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PACEs Research Corner — November 2022, Part 2


[Editor's note: Dr. Harise Stein at Stanford University edits a web site — — 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]

Domestic Violence – Effects on Children

Schuler BR, Vazquez CE, Kobulsky JM, Dumenci L.
Adversity and child body mass index in Fragile Families over 15 years: Do type and timing matter? SSM Popul Health. 2022 Aug 13;19:101197. PMID: 36033351
From a US fragile families study, increased interpersonal/IPV and community adversity (threat) at ages 3-5 was associated with decreased body mass index from ages 5-9 years, while increased economic adversity such as food or housing insecurity (deprivation) was associated with increased BMI during the same age ranges.

LGBTQ Concerns

Andresen JB, Graugaard C, Andersson M, et. al.
Adverse childhood experiences and mental health problems in a nationally representative study of heterosexual, homosexual and bisexual Danes. World Psychiatry. 2022 Oct;21(3):427-435. PMID: 36073708
From a large Danish study, “Compared to heterosexuals, non-heterosexual persons were more likely to report most of the studied ACEs, with odds ratios (ORs) for the ACEs ranging from 1.38 to 1.75 for homosexual women, 1.76 to 2.65 for homosexual men, 2.52 to 3.64 for bisexual women, and 1.58 to 6.07 for bisexual men. Furthermore, non-heterosexual persons had consistently and significantly higher odds for mental health problems (ORs: 1.50 to 4.63)…These findings highlight the need to safeguard the welfare of adults, children and adolescents with non-conforming expressions of sexuality.”

Bourne A, Amos N, Donovan C, et. al.
Naming and Recognition of Intimate Partner Violence and Family of Origin Violence Among LGBTQ Communities in Australia. J Interpers Violence. 2022 Aug 29:8862605221119722. PMID: 36036557
A large, online survey of Australian LGBTQ adults were asked about experiences of violence in family of origin (FOV) and IPV in 2 ways – directly or via a nuanced list of abusive actions.  Positive responses regarding FOV were 30.93% directly vs. 43.18% nuanced, and to IPV were 41.73% directly vs. 60.71% nuanced.  “Some LGBTQ people may struggle to recognize or name their family or relationship experiences as abusive or violent, which may complicate their ability or willingness to access professional support.”

Race/Cultural Concerns

Hoffmann JA, Alegría M, Alvarez K, et. al.
Disparities in Pediatric Mental and Behavioral Health Conditions. Pediatrics. 2022 Sep 15:e2022058227. PMID: 36106466
“Half of United States children with a treatable mental health disorder do not receive treatment from a mental health professional. Children and adolescents in racial, ethnic, sexual, sex, and other minority groups experience inequities in access to care and disparities in outcomes for mental and behavioral health conditions. Suicide rates are nearly twice as high in Black compared to White boys 5 to 11 years old and have been increasing disproportionately among adolescent Black girls 12 to 17 years old. Children identifying as a sexual minority have >3 times increased odds of attempting suicide compared to heterosexual peers…Strategies to address inequities in mental and behavioral health among United States children include investing in a diverse workforce of mental health professionals, improving access to school-based services, ensuring equitable access to telehealth, and conducting quality improvement with rigorous attention to equity.”

Alvarez K, Cervantes PE, Nelson KL, et. al.
Review: Structural Racism, Children's Mental Health Service Systems, and Recommendations for Policy and Practice Change. J Am Acad Child Adolesc Psychiatry. 2022 Sep;61(9):1087-1105. PMID: 34971730
“First, we identify and analyze federal and state policies focused on racism and mental health equity. Second, we evaluate areas of focus in these policies and discuss the evidence base informing their implementation. Finally, we provide recommendations for what states, counties, cities, and mental health systems can do to promote antiracist evidence-based practices in children's mental health.”

