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PACEs in Pediatrics

PACEs Research Corner — May 2021, Part Two

 

[Editor's note: Dr. Harise Stein at Stanford University edits a web site — abuseresearch.info — that focuses on the health effects of abuse, and includes research articles on ACEs. Every month, she posts  the summaries of the abstracts and links to research articles that address only ACEs. This month, there were so many that she added a Part Two. Thank you, Harise!! -- Jane Stevens]

CHILD ABUSE

Jackson DB, Testa A.
The Intersection Between Adverse Childhood Experiences and Environmental Tobacco Smoke in U.S. Households With Children. Nicotine Tob Res. 2021 Mar 19;23(4):732-740. PMID: 33107577
From a large national study, children’s ACEs are strongly and uniquely associated with family smoking inside the housing unit - above and beyond family members smoking more generally.

Crouch E, Radcliff E, Bennett KJ, Brown MJ, Hung P.
Examining the relationship between adverse childhood experiences and ADHD diagnosis and severity. Acad Pediatr. 2021 Mar 18:S1876-2859(21)00149-2. PMID: 33746042
From a large national survey, children exposed to 4+ ACEs had 2.16 times higher odds of a diagnosis of ADHD, and 1.89 times of moderate to severe ADHD than children exposed to <4 ACEs.

Finkelhor D, Turner H, LaSelva D.
Receipt of Behavioral Health Services Among US Children and Youth With ACEs or Mental Health Symptoms. JAMA Netw Open. 2021 Mar 1;4(3):e211435. PMID: 33720370
From large national surveys of children’s exposure to violence, among those aged 2-9 years, no behavioral health services were reported for 57% of the high ACE group, 53% of the high distress symptoms group, and 41% with high levels of both indicators. Even less contact was reported for the 10-17 year group. Among racial groups, odds of contact were very low for Black children aged 2 to 9 years with high ACEs compared to other groups.

ACES - ADULT MANIFESTATIONS OF CHILD ABUSE

Wade M, Prime H, Johnson D, et. al.
The disparate impact of COVID-19 on the mental health of female and male caregivers. Soc Sci Med. 2021 Feb 24;275:113801. PMID: 33713927
From a multinational (UK, US, Canada, Australia) study of caregivers of children in the home during the pandemic, male and female caregiver history of personal ACEs significantly impacted coping.

Chandan JS, Okoth K, Gokhale KM, et. al.
Increased Cardiometabolic and Mortality Risk Following Childhood Maltreatment in the United Kingdom. J Am Heart Assoc. 2020 May 18;9(10):e015855. PMID: 32410481
From a large UK database, matching adults with a history of childhood maltreatment vs. unexposed patients, the maltreated group showed a significant increased rate for heart disease, hypertension, type 2 diabetes, and all-cause death rate. “Considering the high prevalence of exposure to childhood maltreatment, we have demonstrated the substantial associated burden of preventable cardiometabolic disease. There is a clear need to ensure that public health approaches are implemented to prevent the adverse consequences following exposure to childhood maltreatment.”

Emery RL, Yoon C, Mason SM, Neumark-Sztainer D.
Childhood maltreatment and disordered eating attitudes and behaviors in adult men and women. Appetite. 2021 Mar 22:105224. PMID: 33766616
For 1647 adults aged 27-33 as part of a long term study, “A history of any childhood maltreatment was associated with more than 60% greater risk for chronic dieting and overeating, with additional associations found for binge eating, weight and shape concerns, and unhealthy weight control behaviors. All types of abuse and neglect were associated with at least one type of disordered eating outcome…emotional neglect was most consistently related to higher risk for disordered eating attitudes and behaviors.”

Ganson KT, Murray SB, Mitchison D, et. al.
Associations between ACEs and Performance-Enhancing Substance Use among Young Adults. Subst Use Misuse. 2021 Mar 16:1-7. PMID: 33726612
From a large national study, “among both men and women, greater number of cumulative ACEs predicted higher odds of both legal and illegal performance-enhancing substance use.”

Cheung S, Huang CC, Zhang C.
Passion and Persistence: Investigating the Relationship Between ACEs and Grit in College Students in China. Front Psychol. 2021 Feb 22;12:642956. PMID: 33692733
“Grit” (qualities of persistence and passion) is a strong predictor of achievement, well-being and professional success. Of 1871 students across 12 universities in China, ACEs had a negative effect on grit, particularly direct abuse and neglect factors.

Blosnich JR, Garfin DR, Maguen S, et. al.
Differences in childhood adversity, suicidal ideation, and suicide attempt among veterans and nonveterans. Am Psychol. 2021 Feb-Mar;76(2):284-299. PMID: 33734795
From a large survey of veterans compared to non-veterans, male and female veterans reported greater average frequency of ACEs, and in particular >6 ACEs than non-veterans. The strongest correlate of suicidality for veteran men was having >6 ACEs, and for veteran women suicidality before age 18. “Suicide prevention research, policy, and practice should address ACEs among veterans as salient premilitary risk factors.”

