[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]
Race/Cultural Concerns
Stewart TJ, Gonzalez VM.
Associations of historical trauma and racism with health care system distrust and mental health help-seeking propensity among American Indian and Alaska Native college students. Cultur Divers Ethnic Minor Psychol. 2023 Jul;29(3):348-357. PMID: 37067492
For 392 American Indian and Alaska Native college students, greater reported historical trauma as well as greater perceived racial discrimination were associated with greater distrust of the health care system, which in turn was associated with less favorable attitudes toward seeking mental health services.
Haw J, Walrond J, Jayachandran J, et al.
Sickle cell disease and the need for blood: Barriers to donation for African, Caribbean, and Black young adults in Canada. Transfusion. 2023 Jul;63(7):1324-1332. PMID: 37194707
“Many blood operators around the world face the challenge of increasing the number of donors of African ancestry to meet the transfusion needs of people living with sickle cell disease. This article reports results of the barriers to blood donation for young adults (aged 19-35) in Canada who identify as African, Caribbean, or Black…These included macro-level barriers (e.g., systemic racism, mistrust of the healthcare system, sociocultural beliefs and views about blood and sickle cell disease), mezzo-level barriers (e.g., deferral criteria, minimum hemoglobin levels, donor questionnaire, access, parental concerns), and microlevel barriers (e.g., limited knowledge of blood needs for people with sickle cell disease, lacking information about blood donation process, fear of needles, personal health concerns).”
Diyaolu M, Ye C, Huang Z, et al.
Disparities in detection of suspected child abuse. J Pediatr Surg. 2023 Feb;58(2):337-343. PMID: 36404182
From a national trauma databank, suspected child abuse victims (SCA) accounted for 1% of child patients. Of these, 51% were White, 33% Black, 1% Asian, 0.3% Native Hawaiian/Other Pacific Islander, 2% American Indian, and 12% other race. Black patients were disproportionately overrepresented, composing 12% of the US population, but 33% of SCA patients. Although White SCA patients were more severely injured and had higher in-hospital mortality (9% vs. 6%), Black SCA patients were hospitalized longer (7.2 vs. 6.2 days) despite controlling for severity. “Black children were disproportionately identified as potential victims of abuse…also subjected to longer hospitalizations, despite milder injuries. Further studies are needed to better understand the etiology of the observed trends.”
Perpetrators
Kloess JA, van der Bruggen M. Trust and Relationship Development Among Users in Dark Web Child Sexual Exploitation and Abuse Networks. Trauma Violence Abuse. 2023;24(3):1220-37. PMID: 34875932
“The increased potential and speed of the Internet has changed the nature of sexual crimes against children. It enables individuals with a sexual interest in children to meet, interact, and engage in illegal activities. The literature review presented here aims to provide an overview of the current knowledge and understanding of trust and relationship development among users of online networks that are dedicated to the sexual exploitation and abuse of children…Our findings reveal that the engagement in interpersonal communication and interactions with like-minded others serves various functions, including validation, normalization, and support, as well as access to expert advice, information, and material.”
Police and Court Systems
McLachlan KJ.
Trauma-Informed Sentencing: How South Australian Sentencing Judges Use Information About defendants' Child Sexual Abuse Victimization and Subsequent Trauma. J Child Sex Abus. 2023:1-22. PMID: 37249567
“This article explores how South Australian judges use information about childhood sexual abuse (CSA) victimization history and its potentially traumatic impact, when sentencing adult defendants…the paper discusses potential initiatives to better achieve community safety when sentencing people with past trauma from CSA.”
Finkelhor D, Turner H, Colburn D, Mitchell K, Mathews B.
Child sexual abuse images and youth produced images: The varieties of Image-based Sexual Exploitation and Abuse of Children. Child Abuse Negl. 2023;143:106269. PMID: 37336088
From a national online survey of young adults over aged 18 about child sexual abuse images, “The analysis classified the cases into five incident types: 1) adult made images (child sexual abuse images), 2) images non-consensually made by other youth, 3) voluntarily provided self-made images that were non-consensually shared by other youth, 4) voluntarily provided self-made images non-consensually shared by adults, and 5) voluntarily provided self-made images to adults that entailed an illegal age difference or were part of a commercial transaction…Only 12 % of the image episodes qualified as adult produced, child sexual abuse images…Only 10 % of the episodes involved images of children under age 13. The study highlights the predominance of youth made sexual images among the image exploitation and…the difference between what victim surveys reveal about the problem and what is inferred from police record studies.”
