[Editor's note: Dr. Harise Stein at Stanford University edits a web site —abuseresearch.info — that focuses on the effects of abuse, and includes research articles on PACEs. Every month, she posts the summaries of the abstracts and links to research articles that address only ACEs, PCEs and PACEs. Thank you, Harise!! — Rafael Maravilla]
Child abuse
Hails KA, Petts RA, Hostutler CA, et. al.
COVID-19 distress, negative parenting, and child behavioral problems: The moderating role of parent adverse childhood experiences. Child Abuse Negl. 2022 Aug;130(Pt 1):105450. PMID: 34969517
From an online survey of 267 parents of children ages 1.5-5 years recruited from five primary care sites across the United States, negative parenting significantly influenced the association between Covid-19 distress and child emotional/behavioral problems. Higher parental ACE score strengthened the association between Covid-19 distress and both negative parenting and child emotional/behavioral problems.
Tso WWY, Chan KL, Lee TMC, et. al.
Mental health & maltreatment risk of children with special educational needs during COVID-19. Child Abuse Negl. 2022 Aug;130(Pt 1):105457. PMID: 35033372
In this Hong Kong study comparing 417 children with special educational needs (SEN) studying at special schools, compared to 25,427 children in main stream schools, children with SEN had poorer overall quality of life, 23.5% experienced at least one episode of severe physical abuse, and 1.9% very severe physical assault during Covid-19. Rates of physical assault for these children significantly increased during the pandemic (59.8% to 71.2%), and rates were higher for those with mental disorders.
Esposito T, Caldwell J, Chabot M, et. al.
Reunification trajectories in Quebec: Acknowledging chronic family challenges to support stability. Child Abuse Negl. 2022 Aug;130(Pt 3):105437. PMID: 34949485
For 1120 Canadian children placed in care, 847 were reunified with their families; however 54% of these returned to out-of-home placement. Risk factors for failed reunification included academic difficulties, attachment issues, and caregiver drug use.
Liu RT, Walsh RFL, Sheehan AE, Cheek SM, Sanzari CM.
Prevalence and Correlates of Suicide and Nonsuicidal Self-injury in Children: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2022 Jul 1;79(7):718-726. PMID: 35612875
“Considerably less is known about self-injurious thoughts and behaviors (SITBs) in preadolescence than older age groups, owing partly to the common view that young children are incapable of suicidal thoughts. Yet, preadolescent suicide has increased in recent years and is now the fifth leading cause of death in this age group…Prevalence for lifetime suicidal thoughts, suicide attempts, and nonsuicidal self-injury among preadolescents were 15.1%, 2.6%, and 6.2%, respectively, in community samples. These data suggest that approximately 17.0% of preadolescents with suicidal ideation transition to attempting suicide…Among interpersonal factors, child maltreatment [towards] and parental support [against] had the strongest effects on suicidal ideation.”
Bell V, McCann A, Power C, et. al.
Child protection concern in patients during the COVID-19 lockdown. Ir J Med Sci. 2022 Jul 26:1–3. PMID: 35879544
In a comparison of matched time periods pre- and during Covid in Ireland, while there were fewer assessments for child protection concerns, there was significantly increased complexity – higher physical abuse (52.3% vs. 11%), emotional abuse (7.0% vs. 1.2%) and multiple types of abuse (48.8% vs. 13.5%).
Palmer L, Font S, Eastman AL, Guo L, Putnam-Hornstein E.
What Does Child Protective Services Investigate as Neglect? A Population-Based Study. Child Maltreat. 2022 Jul 13:10775595221114144. PMID: 35829657
“Most child protective services (CPS) investigations involve allegations of neglect…in California in 2017, the most common types of neglect were inadequate supervision (44%) and failure to protect (29%), followed by physical neglect (14%). Common risk factors identified in neglect investigations were parental substance use (41%), domestic violence (21%), mental illness (18%), and co-reported physical or sexual abuse (29%).”
Matte-Landry A, Grisé Bolduc MÈ, Tanguay-Garneau L, et. al.
Cognitive Outcomes of Children With Complex Trauma. Trauma Violence Abuse. 2022 Jul 4:15248380221111484. PMID: 35786061
Children with complex trauma (exposure to multiple or repeated traumatic events of an interpersonal nature) had poorer overall cognitive functioning than controls, and recency of trauma was an important factor. “Findings suggest that children with complex trauma are at risk of cognitive difficulties quickly after trauma exposure”. Authors suggest that the impact on cognitive outcomes with more prompt interventions should be assessed.