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
Of 303 pregnant women from a US Southern academic medical center, almost ¼ reported 4+ ACEs. Higher ACEs and different types of ACEs were variously associated with increased maternal depression, anxiety, PTSD, and use of tobacco, cannabis, alcohol and opioids.

ACES - ADOLESCENTS

Cusimano MD, Zhang S, Mei XY, et. al.
Traumatic Brain Injury, Abuse, and Poor Sustained Attention in Youth and Young Adults Who Previously Experienced Foster Care. Neurotrauma Rep. 2021 Feb 17;2(1):94-102. PMID: 33748814
“Former foster care is associated with high frequency of TBI [traumatic brain injury], poorer sustained attention, and ACEs of abuse and neglect…[which] may play a large role in shaping the poor long-term health and life outcomes observed in this disadvantaged population.”

Folk JB, Kemp K, Yurasek A, Barr-Walker J, Tolou-Shams M.
Adverse childhood experiences among justice-involved youth. Am Psychol. 2021 Feb-Mar;76(2):268-283. PMID: 33734794
This review “offers recommendations for data-driven intervention…which describes different points of justice system contact (i.e., first arrest, court diversion, detention, and community supervision) in which there is opportunity to intervene and improve youth behavioral health, legal, and associated outcomes.” Interventions such as at the time of first ACE documentation (i.e. parent's arrest) are discussed.

Luthar SS, Ciciolla L, Suh BC.
Adverse childhood experiences among youth from high-achieving schools: Appraising vulnerability processes toward fostering resilience. Am Psychol. 2021 Feb-Mar;76(2):300-313. PMID: 33734796
527 adolescents at high-achieving high schools “experience and are affected by ACEs as frequently as their counterparts from other socioeconomic groups. In early adulthood, those who reported experiences of 3 and 4 ACEs showed odds for lifetime internalizing disorders [mood] that were over six to 12 times as high, compared with those with none…high-achieving school youth and their parents experience their own set of nontrivial life stressors” including parental harsh criticism, depression, divorce/separation and neglect.

Miller-Graff LE, Howell KH, Grein K, Keough K.
Women's Cigarette and Marijuana Use in Pregnancy: the Role of Past Versus Recent Violence Exposure. J Interpers Violence. 2021 Apr;36(7-8):NP3982-NP3998. PMID: 29936890
For 101 high-risk low-income pregnant women, ¼ reported smoking and few were able to quit when they became pregnant. “Past year physical abuse by a partner was associated with light cigarette use during pregnancy whereas high rates of childhood adversity were associated with moderate cigarette use during pregnancy. Sexual IPV was associated with marijuana use during pregnancy.”

ACES – RACE/CULTURAL

Woods-Jaeger B, Briggs EC, Gaylord-Harden N, et. al.
Translating cultural assets research into action to mitigate adverse childhood experience-related health disparities among African American youth. Am Psychol. 2021 Feb-Mar;76(2):326-336. PMID: 33734798
“In this article, we reviewed the disproportionate exposure to ACEs and racism experienced by African American youth, and the subsequent increased risk for allostatic load and physical and mental health disparities. We described an approach for translating cultural assets research into action through task-shifting [shifting components of prevention and intervention to those less-trained, such as natural mentors and after school staff] and youth-partnered advocacy.”

ACES - PROVIDERS

Barnett ML, Sheldrick RC, Liu SR, Kia-Keating M, Negriff S.
Implications of adverse childhood experiences screening on behavioral health services: A scoping review and systems modeling analysis. Am Psychol. 2021 Feb-Mar;76(2):364-378. PMID: 33734801
Authors discuss clinical modeling of supply and demand issues for behavioral health treatment relating to ACEs screening. “Behavioral health care delivery is essential to successful implementation and should be carefully considered by researchers, clinicians, and, policymakers…it is critical to take a systems level perspective.”

ACES - PREVENTION

Roubinov DS, Luecken LJ, Curci SG, Somers JA, Winstone LK.
A prenatal programming perspective on the intergenerational transmission of maternal adverse childhood experiences to offspring health problems. Am Psychol. 2021 Feb-Mar;76(2):337-349. PMID: 33734799
Authors review the impact of maternal personal ACEs on the mother-infant bond and functioning, with higher ACEs leading to poorer functioning and increased child behavior problems. They discuss prevention and treatment strategies including perinatal assessment of maternal ACEs and psychosocial risk, perinatal treatment of maternal distress, and mother-infant therapy in the postpartum period.

ACES - RESEARCH

Briggs EC, Amaya-Jackson L, Putnam KT, Putnam FW.
All adverse childhood experiences are not equal: The contribution of synergy to adverse childhood experience scores. Am Psychol. 2021 Feb-Mar;76(2):243-252. PMID: 33734792
“Certain pairs of ACEs comprising the cumulative ACE score interact synergistically to significantly increase the overall risk beyond the sum (or product) of the contributions of each ACE to the outcome…Synergistic pairs of ACEs vary by gender and age group…Across studies, sexual abuse is the most synergistically reactive ACE.”

