[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
Andrzejewski T, DeLucia EA, Semones O, et al.
Adverse Childhood Experiences in Autistic Children and Their Caregivers: Examining Intergenerational Continuity. J Autism Dev Disord. 2023 Jul;53(7):2663-2679. PMID: 35412212
“242 caregivers of autistic (n = 117) and non-autistic (n = 125) youth reported on ACEs that they experienced in their own childhoods and ACEs experienced by their children, as well as measures of depression, stress, and child autistic traits and behavioral concerns. Autistic youth and their caregivers both experienced significantly higher rates of ACEs than the non-autistic dyads. Intergenerational continuity, the association between caregiver and child ACEs, was significantly stronger for autistic youth.”
Murray L, Puls HT.
Clinical guideline highlights for the hospitalist: Evaluation for bleeding disorders in suspected child abuse. J Hosp Med. 2023 Jul;18(7):627-629. PMID: 36751695
“Updated guidelines were published in 2022 by the American Academy of Pediatrics (AAP) to provide recommendations for the necessity and type of laboratory testing to evaluate for bleeding disorders among cases of suspected child abuse. Laboratory testing for bleeding disorders is not indicated in all cases of suspected child abuse. Determination of the necessity of testing requires consideration of the patient and family history, age and mobility status of the child, clinical and exam findings, and specific characteristics of the clinical presentations …the authors developed separate recommendations for testing cases involving bruising and intracranial hemorrhage, specifically.”
Canty KW, Keogh A, Kurtz MP, Peréz-Rosselló JM.
Genital Manifestations of Physical Abuse in Male Infants and Children. Urology. 2023 Jun 3:S0090-4295(23)00467-3. PMID: 37271187
“We present 3 male patients with genital bruising due to physical abuse to improve recognition of genital trauma as a sentinel injury. In the absence of an underlying medical condition or a clear acceptable accidental mechanism for the injury, an evaluation for child abuse is recommended.”
Iantorno SE, Swendiman RA, Bucher BT, Russell KW.
Surge in Pediatric Firearm Injuries Presenting to US Children's Hospitals During the COVID-19 Pandemic. JAMA Pediatr. 2023 Feb 1;177(2):204-206. PMID: 36534391
Using administrative data from 49 tertiary pediatric US hospitals, rates of children with firearm injuries significantly increased during the COVID-19 pandemic and remained elevated throughout 2021. Non-Hispanic Black children and those with public insurance had greater proportions of firearm-injured children during vs. before the pandemic. “There were no significant differences between cohorts by sex, household income, rurality, region, mortality, or intent. The COVID-19 pandemic was independently associated with increased monthly firearm injuries after controlling for all covariates.”
Bach-Mortensen AM, Goodair B, Barlow J.
For-profit outsourcing and its effects on placement stability and locality for children in care in England, 2011-2022: A longitudinal ecological analysis. Child Abuse Negl. 2023:106245. PMID: 37258367
“The responsibility of local authorities in England to provide children in care with stable, local placements has become increasingly difficult due to the rising number of children in need of care and a shortage of available placements.” This paper shows that local authorities who outsource children's social care to the private market “have the highest rates of placement disruptions and out-of-area placements.”
Grossman ER, McClendon JE, Gielen AC, et al.
A review of state regulations for child care: Preventing, recognizing and reporting child maltreatment. Child Care Health Dev. 2023;49(4):657-68. PMID: 36377347
“We reviewed state regulations for all 50 states and the District of Columbia for child care centres and family child care homes 2021 and compared these regulations to eight national health and safety standards on child maltreatment…Three states (Colorado, Utah and Washington) had regulations for centres, and one state (Washington) had regulations for homes that at least partially met all eight national standards. Nearly all states had regulations requiring that caregivers and teachers are mandated reporters of child maltreatment and requiring that they be trained in preventing, recognizing and reporting child maltreatment. One state (Hawaii) did not have regulations consistent with any of the national standards for either centres or homes…Encouraging states to adopt regulations that meet national standards and exploring their impact on child welfare are important next steps.”
Vega S, Huang JS, Kuelbs CL, Rebbe R, Putnam-Hornstein E.
A Longitudinal Study of Health Care Utilization Among Infants Investigated for Maltreatment. Acad Pediatr. 2023 May 27:S1876-2859(23)00159-6. PMID: 37247840
Of 3692 children investigated for maltreatment within the first year of life, compared to matched controls, children with infancy maltreatment had significantly more high-acuity health care visits. “These findings highlight this population's need for well-defined medical homes to ensure appropriate health care. Further understanding of the underlying reasons for this increased health care burden will help inform these efforts.”