Cai JY.
Economic instability and child maltreatment risk: Evidence from state administrative data. Child Abuse Negl. 2022 Aug;130(Pt 4):105213. PMID: 34334214
Using administrative data for CPS-involved families in Wisconsin, “Experiencing a negative earnings shock of 30% or more increases the likelihood of CPS involvement by approximately 18%. The effect becomes nonsignificant when an earnings decline is compensated by benefit receipt. Each additional earnings drop is associated with a 15% greater likelihood of CPS involvement. Each consecutive quarter with stable income is associated with 5% lower probability of a CPS report.”
Schneider W, Schenck-Fontaine A.
Growing up unequal: Objective and subjective economic disparities and authoritarian parenting. Child Abuse Negl. 2022 Aug;130(Pt 4):105332. PMID: 34627622
Using 30 years of General Social Survey data, socioeconomic status (SES) and perceived social subjective status (SSS) were both associated with increased odds of endorsing authoritarian parenting, with white parents' parenting more influenced by both SES and SSS than Black parents. “This is important because authoritarian parenting is not only directly associated with adverse outcomes for children, but is also associated with an increased risk for child maltreatment.”
Regeffe F, Chevignard M, Millet A, et. al.
Factors associated with poor neurological outcome in children after abusive head trauma: A multicenter retrospective study. Child Abuse Negl. 2022 Jul 9;131:105779. PMID: 35816903
Of 117 children under one year old admitted to three pediatric intensive care units for suspected or confirmed abusive head trauma, mean age was 4.3 months, with 61% male. 85% of these children were followed for two years. At discharge, 40% had at least a moderate disability, and at 2 years 44% had moderate and 19% severe disabilities. The main neurological disabilities were 35% neurodevelopmental (such as difficulties with language and speech, motor skills, behavior, memory, and learning), 33% hyperactivity disorder, and 31% epilepsy.
Wear KR, Li S.
Guideline review: RCPCH perplexing presentations, fabricated or induced illness in children guidance 2021.
Arch Dis Child Educ Pract Ed. 2022 Aug;107(4):288-291. PMID: 34728544
“The Royal College of Paediatrics and Child Health (RCPCH) outlines guidance and procedures in order to safeguard children who present with perplexing presentations (PP) and fabricated or induced illness (FII). It offers practical advice on how to recognise it, how to manage risk and how to manage these presentations.” Some of the alerting signs include: reported physical, psychological or behavioural symptoms and signs not observed independently; unusual results of investigations; inexplicably poor response to prescribed treatment; characteristics of the child’s illness may be physiologically impossible; and unexplained impairment of child’s daily life, including school attendance and social isolation.
Graber EA, Puchalski A, Magill C, Reynolds S.
Prevalence of Adverse Childhood Experiences in a Pediatric Emergency Department: Support for Trauma-Informed Pediatric Emergency Care. Pediatr Emerg Care. 2022 Aug 1;38(8):372-375. PMID: 35904951
“Five hundred children aged 0 to 17 years were evaluated for ACE exposure in an academic, urban, tertiary-care, pediatric ED… We found that 40.2% had ACE exposure. The most frequently reported ACEs were poverty (20.8%), divorce/separation (18.2%), and mental illness within the household (7.2%). Adverse childhood experience exposure in this pediatric ED was similar to the national prevalence. There was no significant relationship between ACE exposure and high ED recidivism [multiple ED visits] as an adverse outcome."
Langevin R, Hébert M, Kern A.
Maternal History of Child Sexual Abuse and Maladaptive Outcomes in Sexually Abused Children: The Role of Maternal Mental Health.
J Interpers Violence. 2022 Aug;37(15-16):NP14485-NP14506. PMID: 33926300
Of 997 children aged 3-14 years who experienced child sexual abuse (CSA) and their non-offending mothers, “Maternal history of CSA was associated with increased maternal psychological distress, PTSD symptoms, and dissociation following children's disclosure of CSA. In turn, maternal psychological distress and maternal dissociation were associated with increased child internalizing, externalizing, and dissociation symptoms…Clinicians should assess for possible history of CSA in mothers of sexually abused children and determine how best to support them to cope with the aftermaths of their child's disclosure and with their own traumatic past.”
Adult Manifestations of Child Abuse
Chen VH, Caron J, Goddard B, Eng SM, Ades V.