Lyon TD.
Child Maltreatment, the Law, and Two Types of Error. Child Maltreat. 2023;28(3):403-6. PMID: 37196319
“In what follows, I will focus on the difficulties in assessing evidence of abuse, and in particular the difficulties in assessing children’s behavior that might indicate that abuse occurred. This behavior includes what is probably the most important evidence in sexual abuse cases: the child’s statements describing abuse…Even the strongest proponents of heightened standards of proof in criminal cases acknowledge false acquittals are a concern…Moreover, child abuse allegations are made in many different forums, most of which have adopted more lenient standards of proof in order to ensure that true victims are not overlooked. The only value-free approach is to search for solutions that minimize both false positives and false negatives.”
Quas JA, Mukhopadhyay S, Winks KMH, et al.
Successful Criminal Prosecutions of Sex Trafficking and Sexual Abuse of Minors: A Comparative Analysis. Child Maltreat. 2023;28(3):500-16. PMID: 37232445
“We compared appellate opinions in two types of successfully prosecuted criminal cases: sex trafficking and sexual abuse of adolescent victims. In the trafficking opinions, victims were rarely described as disclosing on their own or as knowing their trafficker before the victimization. The opinions also often alluded to the trafficking victims' uncooperativeness and delinquency history, and frequently mentioned electronic evidence and prosecution experts. The sexual abuse opinions, in contrast, tended to suggest that victims' own disclosures initiated the case, perpetrators were known and trusted adults, and caregiver support during the case was common.”
Providers
Kass M, Alexander L, Moskowitz K, et al.
Parental Preferences for Mental Health Screening of Youths From a Multinational Survey. JAMA network open. 2023;6(6):e2318892. PMID: 37338905|
In this survey of English-speaking parents and caregivers from US, UK, Canada, and 16 other countries, parent-reported and child self-reported mental health screening in primary care settings was supported by the majority of the sample, although comfort levels differed according to various factors (greatest comfort was with sleep problems, the least comfort was with firearms, gender identity, suicidality, and substance use or abuse). 89.7% of participants preferred to discuss screening results with professional health care staff. “In addition to parental need for expert guidance, the study findings highlight the growing awareness of child mental health needs and the importance of addressing mental health concerns early via regular mental health screenings.”
Thackeray J, Livingston N, Ragavan MI, et al.
Intimate Partner Violence: Role of the Pediatrician. Pediatrics. 2023 Jul 1;152(1):e2023062509. PMID: 37337842
“The American Academy of Pediatrics and its members recognize the importance of improving the physician's ability to recognize intimate partner violence (IPV) and understand its effects on child health and development and its role in the continuum of family violence. Pediatricians are in a unique position to identify IPV survivors in pediatric settings, to evaluate and treat children exposed to IPV, and to connect families with available local and national resources. Children exposed to IPV are at increased risk of being abused and neglected and are more likely to develop adverse health, behavioral, psychological, and social disorders later in life. Pediatricians should be aware of these profound effects of exposure to IPV on children and how best to support and advocate for IPV survivors and their children.”
Norman C, Jacob H.
Guideline review: Child Protection service delivery standards. Arch Dis Child Educ Pract Ed. 2023 Jun 13:edpract-2022-324130. PMID: 37311619
This article reviews a guideline developed in 2020 by the Royal College of Paediatrics & Child Health (RCPCH) and its Child Protection Special Interest Group, intended to enable a unified, appropriate service across the UK to protect children. The guideline provides a list of 13 standards that services are expected to meet. Each standard comes with a list of recommended metrics to assist auditing against the guideline.
DiGiovanni SS, Hoffmann Frances RJ, Brown RS, et al.
Pediatric Trauma and Posttraumatic Symptom Screening at Well-child Visits. Pediatric quality & safety. 2023;8(3):e640. PMID: 37250613
This article describes an interdisciplinary behavioral and medical health team implementation of screening children for trauma at well-child visits, screening for PTSD in those with positive trauma screens, and increasing referrals to behavioral health. “It is feasible to screen and respond to trauma during well-child visits. Screening method and training implementation changes can improve screening and response to pediatric trauma and PTSD.”
Lechner M, Hagedorn S.