ACES - OTHER

Purtle J, Nelson KL, Gollust SE.
Public Opinion About Adverse Childhood Experiences: Social Stigma, Attribution of Blame, and Government Intervention. Child Maltreat. 2021 Mar 26:10775595211004783. PMID: 33769126
From a nationally representative online survey of US adults, “We found that inter-personal stigma and parental blame related to ACEs were prevalent, with 25.0% of respondents unwilling to have a person with "a lot of ACEs" as a close co-worker and 65.2% believing that parents were very much to blame for the consequences of ACEs. Fifty percent of respondents believed that government intervention to prevent ACEs was very important…Public opinion and communications studies are important…to ensure that information about ACE science does no harm.”

RELATED OF INTEREST

Dunn EC, Nishimi K, Neumann A, et. al.
Time-Dependent Effects of Exposure to Physical and Sexual Violence on Psychopathology Symptoms in Late Childhood: In Search of Sensitive Periods in Development. J Am Acad Child Adolesc Psychiatry. 2020 Feb;59(2):283-295. PMID: 31078631
“Interpersonal violence is harmful to childhood mental health regardless of when it occurs. However, very early childhood may be a particularly sensitive period when exposure results in worse psychopathology outcomes.”

Walker-Descartes I, Mineo M, Condado LV, Agrawal N.
Domestic Violence and Its Effects on Women, Children, and Families. Pediatr Clin North Am. 2021 Apr;68(2):455-464. PMID: 33678299
General review article. “There are significant mental and physical health consequences for all members in a household with an established culture of violence. Any level of exposure to violence in any form is associated with considerable impairment in children similar to other forms of child abuse and maltreatment. Families with an established culture of violence experience heightened vulnerabilities during pandemics and natural disasters.”

Morrison PK, Hawker L, Cluss PA, et. al.
The Challenges of Working With Men Who Perpetrate Partner Violence: Perspectives and Observations of Experts Who Work With Batterer Intervention Programs.J Interpers Violence. 2021 Apr;36(7-8):NP3524-NP3546. PMID: 29897001
From interviews with 36 professionals working with batterer intervention programs, challenges to behavioral change among men who perpetrate violence were: (a) social acceptance of IPV, (b) hypermasculine attitudes, (c) emotional problems, (d) childhood exposure to violence, (e) co-morbid mental health issues, and (f) denial, minimization, and blame.

Chen JA, Zhang E, Liu CH.
Potential Impact of COVID-19-Related Racial Discrimination on the Health of Asian Americans. Am J Public Health. 2020 Nov;110(11):1624-1627. PMID: 32941063
“We provide a general overview of the history of anti-Asian discrimination in the United States, review theoretical and empirical associations between discrimination and health, and describe the associated public health implications of the COVID-19 pandemic.”

Kidman R, Margolis R, Smith-Greenaway E, Verdery AM.
Estimates and Projections of COVID-19 and Parental Death in the US. JAMA Pediatr. 2021 Apr 5:e210161. PMID: 33818598
“Children who lose a parent are at elevated risk of traumatic grief, depression, poor educational outcomes, and unintentional death or suicide, and these consequences can persist into adulthood. Sudden parental death, such as that occurring owing to COVID-19, can be particularly traumatizing …Moreover, COVID-19 losses are occurring at a time of social isolation, institutional strain, and economic hardship.” Authors estimate that as of Feb 1, 2021 37,300 – 43,000 children have lost a parent to the pandemic, not including nonparental primary caregivers. “For comparison, the attacks on September 11, 2001, left 3000 children without a parent…Black children are disproportionately affected, comprising only 14% of children in the US but 20% of those losing a parent to COVID-19.” Authors support the establishment of a national child bereavement cohort to identify and aid these children.

Belen H.
Fear of COVID-19 and Mental Health: The Role of Mindfulness During Times of Crisis. Int J Ment Health Addict. 2021 Apr 26:1-12. PMID: 33935608
From a survey of 355 students age 18-41, there was a direct correlation between fear of Covid-19 and levels of anxiety and depression; and there was an inverse correlation between fear of Covid-19 and degree of mindfulness.

Warren MT, Schonert-Reichl KA, Gill R, et. al.
Naturalistic development of trait mindfulness: A longitudinal examination of victimization and supportive relationships in early adolescence. PLoS One. 2021 May 7;16(5):e0250960. PMID: 33961643
Of 4,593 Canadian 4th graders followed to 7th grade, trait mindfulness developed as a function of the sum of adolescents’ everyday lives. Mindfulness levels tracked inversely with degree of victimization, while peer belonging and connectedness with adults at home increased mindfulness.

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