Polyvictimization and Psychiatric Sequelae Associated with Female Genital Mutilation/Cutting (FGM/C). J Immigr Minor Health. 2022 Aug;24(4):1020-1028. PMID: 35217978
Of 80 adult women seen in a NYC program for patients who had experienced Female Genital Mutilation/Cutting (FGM/C), 53.8% also experienced physical abuse, 43.8% emotional abuse, 43.8% sexual abuse, 25% forced marriage, 16.3% child marriage, and 1.4% sex trafficking. There was a high degree of polyvictimization, with 51.2% experiencing 3 or more of the aforementioned abuses. Having FGM/C on or after age 13 or having a higher total abuse score was also found to be strong predictors of depression and PTSD…Health care providers should understand the high risk of polyvictimization when caring for this patient population.”
Demakakos P, Steptoe A, Mishra GD.
Adverse childhood experiences are associated with increased risk of hysterectomy and bilateral oophorectomy: A national retrospective cohort study of women in England. BJOG. 2022 Aug;129(9):1481-1489. PMID: 34978369
From a national study of British women, and after controlling for multiple factors, ACE score had a graded association with hysterectomy (surgical removal of uterus/womb) and bilateral oophorectomy (surgical removal of both ovaries). Compared with women with no ACE, those with ≥3 ACE had 2.01 times the odds of hysterectomy, and 2.61 times the odds of bilateral oophorectomy. The exclusion of women with cancer history made the associations stronger, especially for younger women – 2.97 odds of hysterectomy and 3.48 for bilateral oophorectomy. “Our working hypothesis is that ACE-induced chronic stress and resultant hormonal and immune imbalances are related to the observed associations.”
Rocca WA.
Adverse childhood experiences and gynaecological surgery. BJOG. 2022 Aug;129(9):1490-1491. PMID: 35094477
In this commentary on an article showing that ACEs were associated with both increased risk of removal of uterus and ovaries in women as well as at a younger age, “There is an urgent need to educate gynaecologists, psychiatrists and general practitioners about the pervasive harmful sequelae of adverse childhood experiences, including the increased risk of gynaecological diseases and surgery…The high rate of hysterectomy and oophorectomy among young patients with adverse childhood experiences may lead to increased cardiovascular disease, osteoporosis, cognitive decline and mortality. Provision of adequate mental health care and emotional support in childhood, adolescence and adulthood to women who have undergone adverse childhood experiences could help to reduce avoidable gynaecological surgery, and its unintended consequences.”
Wood SK, Ford K, Madden HCE, et. al.
Adverse Childhood Experiences and Their Relationship with Poor Sexual Health Outcomes: Results from Four Cross-Sectional Surveys. Int J Environ Res Public Health. 2022 Jul 21;19(14):8869. PMID: 35886718
“This study explored associations between 4 adult ACE surveys from different regions in the UK and sexual health outcomes. ACE count was a consistent and significant predictor of having early sex (<16 years), having an accidental teenage pregnancy, becoming a teenage parent, or having a lifetime diagnosis of a sexually transmitted infection, for both males and females. Odds of these outcomes were between three and seven times higher for those with 4+ ACEs compared to those with no ACEs.”
Cleland L, McLeod GFH, Dhakal B, et. al.
Childhood maltreatment and the menopause transition in a cohort of midlife New Zealand women.
Menopause. 2022 Jul 1;29(7):816-822. PMID: 35796554
For 468 New Zealand women, after controlling for both childhood and adult factors relating to menopause, those who experienced severe childhood sexual abuse involving attempted/completed sexual penetration had twice the rate of entering or completed menopausal transition at age 40 compared to those with no reported child sexual abuse.
Roberts AL, Liu J, Lawn RB, et. al.
Association of Posttraumatic Stress Disorder With Accelerated Cognitive Decline in Middle-aged Women. JAMA Netw Open. 2022 Jun 1;5(6):e2217698. PMID: 35771577
“Of 12 270 trauma-exposed middle-aged women, individuals with high levels of PTSD symptoms experienced significantly worse cognitive decline in learning and working memory as well as psychomotor speed and attention compared with those with no PTSD symptoms. These findings were not fully explained by demographic characteristics, behavioral factors, or health conditions, including comorbid depression.”
Schickedanz HB, Jennings LA, Schickedanz A.