Increasing Access to Medical Forensic Care for the Pediatric Patient. J Forensic Nurs. 2023 Apr-Jun 01;19(2):75-80. PMID: 37205613
“About one in every four girls and one in every 13 boys in the United States experience sexual abuse. In order to best serve these patients and families, the forensic nurse examiner team from a large urban Level 1 trauma center partnered with the local child advocacy center to provide ready access to educated, competent pediatric examiners who provide developmentally appropriate medical forensic care in a child-friendly environment…as part of a coordinated, co-located, highly functional multidisciplinary team. These services are provided free of charge and regardless of timeline from abuse. This partnership removes several key barriers to this care.”
Joh-Carnella N, Livingston E, Kagan-Cassidy M, et al.
Understanding the roles of the healthcare and child welfare systems in promoting the safety and well-being of children. Frontiers in psychiatry. 2023;14:1195440. PMID: 37324821
Canadian healthcare providers and child welfare workers were interviewed about their efforts to protect children. “Healthcare providers spoke about positive experiences making reports, factors impacting reporting decisions, areas for improvement (e.g., difficulties communicating, lack of collaboration, and disruption of therapeutic alliance), training, and professional roles. For interviews with child welfare workers, identified themes included healthcare professionals' perceived expertise and understanding the role of child welfare…Our core finding was a reported lack of communication between the groups of professionals. Other identified barriers in collaboration included a lack of understanding of each other's roles, hesitation for healthcare providers making reports, as well as legacies of harm and systemic inequities in both institutions. Future research should build on this examination…to identify sustainable solutions for increased collaboration.”
Prevention
Panlilio CC, Dube SR, Corr C.
A framework for promoting learning and development in the context of adversity: An introduction to the special issue.
Child Abuse Negl. 2023:106176. PMID: 37059648
See Table of Contents for this special issue relating to childhood adversity and school learning.
Lurie LA, Hangen EJ, Rosen ML, Crosnoe R, McLaughlin KA.
Reduced growth mindset as a mechanism linking childhood trauma with academic performance and internalizing psychopathology. Child Abuse Negl. 2023 Aug;142(Pt 1):105672. PMID: 35610110
For 408 youth aged 10-18, experiences of threat were associated with lower growth mindset which in turn was associated with worse academic performance and greater symptoms of both anxiety and depression…growth mindset could be a promising target for efforts aimed at mitigating the impact of childhood adversity on academic achievement and psychopathology, given the efficacy of existing brief, scalable growth mindset interventions.
Lee K.
Effects of formal center-based care and positive parenting practices on children in foster care. Child Abuse Negl. 2023 Aug;142(Pt 1):105946. PMID: 36435641
Children in foster care who enrolled in formal center-based childcare at pre-school age have higher cognitive and socio-emotional scores at kindergarten age. Positive parenting practice also promotes children's outcomes. Children in foster care who are both enrolled in formal center-based care and experience positive parenting practice had the most positive outcomes.
Judd N, Hughes K, Bellis MA, Hardcastle K, Amos R.
Is parental unemployment associated with increased risk of adverse childhood experiences? A systematic review and meta-analysis. J Public Health (Oxf). 2023 May 30:fdad069. PMID: 37253685
From a research review, “Paternal/any parental unemployment was associated with a 29% increased risk of sexual abuse, 54% increased risk of neglect, 60% increased risk of physical abuse and around 90% increased risk of child maltreatment and parental mental illness. No associations were found between maternal unemployment and ACEs…Children who grow up with parental unemployment can be at increased risk of ACEs. A combination of socioeconomic measures to increase employment opportunities and parental support targeting fathers and mothers may help break multigenerational cycles of abuse and deprivation.”
Hostutler CA, Snider T, Wolf N, Grant R.
ACEs screening in adolescent primary care: Psychological flexibility as a moderator. Fam Syst Health. 2023 Jun;41(2):182-191. PMID: 35679216
For 402 adolescents, those with high psychological flexibility reported fewer depressive symptoms when they experienced more ACEs. Psychological flexibility is the capacity to adapt to difficult experiences while remaining true to one's values rather than responding to immediate short-term emotions, and to be able to look at things from different perspectives. “Psychological flexibility is a modifiable process and may represent an important population health variable to develop prior to exposure or reduce negative outcomes following ACEs.”
Scott J, Silva S, Gonzalez-Guarda RM, et al.