McDoniel ME, Bierman KL.
Exploring pathways linking early childhood adverse experiences to reduced preadolescent school engagement. Child Abuse Negl. 2023 Aug;142(Pt 1):105572. PMID: 35216816
Following 556 children from Headstart preschool classrooms, a path model linked early childhood ACES through poor kindergarten student-teacher relationship quality to elevated third grade internalizing problems, which, in turn, led to reduced fifth-grade school engagement.
Adult Manifestations of Child Abuse
Sucich J, Breitbart V, Williams S, et al.
Prevalence of Childhood Trauma in a Community-Based Mental Health Clinic. Community Ment Health J. 2023 Aug;59(6):1136-1149. PMID: 36752932
Of 856 participants seen at a community mental health clinic, “40% reported 4+ ACEs. Among high scorers, emotional abuse, physical abuse and emotional neglect were the most prevalent. High mean ACE sum scores were observed among patients with PTSD, depression, impulse disorder and substance use disorder. Having a higher ACE sum score was associated with a greater number of co-occurring psychiatric disorders.”
Hartwell M, Hendrix-Dicken A, Terry R, et al.
Trends and forecasted rates of adverse childhood experiences among adults in the United States: an analysis of the Behavioral Risk Factor Surveillance System. J Osteopath Med. 2023 Mar 22;123(7):357-363. PMID: 36947857
From a large national ACE database evaluated by age group, “The mean reported ACEs among individuals 80 years or older (born in or before 1940) was 0.79, while the highest mean ACEs (2.74) were reported among the cohort born in 1998-an average increase of 0.022 ACEs per year. The model forecasted that individuals born in 2018 will, on average, surpass a cumulative of three ACEs. Given the connection of ACEs to poor health outcomes and quality of life, this trend is alarming and provides evidence for the necessity of child maltreatment prevention.”
Schröder J, Briken P, Tozdan S.
Comparing female- to male-perpetrated child sexual abuse as presumed by survivors – A qualitative content analysis. Child Abuse Negl. 2023;143:106252. PMID: 37295191
“Female-perpetrated child sexual abuse (CSA) is taboo topic in society and an under-recognized issue in research and mental health care.” From an online study of 212 survivors of female-perpetrated CSA, compared with responses to male-perpetrated CSA, “The analyses reveal ten categories of differences, such as a more subtle approach, different levels of violence, and more psychological manipulation. Further, the analyses suggest ten categories of different personal consequences, such as less belief and support, more psychological sequelae, and disturbed relationships with women.”
Hautle LL, Jellestad L, Schenkel S, et al.
Adults with a history of childhood maltreatment with and without mental disorders show alterations in the recognition of facial expressions. European journal of psychotraumatology. 2023;14(2):2214388. PMID: 37317552
98 adults with childhood maltreatment (CM) experiences, compared to a control group without CM, showed significantly lower scores on recognition of facial expressions – neutral and 8 different emotions – regardless of mental health disorder diagnosis or not. “Future research should explore…interventions that improve social functioning.”
Klimek M, Entringer S, Matras A, et al.
Early-life adversities and later-life reproductive patterns in women with fully traced reproductive history. Scientific reports. 2023;13(1):9328. PMID: 37291139
Of 105 Polish women mean age 59.7 years from a traditional population with low birth control usage, and tracking complete reproductive health histories, those who were exposed to childhood emotional and physical neglect had an earlier age at menarche, and those who experienced emotional abuse reported an earlier age at first birth.
Hamlat EJ, Neilands TB, Laraia B, Zhang J, Lu AT, Lin J, et al.
Early life adversity predicts an accelerated cellular aging phenotype through early timing of puberty. Psychol Med. 2023:1-9. PMID: 37325994
In a study of 187 Black and 198 White women, mean age 39.4 years, women who experienced more childhood adversity, especially Black women, were younger at menarche (onset of menstruation), associated with greater accelerated aging.
Kim K, Yaffe K, Rehkopf DH, et al.
Association of Adverse Childhood Experiences With Accelerated Epigenetic Aging in Midlife. JAMA network open. 2023;6(6):e2317987. PMID: 37306997
Of 895 US adults, and using 5 different measurement tools for biological aging, 4+ ACEs compared to fewer ACEs “were associated with epigenetic age acceleration of middle-aged adults after controlling for demographics, behavior, and socioeconomic status.”
Rokach A, Clayton S.
The Consequences of Child Abuse. Healthcare (Basel, Switzerland). 2023;11(11). PMID: 37297790
“This review provides an overview of the consequences of early adverse experiences across various domains of life…sheds light on the implications of ACEs for health, socio-emotional and psychosocial well-being, relationships, personality, and cognitive functioning.”