The Association Between Adverse Childhood Experiences and Positive Dementia Screen in American Older Adults. J Gen Intern Med. 2022 Aug;37(10):2398-2404. PMID: 34782990
From a survey of 1223 elders with a mean age of 73.4 years, greater exposure to ACEs was independently associated with higher probability of a positive dementia screen in older adulthood. This link was strongest in adults aged 65-74 and in those with four or more ACEs. Older adults with childhood experiences of emotional abuse, sexual abuse, exposure to intimate partner violence, or a parent’s mental illness had the greatest likelihood of a positive screen for dementia. Differences in chronic conditions, including hypertension, diabetes, cardiovascular disease, prior stroke or heart attack, severe mental illness, and alcohol use did not change the association between ACEs and positive screen for dementia.
Rodriguez-Miguelez P, Looney J, Blackburn M, et. al.
The Link Between Childhood Adversity and Cardiovascular Disease Risk: Role of Cerebral and Systemic Vasculature. Function (Oxf). 2022 May 26;3(4):zqac029. PMID: 35774591
“The medial prefrontal cortex (mPFC) is a core region in the brain that handles emotions and is directly involved in the cardiovascular response to stress by increasing vascular resistance [tightening the muscles around the blood vessels, making it harder for blood to go through].” For 45 adults, average age 33 years, 22 of whom had experienced ACEs, and using multiple assessment methods in multiple vascular areas (small, medium, and large blood vessels), there was a graded response between increasing ACEs and more dysfunction in the mPFC as well as increased vascular resistance. “These findings provide novel insights into the potential role that the brain and the peripheral vasculature may have in connecting adverse childhood events to the increased risk of cardiovascular disease.”
Khoury JE, Dimitrov L, Enlow MB, et. al.
Patterns of Maternal Childhood Maltreatment and Disrupted Interaction Between Mothers and Their 4-Month-Old Infants. Child Maltreat. 2022 Aug;27(3):366-377. PMID: 33853345
“Maternal childhood maltreatment (MCM) is associated with parenting disruptions which may contribute to the intergenerational transmission of negative health and social outcomes.” In this study of 179 mothers and their 4-month-olds, authors found that maternal childhood physical abuse history was associated with negative or intrusive maternal behavior, maternal-experienced childhood physical neglect with confusion about maternal role, and mothers who had experienced multiple types of childhood maltreatment displayed more maternal withdrawal.”
Tidmarsh LV, Harrison R, Ravindran D, et. al.
The Influence of Adverse Childhood Experiences in Pain Management: Mechanisms, Processes, and Trauma-Informed Care. Front Pain Res (Lausanne). 2022 Jun 10;3:923866. PMID: 35756908
“This topical review aimed to highlight the role of ACEs in the experience of chronic pain, pain management services, and clinical decision making by: (1) providing an overview of the relationship between ACEs and chronic pain; (2) identifying biopsychosocial mechanisms through which ACEs may increase risk of persistent pain; (3) highlighting the impact of ACEs on patient adherence and completion of pain management treatment; and (4) providing practical clinical implications for pain management.”
Yoon CY, Mason SM, Loth K, Jacobs DR Jr.
Adverse childhood experiences and disordered eating among middle-aged adults: Findings from the coronary artery risk development in young adults study. Prev Med. 2022 Jul 1:107124. PMID: 35787840
From a study of 3340 adults aged 32-46, disordered eating behaviors (DEB - concerns about weight and shape, anxiety about eating or food, unhealthy weight control behaviors, chronic dieting, overeating, and binge eating) were associated with ACE score in a stepwise manner.”
Polick CS, Polick SR, Stoddard SA.
Relationships between childhood trauma and multiple sclerosis: A systematic review. J Psychosom Res. 2022 Jun 25;160:110981. PMID: 35779440
From a research review, “Twelve studies examined relationships between any ACE(s) and the prevalence or physical clinical features of MS. There was considerable variance in the measurement of stressors, confounders, and categorization of MS; however most studies (n = 10) demonstrated an association between ACEs and MS.”
Alsubaie MA, Alkhalifah HA, Ali AH, et. al.
Adverse Childhood Experiences and Their Effect on Irritable Bowel Syndrome Among Saudi Arabian Adults. Cureus. 2022 Jun 9;14(6):e25791. PMID: 35812574
Of 196 Saudi Arabian patients (56.7% female) seen for irritable bowel syndrome, “The prevalence of ACEs was 63.3%. The most prevalent type was emotional abuse (34.9%), followed by both physical abuse and emotional neglect (28.4%). Females reported significantly more ACEs than males. Overall IBS symptoms and abdominal pain severity were significantly correlated with total ACEs score.”