Adverse Childhood Experiences and Cardiovascular Health: An Exploration of Protective Social Determinants Among Young Adult Black Women. ANS Adv Nurs Sci. 2022 Dec 7:10.1097/ ANS.0000000000000468. PMID: 36729910
“Neither maternal relationship nor religion/spirituality was able to buffer the stress of ACEs on ideal cardiovascular health [CVH] for young adult Black women. Findings are discussed in terms of cultural aspects of potential protective factors that are critical for future research. Identifying protective factors that may buffer the influence of ACEs on CVH remains a priority to promote health equity.”
Brier ZMF, Burt KB, Legrand AC, Price M.
An examination of the heterogeneity of the relationships between posttraumatic stress disorder, self-compassion and gratitude. Clin Psychol Psychother. 2023;30(3):566-74. PMID: 36508309
From an online survey of 1424 trauma-exposed individuals, mean age 31.5 years and 55.3% female, factors of self-compassion and gratitude were important protective factors for PTSD symptoms in all PTSD symptom clusters, but especially alterations in cognition and mood.
Giovanelli A, Mondi CF, Reynolds AJ, Ou SR.
Evaluation of Midlife Educational Attainment Among Attendees of a Comprehensive Early Childhood Education Program in the Context of Early Adverse Childhood Experiences. JAMA network open. 2023;6(6):e2319372. PMID: 37347483
For 989 Chicago children entering the Child-Parent Center preschool Early Childhood Education (ECE) program in the 1980s, compared to a group using usual early childhood services, those who attended the intervention program were significantly more likely than the control group to attain a bachelor’s degree or higher and an associate’s degree or higher, with rates similar to students without ACEs. “These results build on research suggesting that youths at higher risk can benefit most from intervention, and support ECE as a tool for reducing ACE-related disparities.”
Huang CX, Halfon N, Sastry N, Chung PJ, Schickedanz A.
Positive Childhood Experiences and Adult Health Outcomes. Pediatrics. 2023 Jul 1;152(1):e2022060951. PMID: 37337829
From a large national study over time, “Positive childhood experiences [PCEs] were independently associated with lower risks of fair or poor adult health, adult mental health problems, and developing any physical or mental health condition at any given age after adjusting for ACEs.” PCEs for this study included “(1) comfort confiding in at least 1 parent about things that were bothering them, (2) perception that at least 1 parent understood their problems, (3) rating of their relationship with their parents, (4) happiness at school, (5) comfort with friends, and (6) perception of their neighbors’ helpfulness.”
Researchers
Campbell R, Goodman-Williams R, Engleton J, et al.
Open science and data sharing in trauma research: Developing a trauma-informed protocol for archiving sensitive qualitative data. Psychol Trauma. 2023;15(5):819-28. PMID: 36074633
“The open science movement seeks to make research more transparent, and to that end, researchers are increasingly expected or required to archive their data in national repositories. In qualitative trauma research, data sharing could compromise participants' safety, privacy, and confidentiality because narrative data can be more difficult to de-identify fully. There is little guidance in the traumatology literature regarding how to discuss data-sharing requirements with participants during the informed consent process.” From interviews with 32 research participants, “No potential participants declined participation after learning about the archiving mandate. Survivors indicated that they wanted input on archiving because the interview is their story of trauma and abuse and…to help guard their privacy, confidentiality, and safety. None of the participants elected to redact substantive data prior to archiving.”
Massullo C, De Rossi E, Carbone GA, et al.
Child Maltreatment, Abuse, and Neglect: An Umbrella Review of Their Prevalence and Definitions. Clin Neuropsychiatry. 2023;20(2):72-99. PMID: 37250758
“The data from this umbrella review show that the different age groups, methods, and instruments used in the literature to collect the data on the epidemiology of CM [child maltreatment] make it difficult to compare the results. Although definitions appear to be quite homogeneous, CM categorization varies widely across studies.”
Peckham H.
Introducing the Neuroplastic Narrative: a non-pathologizing biological foundation for trauma-informed and adverse childhood experience aware approaches. Frontiers in psychiatry. 2023;14:1103718. PMID: 37283710
“Neuroplasticity refers to the capacity of neural systems to adapt and change…This learning and adaption in turn allows us to better anticipate and physiologically prepare for future experiences that (nature assumes) are likely to occur, based on past experiences. However, neuroplastic mechanisms cannot discriminate between experiences; they function to embed experience regardless of the quality of that experience, generating vicious or virtuous cycles of psychobiological anticipation, to help us survive or thrive in futures that resemble our privileged or traumatic pasts. The etiology of suffering that arises from this process is not a pathology (a healthy brain is a brain that can adapt to experience) but is the evolutionary cost of surviving traumatizing environments. Misidentifying this suffering as a pathology and responding with diagnosis and medication is not trauma-informed and may cause iatrogenic harm, in part through perpetuating stigma and exacerbating the shame which attends complex trauma and ACEs. As an alternative, this study introduces the Neuroplastic Narrative…The Neuroplastic Narrative complements both Life History and Attachment Theory and provides a non-pathologizing, biological foundation for trauma-informed and Adverse Childhood Experience aware approaches.”