Nakama N, Usui N, Doi M, Shimada S.
Early life stress impairs brain and mental development during childhood increasing the risk of developing psychiatric disorders. Prog Neuropsychopharmacol Biol Psychiatry. 2023;126:110783. PMID: 37149280
“Our review provides the latest insights into the negative effects of childhood maltreatment on children's development and psychiatric disorders in adulthood.”
Winter JJ, Rodríguez-Acevedo KL, Dittrich M, Heller EA.
Early life adversity: Epigenetic regulation underlying drug addiction susceptibility. Mol Cell Neurosci. 2023;125:103825. PMID: 36842544
“Early life adversity is causally relevant to adult psychiatric disease and may contribute to the risk of addiction. Here we review recent pre-clinical evidence showing that early life exposure to stress and/or drugs regulates changes in behavior, gene expression, and the epigenome that persist into adulthood…The effects of early life adversity are sex-, brain-region, and exposure-specific. The type of early life adversity often informs adult drug addiction susceptibility in both men and women. Underlying molecular mechanisms include regulation of genome-wide neuronal epigenetic modifications and gene expression.”
Oltean LE, Șoflău R, Miu AC, Szentágotai-Tătar A.
Childhood adversity and impaired reward processing: A meta-analysis. Child Abuse Negl. 2023;142(Pt 1):105596. PMID: 35346502
From a research review, “results suggest that multidimensional reward processing impairments are a consistent marker of childhood adversity, and may represent mechanisms underlying the increased risk of psychopathology.” Reward processing encompasses the response to rewarding stimuli, the ability to learn from reward, the anticipation of future rewards, and engagement in goal-directed behavior towards rewards.
Mackle T, Colodro-Conde L, de Dassel T, et al.
"Echoes of a dark past" is a history of maternal childhood maltreatment a perinatal risk factor for pregnancy and postpartum trauma experiences? A longitudinal study. BMC Pregnancy Childbirth. 2023;23(1):397. PMID: 37248446
Of 262 pregnant women completing an online survey mid-pregnancy and 8 weeks after delivery, those who reported having at least one ACE relating to abuse or neglect were 6.7 times more likely to report a perinatal trauma (defined as a very frightening or distressing event that may result in psychological harm). For those who reported a perinatal trauma and PTSD symptoms, symptoms were more severe in those who also reported ACEs. “Awareness of maternal exposure to childhood adversity/maltreatment is critical to providing trauma-informed approaches in the perinatal setting. Our study suggests that routine screening for ACEs in pregnancy adds clinical value.”
Allen MEC, Goslawski MM, Taple BJ, et al.
The association between adverse childhood experiences and perinatal depression symptom trajectories. Am J Obstet Gynecol MFM. 2023:101039. PMID: 37247667
Of 1270 pregnant persons referred to a mental healthcare program, and after controlling for risk factors, 10.3% of those with 4+ ACEs experienced a worse depression trajectory during pregnancy vs. 4.3% of those with a low ACE score. ACE score did not influence depression rates after delivery.
Porthan E, Lindberg M, Härkönen J, et al.
Childhood trauma and fear of childbirth: findings from a birth cohort study. Arch Womens Ment Health. 2023 Aug;26(4):523-529. PMID: 37243781
In a retrospective self-report study of 2556 Finnish pregnant women, childhood emotional abuse, emotional neglect, and a greater total burden of childhood trauma, but not childhood physical abuse, physical neglect or sexual abuse, increased the risk for fear of childbirth.
Adolescents
Chen JK, Lin L, Hong JS, Wang LC.
Temporal association of parental corporal punishment with violence in school and cyberbullying among adolescents. Child Abuse Negl. 2023;143:106251. PMID: 37267760
For 702 both male and female Taiwanese junior high school students, parental corporal punishment at Time 1 predicted violence against peers, teachers, and cyberbullying at Time 2 (T1 and T2 9 months apart). “Parental corporal punishment is a predictor rather than an outcome of adolescent school violence against teachers, peers and cyberbullying. Policies and interventions need to target parental corporal punishment to prevent student violence.”
Brieant A, Vannucci A, Nakua H, et al.
Characterizing the dimensional structure of early-life adversity in the Adolescent Brain Cognitive Development (ABCD) Study. Developmental cognitive neuroscience. 2023;61:101256. PMID: 37210754
Authors identify and correlate multiple environmental and experiential variables that reflect adverse experiences with internalizing problems (such as depression, anxiety), externalizing problems (such as anger, aggression), cognitive flexibility (brain's ability to adapt to new, changing, or unplanned events), and inhibitory control (the ability to suppress or countermand a thought, action, or feeling).