Kuzminskaite E, Vinkers CH, Milaneschi Y, et. al.
Childhood trauma and its impact on depressive and anxiety symptomatology in adulthood: A 6-year longitudinal study. J Affect Disord. 2022 Sep 1;312:322-330. PMID: 35760192
From a study of Dutch adults, “Individuals with CT [childhood trauma], especially severe CT, compared to those without CT, had significantly higher scores in overall depressive symptomatology. Differences were lower, but still highly significant for anxiety, worry, and fear/phobic symptomatology. Effects were consistent across CT types and maintained over six years…Screening for CT is essential to identify individuals at risk for more severe and chronic manifestations of affective disorders.”
Betz LT, Rosen M, Salokangas RKR, Kambeitz J.
Disentangling the impact of childhood abuse and neglect on depressive affect in adulthood. J Affect Disord. 2022 Jul 23:S0165-0327(22)00810-2. PMID: 35882299
Using data from two different US midlife surveys, “Emotional abuse, particularly its more subjective components such as reactions to and appraisal of the abuse, emerged as the strongest predictors of adult depressive symptoms…Our findings corroborate the strong role of subjective experience in childhood maltreatment-related psychopathology across the lifespan.”
Henkhaus LE.
The lasting consequences of childhood sexual abuse on human capital and economic well-being. Health Econ. 2022 Sep;31(9):1954-1972. PMID: 35815810
Using US national longitudinal survey data, the author measured negative effects of childhood sexual abuse on education and labor market outcomes, controlling for socioeconomic status and other childhood maltreatment, showing robust negative effects. These effects were similar for males and females, as well as for sexual abuse from a caregiver or non-caregiver. “Results suggest that childhood sexual abuse leads to a 36%–41% greater likelihood of high school dropout, 17%–24% lower likelihood of Bachelor's degree attainment, 6%–8% lower likelihood of full-time employment, and 13%–19% lower earnings in young adulthood…aggregate productivity loss due to childhood sexual abuse totals roughly $38 billion to $44 billion each year.”
Adolescents
Mortier P, Alonso J, Auerbach RP, et. al.
Childhood adversities and suicidal thoughts and behaviors among first-year college students: results from the WMH-ICS initiative. Soc Psychiatry Psychiatr Epidemiol. 2022 Aug;57(8):1591-1601. PMID: 34424350
“Web-based self-report surveys administered to 20,842 incoming college students from nine countries (response rate 45.6%) assessed lifetime suicidal ideation, plans and attempts along with seven childhood adversities (CA).” The transition from ideation to plan was best explained by an increased number of CA types. The transition to attempts were best explained by the frequency of specific CA types. Authors calculated that 63% of suicidal ideation and 30-47% of suicidal thought and behavior transitions were associated with CAs.
Santos M, Burton ET, Cadieux A, et. al.
Adverse childhood experiences, health behaviors, and associations with obesity among youth in the United States. Behav Med. 2022 Jul 6:1-11. PMID: 35792894
From a national survey of children aged 10-17, 25.3% experienced 1 ACE and another 25.9% 2 or more ACEs. “Having ACEs was related to excess screen time and inadequate sleep, and independently associated with obesity.”
Lim L, Khor CC.
Examining the common and specific grey matter abnormalities in childhood maltreatment and peer victimisation. BJPsych Open. 2022 Jul 12;8(4):e132. PMID: 35817782
For 105 age and gender-matched youth aged 17-21 years, while both childhood maltreatment and peer victimization showed brain changes in areas common to both – involving cognitive control (allows for information processing and behavior to adapt moment to moment), emotion, and sensory processing (organizes input from the 5 senses from the body and external world) – the changes were different and specific to maltreatment and peer victimization. This “suggests that peer victimisation, particularly cyberbullying, could be as detrimental as childhood maltreatment.”
Musicaro RM, Langer DA.
Applying shared decision-making to screening for trauma and adversity in youth. Child Abuse Negl. 2022 Jun 28;131:105762. PMID: 35777339
“Despite significant support for widespread adversity screening, and many guidelines on how to conduct such screening, successful implementation has lagged behind enthusiasm. This paper outlines the challenges of adversity screening and then proposes applying the shared decision-making (SDM) model to improve adversity screening by increasing youths' 1) engagement in adversity screening if doing so is appropriate for them, and 2) disclosure of honest information during screens. Using an SDM approach honors youth preferences and perspectives.”
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