Mashford-Pringle A, Hiscock C, Rice EJ, Scott B.
Weaving First Nations, Inuit, and Métis principles and values into health research processes. J Clin Epidemiol. 2023 May 20;160:54-60. PMID: 37217105
From discussions with indigenous leaders on nine key health-related topics to develop an anti-Indigenous racism strategy for health systems in Toronto, Ontario, Canada, “The Weaved Indigenous Framework for Research was created for researchers to use as a guiding document as they embark upon health research with Indigenous communities. Inclusive, culturally responsive research frameworks are needed within Indigenous health research to ensure each culture can be respected and honored.”
Williams BC, Hayer R, Henderson DD, et al. A 7-Domain Framework That Can Bridge Clinical Care, Health Systems Science, and Health Equity: Lessons From the H&P 360. Acad Med. 2023;98(6):664-71. PMID: 36652503
“The H&P 360 is a reconceptualized history and physical (H&P), which clinical medical students have reported reveals clinically relevant information not elicited by the traditional H&P, informs care planning, promotes interprofessional team care, and enhances patient rapport. In addition to the traditional checklist focused on patients' medical conditions, the H&P 360 includes prompts for gathering limited but critical information in 6 other domains directly relevant to patients' overall health-patient values, goals, and priorities; mental health; behavioral health; social support; living environment and resources; and function…The authors invite discussion and experimentation around the use of the 7-domain framework in teaching, assessment, and curriculum development and point to resources for clinical educators for teaching and measuring the effects of the H&P 360 on learners, preceptors, and patients.”
Zhen-Duan J, Colombo D, Alvarez K.
Inclusion of Expanded Adverse Childhood Experiences in Research About Racial/Ethnic Substance Use Disparities. Am J Public Health. 2023;113(S2):S129-s32. PMID: 37339415
“The expansion of the ACE framework to include expanded ACEs is a way to address a critical gap in the original ACE study—namely, a focus on how social and structural inequalities further shape adversity…These expanded ACEs include experiencing poverty, discrimination, bullying, community violence, migration-related stressors, and foster care involvement. Expanded ACEs are mainly community-level stressors and differ from traditional ACEs, which focus on family-level adversity.” Authors urge the field to shift to using expanded ACEs, especially for research on substance use.
Other of Interest
Test Rogers EM, Banks NF, Jenkins NDM.
The effects of sleep disruption on metabolism, hunger, and satiety, and the influence of psychosocial stress and exercise: A narrative review. Diabetes Metab Res Rev. 2023:e3667. PMID: 37269143
“The consequences of sleep disruption manifest in a myriad of ways, including insulin resistance and disrupted nutrient metabolism, dysregulation of hunger and satiety, and potentially increased body weight and adiposity. Consequently, inadequate sleep is related to an increased risk of various cardiometabolic diseases, including obesity, diabetes, and heart disease. Exercise has the potential to be an effective therapeutic to counteract the deleterious effects of sleep disruption listed above, whereas chronic psychosocial stress may causally promote sleep disruption and cardiometabolic risk.”
Morstead T, DeLongis A.
Searching for secrets, searching for self: Childhood adversity, self-concept clarity, and the motivation to uncover family secrets through direct-to-consumer genetic testing. J Genet Couns. 2023 Jun;32(3):698-705. PMID: 36734314
In a study to determine motivation of 433 individuals pursing direct-to-consumer (DTC) genetic testing, “exposure to adverse childhood experiences was associated with the motivation to pursue DTC genetic testing for the purpose of uncovering family secrets…Findings from this line of research could help to identify for whom and under what conditions DTC genetic testing benefits well-being, and which could have adverse psychosocial effects. These insights will be of interest to genetic counselors working in the field of DTC genetic testing, and those working with individuals and families affected by unexpected test results.”
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