Bernard DL, Halliday CA, Are F, Banks DE, Danielson CK.
Rumination as a Mediator of the Association Between Racial Discrimination and Depression Among Black Youth. J Racial Ethn Health Disparities. 2022 Oct;9(5):1937-1945. PMID: 34410607
In this study of 158 Black early adolescents (mean age 11.5 years, 53% female), racial discrimination was positively associated with rumination (= focused attention to, and continuously thinking about, one’s distress), which in turn was positively associated with depressive symptoms.  “Rumination represents a potential pathway that can be targeted at early developmental stages to reduce the deleterious impact of racism-related stressors.”

Moody MD, Lewis JCJ.
Lifetime vicarious experiences of major discrimination and depressive symptoms among middle-aged and older black adults. Aging Ment Health. 2022 Aug 29:1-8. PMID: 36038955
From a subsample of a Nashville Stress and Health Study, for Black adults aged 50 or older, “the most common discriminatory events that they had vicariously experienced in their lifetime occurred as a result of their loved ones' unfair interactions with law enforcement and the job market, respectively. Furthermore, our findings revealed that vicarious experiences of major discrimination were associated with higher levels of depressive symptoms among middle-aged and older Black adults.”  Authors note that vicarious as well as personal exposure to discrimination impact health.

Spanierman LB.
Confronting Whiteness in Developmental Science: Disrupting the Intergenerational Transmission of White Racism. J Res Adolesc. 2022 Sep;32(3):808-814. PMID: 35980824
Introduction to a special section of this journal looks at White adolescents’ racial identity development, identity development during incarceration, White racial socialization (WRS) practices in White families, digital WRS, and recommendations for future research.


Brown SJ, Zammit J, King S.
A contemporary case file analysis of child sexual abuse in institutional settings in England and Wales. Child Abuse Negl. 2022 Sep;131:105633. PMID: 35696832
In an analysis of child sexual abuse (CSA) in institutions in England and Wales during the past 5 years, “In 79% of cases there was some level of awareness of concerns relating to inappropriate behaviour or CSA, through rumours and gossip, concerns about professionalism, and observed changes in the behaviour of subsequently barred individuals or victims. There was wide variation in the degree to which institutions responded. In a small number of cases action was taken promptly; however, this was not typical.”

Police and Court Systems

Austin AE, Naumann RB, Simmons E.
Association of State Child Abuse Policies and Mandated Reporting Policies With Prenatal and Postpartum Care Among Women Who Engaged in Substance Use During Pregnancy. JAMA Pediatr. 2022 Sep 19:e223396. PMID: 36121649
In states that have policies for mandated reporting of maternal substance use and/or consider maternal substance use to be child abuse, mothers received prenatal care approximately one month later, had lower likelihood of adequate prenatal care, and were less likely to have a postpartum health care visit, than in those states without such policies.

Koulu S, Nikupeteri A, Laitinen M, Lohiniva-Kerkelä M.
Does children's fear matter? Evaluating children's positions in Finnish court decisions on stalking. Behav Sci Law. 2022 Sep;40(5):699-714. PMID: 36076326
“Children are at particular risk when one parent is targeted by the other parent's stalking behaviors post-separation.”  Using data from 127 Finnish court decisions on stalking, authors identified four categories in how children were positioned: (1) children relegated to the background, (2) children's involvement recounted as part of the facts, (3) children's involvement assessed as relevant because it affected the parent, and (4) children as agents or victims in their own right. “The findings highlight a significant risk of losing sight of children when the focus is on parents, and our concern is that this may also contribute to children not receiving the support they need.”


Watson C, Wei J, Varnado N, et. al.
Pregnant women's perspectives on screening for adverse childhood experiences and resilience during prenatal care. Psychol Trauma. 2022 Nov;14(8):1299-1303. PMID: 35025559
From surveys of pregnant women from two medical centers who were given ACEs and resilience screening, “The sample (N = 119) was 36.1% non-Hispanic White, 26.1% Hispanic, 8.4% Black, 23.5% Asian/Pacific Islander, and 5.9% Other, with a median age of 31 and average neighborhood median household income of $100,734. Most women thought prenatal care should include conversations about ACEs (82.2%) and resilience (94.0%) and very strongly believed that good coping skills can help reduce the harmful effects of childhood stress (79.0%). Nearly half (41.2%) used ≥1 mental health resource from the resource handout provided at screening…Notably, most women (73.5%) would like their partner to also receive the screening. Women with more ACEs were more likely to want a longer conversation, and those with low versus high resilience were more likely to prefer that a mental health professional conduct the screening.”