McKnight ER, Gardner SM, Cottrill AC, Levy CB, Bonny AE.
Trauma and Resilience in Adolescents and Young Adults With Opioid Use and Eating Disorders. Clin Pediatr (Phila). 2023:99228231181742. PMID: 37326039
Among 90 adolescents seeking outpatient treatment for either opioid use disorder (OUD) or feeding and eating disorder (FED), reported ACEs were high in both groups compared to a national average (80.0% of OUD and 34.0% of FED reported 4+ ACEs compared with 16% national average). The prevalence of emotional neglect, household mental illness, and peer victimization/isolation/rejection was similar between groups. Patients with OUD endorsed substantially fewer resilience factors compared with those with FEDs.
Domestic Violence – Effects on Children
Agarwal S, Prasad R, Mantri S, et al.
A Comprehensive Review of Intimate Partner Violence During Pregnancy and Its Adverse Effects on Maternal and Fetal Health. Cureus. 2023;15(5):e39262. PMID: 37342735
“The consequences of IPV during pregnancy can be severe, with adverse effects on maternal and fetal health including an increased risk of preterm birth, low birth weight (LBW), fetal injury, maternal depression, anxiety, post-traumatic stress disorder (PTSD), and even maternal death…The review discusses various interventions and strategies that can be used to prevent IPV during pregnancy, such as screening and counseling for IPV, training healthcare providers to identify and manage IPV during pregnancy, and providing resources and support for women who experience IPV.”
Guo C, Wan M, Wang Y, et al.
Associations between intimate partner violence and adverse birth outcomes during pregnancy: a systematic review and meta-analysis. Front Med (Lausanne). 2023;10:1140787. PMID: 37265489
This research review of IPV during pregnancy showed that IPV was associated with preterm birth (Odds Ratio 1.84), low birth weight (OR 2.73), and stillbirth (OR 1.74).
Tiyyagura G, Clayton N, Schaeffer P, et al.
Evaluation of Children After Caregiver Intimate Partner Violence: A Qualitative Study of Barriers, Facilitators, and Trauma- and Violence-Informed Care. J Pediatr. 2023:113519. PMID: 37244576
Interviews were held with ED clinicians, child abuse pediatricians, child protective services staff, and IPV survivors to identify barriers and facilitators of evaluating children exposed to caregiver intimate partner violence (IPV) and to develop a strategy to optimize the evaluation. “Routine evaluation of IPV-exposed children may lead to the detection of physical abuse and linkage to services for the child and the caregiver. Collaboration, improved data on the risk of child physical abuse in the context of IPV, and implementation of trauma-and-violence-informed care may improve outcomes for families experiencing IPV.”
Whitten T, Tzoumakis S, Green MJ, Dean K.
Global Prevalence of Childhood Exposure to Physical Violence within Domestic and Family Relationships in the General Population: A Systematic Review. Trauma Violence Abuse. 2023:15248380231179133. PMID: 37300288
“The global pooled prevalence of childhood exposure to physical domestic and family violence as a victim or witness was 17.3% and 16.5%, respectively. Prevalence estimates were highest in West Asia and Africa (victim = 42.8%; witness = 38.3%) and lowest for the Developed Asia Pacific region (victim = 3.7%; witness = 5.4%). Males were 25% more likely than females to be the victim of physical domestic and family violence during childhood, while both were equally likely to have witnessed it. These findings suggest that childhood exposure to domestic and family violence is relatively common, affecting around one-in-six people by 18 years of age globally.”
Johnson L.
Intimate Partner Violence, Child Custody, and Financial Issues Among Female Suicide Decedents With Known Intimate Partner Problems: National Violent Death Reporting System, 2018. Womens Health Issues. 2023 May 26:S1049-3867(23)00096-8. PMID: 37246042
Using national data on violent deaths from 2018, of women who were experiencing IPV and committed suicide, child custody issues but not financial stress was a contributing factor. “Suicide prevention and intervention efforts should recognize child custody issues as a risk factor, particularly when coupled with IPV.”
Orr C, Fisher C, Bell M, et al.
Exposure to family and domestic violence is associated with lower attendance and higher suspension in school children. Child Abuse Negl. 2023 Aug;142(Pt 1):105594. PMID: 35459527
Combining a study of Australian schoolchildren grades 1-10 with administrative data, “Exposure to FDV [family and domestic violence] is associated with an increased odds of poor school attendance and school suspension. Evidence-based and innovative strategies are needed to support children who are exposed to FDV. This involves responding in ways that does not cause further trauma to children; a restorative and trauma-informed approach is vital.”
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