factors included learning what not to do from their families and breaking the cycle of violence and dysfunction from occurring in their adult lives. We learn how daughters of abused women may create a life informed, rather than directed, by their childhood adversity.”
Spawton-Rice JH, Walker Z.
Do cognitive training applications improve executive function in children with adverse childhood experiences? Appl Neuropsychol Child. 2020 Dec 8:1-10. PMID: 33290097
“Executive function (EF)…includes problem solving, reasoning and planning. Adverse childhood experiences (ACE) negatively impact the development of these skills and in turn life outcomes. This pilot-study showed a significant positive impact on executive function in 32 children aged 6-11 years with 4+ ACEs, using computerized cognitive training applications (CCTA) (software-based training programs) in school.
Armfield JM, Ey LA, Zufferey C, Gnanamanickam ES, Segal L.
Educational strengths and functional resilience at the start of primary school following child maltreatment. Child Abuse Negl. 2021 Sep 4;122:105301. PMID: 34488051
Of 3414 high-risk children who had a maltreatment substantiation or investigation, CPS involvement was strongly associated with poorer functioning at school, but 51.2% demonstrated resilience. Predictors of resilience were being older, not having an emotional condition, and being read to at home. Boys who had been maltreated demonstrated few strengths and had less resilience than girls. Boys and girls who were read to regularly at home had more than three times the odds of showing resilience than children who were not read to at home.
Researchers
Hamby S, Mariscal ES.
Next Steps in Untangling the Web of Violence: A Research Agenda. Child Maltreat. 2021 Nov;26(4):470-475. PMID: 34554007
“In this commentary, we outline four key trends in violence and trauma research and describe needed research to advance our ability to understand, prevent, and respond to these problems. The trends are the move toward evidence-based policy, the recognition of the importance of trauma dosage, the shift to strengths-based approaches, and increased attention to race, gender, and other personality and community characteristics regarding health disparities and culturally appropriate interventions. For each trend, we have identified needed research areas.”
Reidy DE, Niolon PH, Estefan LF, et. al.
Measurement of Adverse Childhood Experiences: It Matters. Am J Prev Med. 2021 Sep 3:S0749-3797(21)00388-3. PMID: 34489139
“Results demonstrate potentially drastic differences in the interpretation of the association between ACEs and outcomes based on the chosen measurement model…a great deal more attention needs to be paid to the best way to measure ACEs to clearly understand their vast impacts and consequences…In almost all instances, measuring ACEs individually, rather than as a sum score, substantially improved the amount of variance explained in the overall outcome…These patterns were observed across both men and women, incarcerated and general population participants, and White and racial/ethnic minority participants …better measurement of ACEs might help identify which ACEs are most critical to certain outcomes when designing prevention strategies.
Other of Interest
Ferguson CJ, Smith S.
Examining homicides and suicides cross-nationally: Economic factors, guns and video games. Int J Psychol. 2021 Oct;56(5):812-823. PMID: 33786817
“In the current study, several factors were considered in combination across a sample of 92 countries. These included income inequality (Gini index), Human Capital Index (education and employment), per capita gun ownership and per capita expenditure on video games. Results suggest that economic factors primarily were related to homicide and suicide cross-nationally. Video game consumption was not a major indicative factor. More surprisingly, per capita gun ownership was not an indicator factor cross-nationally. The results suggest that a focus on economic factors and income inequality are most likely to bear fruit regarding reduction of violence and suicide.”
Srivastav A, Park K, Koziarski A, Strompolis M, Purtle J.
Who Is Talking About Adverse Childhood Experiences? Evidence From Twitter to Inform Health Promotion. Health Educ Behav. 2021 Oct;48(5):615-626. PMID: 34053309 “We obtained tweets on the topics of ACEs, childhood resilience, and childhood trauma between January 1, 2018, and December 31, 2019…The weekly volume was approximately 1,864 tweets. Key topics included general use of the term ACEs (23%), trauma and ACEs (19%), long-term impact of ACEs (12%), preventing ACEs (11%), short-term effects of ACEs (8%), the 1997 ACE Study (5%), and students with ACEs (5%). The top two sentiments were fear and joy. Top conversation influencers included pediatricians, child health advocacy organizations, California's state government, the Centers for Disease Control and Prevention, and National Public Radio…This presents an opportunity to leverage social media tools to increase public engagement and awareness.
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