Agoston AM.
Expanding Neuroprotective Care: A Trauma-Informed Approach to Delivery of Services within Pediatric Inpatient Units. Clin Pediatr (Phila). 2022 Aug 30:99228221120290. PMID: 36039787
“Children with a history of trauma or adverse childhood experiences may be at higher risk for poor psychological and physical responses to medical experiences aimed at enhancing their well-being…An approach called neuroprotective care buffers the effects of toxic stress negatively affecting child health and well-being. Although often used in neonatal and cardiac intensive care units, the development and broad implementation of universal neuroprotective care measures across age groups and hospital settings…accounts for children's ecological, biological, and developmental needs, protects them against medical traumatic stress and retraumatization, and provides a tailored, measurable approach that systematically preserves child well-being within hospital settings.”

Rothman EF, Lynch AK.
The State of the Science on Adverse Childhood Experiences. OTJR (Thorofare N J). 2022 Sep 9:15394492221120799. PMID: 36082458
“The objective of this article is to explain the history of the ACEs questionnaire, the current controversy about its use for screening, the emergence of the concept of PCEs, and implications for occupational therapy practitioners and researchers.”

Duprey EB, Handley ED, Wyman PA, et. al.
Child maltreatment and youth suicide risk: A developmental conceptual model and implications for suicide prevention. Dev Psychopathol. 2022 Sep 13:1-24. PMID: 36097812
“We propose a developmental model that integrates principles of developmental psychopathology and current theories of suicide to explain the association between child maltreatment and youth suicide risk. This model bears significant implications for future research on child maltreatment and youth suicide risk, and for suicide prevention efforts that target youth with child maltreatment experiences.”

Afifi TO, Salmon S, Stewart-Tufescu A, Taillieu T.
An Examination of Parents' Adverse Childhood Experiences (ACEs) History and Reported Spanking of Their Child: Informing Child Maltreatment Prevention Efforts. Int J Environ Res Public Health. 2022 Aug 25;19(17):10580. PMID: 36078294
From a Canadian study of 1000 parents and adolescents, “a parent's own history of physical abuse, emotional abuse, spanking, and household mental illness in childhood were associated with an increased likelihood that their child would have been spanked…Parent's ACEs history may be an important factor to consider when developing and implementing spanking prevention efforts.”

Tang S, Bowen DA, Chadwick L, Madden E, Ghertner R.
Are Home Evictions Associated with Child Welfare System Involvement? Empirical Evidence from National Eviction Records and Child Protective Services Data. Child Maltreat. 2022 Sep 14:10775595221125917. PMID: 36112918
In a national study from DHHS using county data, authors found “one additional eviction per 100 renter-occupied homes in a county was associated with a 1.3% increase in the rate of child abuse and neglect reports and a 1.6% increase in foster care entries. The association between eviction and foster care entries was strongest among Hispanic children with an 8.1% increase. Assisting parents in providing stable housing may reduce the risk of child welfare system involvement, including out-of-home child placement. Primary and secondary prevention strategies could include housing assistance, increasing access to affordable and safe housing, as well as providing economic support for families (e.g., tax credits, childcare subsidies) that reduce parental financial burden to access stable housing.”

Shenk CE, O'Donnell KJ, Pokhvisneva I, et. al.
Epigenetic Age Acceleration and Risk for Posttraumatic Stress Disorder following Exposure to Substantiated Child Maltreatment. J Clin Child Adolesc Psychol. 2022 Sep-Oct;51(5):651-661. PMID: 33471576
For 70 children and adolescents aged 8-15 years exposed to substantiated child maltreatment, epigenetic age acceleration (premature cellular aging), with no differential effects for maltreatment type, predicted current PTSD status.  Since per authors only 40% of maltreated children are diagnosed with PTSD, they suggest this biological finding may help find those at risk for PTSD for prevention treatment.


Camacho S, Clark Henderson S.
The Social Determinants of Adverse Childhood Experiences: An Intersectional Analysis of Place, Access to Resources, and Compounding Effects. Int J Environ Res Public Health. 2022 Aug 27;19(17):10670. PMID: 36078386
Authors present their Intersectional Nature of ACEs Framework to showcase the relationship between high-risk conditions and sociopolitical and economic circumstances that can worsen the effects of ACEs.  This framework “differentiates between ACEs that are consequences of social inequities and ACEs that are inflicted directly by a person. This framework better equips ACEs scholars, policymakers, and stakeholders to address the root causes of inequality and mitigate the effects of ACEs.”

Conway CA, Lewin A.
Development and psychometric properties of the ACE-I: Measuring adverse childhood experiences among Latino immigrant youth. Psychol Trauma. 2022 Nov;14(8):1247-1255. PMID: 35113626
“The purpose of this study was to develop a new measure, the ACE-I, which consists of adversities that may be more relevant among immigrant populations, and to compare these rates to those of traditionally studied ACEs…immigrant youth, on average, reported more adversities on the ACE-I measure than the traditional ACEs measure (3.6 vs. 1.6)…(experiences of violence/unrest in one's home country, danger encountered on the migration journey, and instability of life as an immigrant)…These findings suggest that there are essential early adverse experiences for immigrants that have not previously been considered in ACEs research.”

Gette JA, Gissandaner TD, Littlefield AK, et. al.
Modeling the Adverse Childhood Experiences Questionnaire-International Version. Child Maltreat. 2022 Nov;27(4):527-538. PMID: 34569305
“The ACE-International Questionnaire (ACE-IQ) was developed to assess categories of ACEs (e.g., sexual, emotional, and physical abuse) in internationally representative samples. Though the ACE-IQ has been used world-wide, little work has examined the structure of this measure…The present work used two principal components analyses (PCA) to evaluate the ACE-IQ structure using both the identified ACE categories as defined by the World Health Organization (WHO) and using the ACE-IQ items as individual indicators.”

Seitz KI, Gerhardt S, von Schroeder C, et. al.
Measuring types and timing of childhood maltreatment: The psychometric properties of the KERF-40. PLoS One. 2022 Sep 8;17(9):e0273931. PMID: 36074774
“The KERF-40+ appears to be suited for clinicians and researchers interested in retrospectively assessing in adults different types, timing, and duration of childhood maltreatment experiences during sensitive periods.”

Bounds DT, Stiles-Shields C, Schueller SM, et. al.
Ethical considerations for developing pediatric mhealth interventions for teens with socially complex needs. J Child Adolesc Psychiatr Nurs. 2022 Sep 22. PMID: 36134754
“To safely move mHealth interventions from research into clinical practice, ethical standards must be met during the design phase. In this paper we adapt the Four Box Model (i.e., medical indications, preferences of patients, quality of life, and contextual features) to guide mHealth developers through ethical considerations when designing mHealth interventions for teens who present with a medical diagnosis and a history of ACEs.”

Slep AMS, Glaser D, Manly JT.
Psychological maltreatment: An operationalized definition and path toward application. Child Abuse Negl. 2022 Sep 19;134:105882. PMID: 36137405

“Psychological maltreatment (PM) of children has been difficult to define and even more challenging to operationalize consistently. This fact contributes to child PM being under-recognized and under-addressed by professionals that interact with children with mental health, behavioral, and developmental issues; and by systems such as child welfare, clinical and judicial systems. In this paper, we propose a definition of child PM that is both overarching and operationalized in a manner that will support consistent, fair, and unbiased application in applied contexts.”  Authors use an extensive table for this definition.

Gusler S, Guler J, Petrie R, Marshall H, Cooley D, Jackson Y.
Adversity Interpreted: A Scoping Review of Adversity Appraisal Measurement. Trauma Violence Abuse. 2022 Oct;23(4):1111-1133. PMID: 33511918
“Individuals' appraisals (i.e., subjective interpretations) of adverse or traumatic life events may serve as a mechanism accounting for differences in adversity exposure and psychological adjustment.”  Authors provide a research review of available appraisal tools.

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