[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
Arthur L, Schiro S, Tumin D, et al.
Shelter in Place and an Alarming Increase in Penetrating Trauma in Children and Concerning Decrease in Child Abuse. Am Surg. 2022:31348221148361. PMID: 36583224
Using North Carolina data on child trauma patients seen March – August 2020 and compared to years prior, during lockdown there was a significant decrease in children seen for trauma in general, child abuse trauma, and child abuse reports. However, there were significant increases in penetrating trauma due to stab or firearm [a sign of neglect?], injury severity, and death, with mortality 1.6% in 2018, 1% in 2019, and 8% in 2020.
Whaling KM, Der Sarkissian A, Larez N, et. al.
Child Maltreatment Prevention Service Cases are Significantly Reduced During the COVID-19 Pandemic: A Longitudinal Investigation Into Unintended Consequences of Quarantine. Child Maltreat. 2023;28(1):34-41. PMID: 34908497
“Unprecedented financial and emotional stress, paired with measures to slow the spread of COVID-19 (e.g., school closures), place youth at risk for experiencing increased rates of abuse.” Authors found a 49.17% decrease in opening new child maltreatment cases by CPS in New York City during quarantine, highlighting the severity of quarantine impacts. They make recommendations for local governments, community members, and practitioners on service accessibility.
Suresh S, Barata I, Feldstein D, et al.
Clinical Decision Support for Child Abuse: Recommendations from a Consensus Conference. J Pediatr. 2023;252:213-8.e5. PMID: 35817134
The use of child abuse clinical decision support (CA-CDS) has the potential to improve the identification, evaluation, and reporting of child abuse and thereby improve the safety of children. A gathering of experts describe consensus recommendations on developing, disseminating, and sustaining electronic health record (EHR)-based CA-CDS systems in the ED setting. There were 5 key recommendations: (1) broad implementation of a CA-CDS system in both general and pediatric ED settings for all children <4 years of age; (2) use of active alerts (ie, ones that requires the provider to take action for the clinical workflow to continue) to providers with links to evidence-based order sets embedded in the EHR; (3) standardized hand-offs between medical professionals and CPS (ie, mandated reports) incorporated into the CA-CDS system; (4) use of a data warehouse; and (5) integration of CA-CDS that is feasible, sustainable, and easily disseminated among institutions.”
Tiyyagura G, Asnes AG, Leventhal JM.
Improving Child Abuse Recognition and Management: Moving Forward with Clinical Decision Support. J Pediatr. 2023;252:11-3. PMID: 35987368
In this editorial regarding recently updated consensus guidelines for CA-CDS above, authors note gaps in knowledge, plus unintended consequences, such as overidentification of injuries not due to abuse leading to an increase in unnecessary reports to CPS. “Ongoing work to ensure appropriate reporting, especially in general EDs, may include recommendations to consult with a regional CA expert (leveraging telemedicine, if needed) to plan an appropriate evaluation and to decide whether to report to CPS.” Authors also note factors that need to be in place for successful implementation of CA-CDS.
Brink FW, Lo CB, Shi J, Stanley R, Lindberg DM.
Diagnosis codes dramatically underestimate the burden of abuse. Child Abuse Negl. 2022;135:105986. PMID: 36516562
“International Classification of Diseases (ICD) billing codes are not well-suited to estimate physical abuse prevalence among hospitalized patients and may be even less accurate in emergency departments (EDs). The Centers for Disease Control and Prevention (CDC) has recently published a child abuse and neglect syndromic surveillance definition to more accurately examine national abuse trends among ED visits.” Of 550 children <5 years seen in the ED and evaluated by the child protection team from 2016 to 2020 at a large Midwestern children's hospital, when applying the CDC syndromic definition, only 11.6 % were identified as abused in the ED. However 65.3 % were identified at hospital discharge. “In conclusion, these results suggest the CDC syndromic surveillance definition lacks sensitivity in identifying physically abused patients and does not out-perform methods using abuse-specific diagnostic codes alone. Our results support the need for future…coding that could more reliably estimate the burden of abuse.”
Peace AE, Caruso D, Agala CB, et al.
Cost of Pediatric Trauma: A Comparison of Non-Accidental and Accidental Trauma in Pediatric Patients. J Surg Res. 2022;283:806-16. PMID: 36470207
Using databases from 2006 – 2018, of 58,275 pediatric hospitalized trauma patients, 0.3% were coded as non-accidental trauma (NAT). “Children with NAT were younger, more female, less likely to identify as White, and more under public insurance than those with accidental trauma. Hospital charges were significantly higher in patients with NAT ($27,100 versus $19,900). Mortality (4.9% versus 0.0%) and length-of-stay (3.2 days versus 1.5 days) were significantly higher among patients with NAT.”
Putnam-Hornstein E, Foust R, Cuccaro-Alamin S, et al.
A Population-Based Study of Mental Health Diagnoses and Child Protection System Involvement Among Medicaid-Insured Children. J Pediatr. 2023;252:117-23. PMID: 36027974
“Overall, 14% (n = 470,513) of all children insured through Medicaid in 2014-2015 had a documented mental health diagnosis. Among children with a diagnosis, the percentage with CPS involvement was nearly twice that of the Medicaid population overall (50.4% vs 26.9%)…Most children reported for maltreatment will never be placed in foster care, underscoring the importance of ensuring that the children who remain at home receive the proper array and coordination of services.”
Reynoso M, McLeigh J, Malthaner LQ, Stone KE.
Description of Audiologic, Developmental, Ophthalmologic, and Neurologic Diagnoses at a Primary Care Clinic for Children in Foster Care. J Dev Behav Pediatr. 2022;43(9):511-20. PMID: 36040833
From a chart review of 4977 children seen at an academic-affiliated primary care clinic for children in foster care, overall, 3.5% of children had a hearing diagnosis, 42% had a developmental diagnosis, 9.0% had a vision diagnosis, and 4.5% had a neurologic diagnosis…A medical home may help children in foster care, who experience many barriers to comprehensive health care, to better identify and address these health conditions.”
Adult Manifestations of Child Abuse
Convertino AD, Morland LA, Blashill AJ.
Trauma exposure and eating disorders: Results from a United States nationally representative sample. Int J Eat Disord. 2022 Aug;55(8):1079-1089. PMID: 35719053
From a large national survey, “only events such as rape and sexual assault are associated with anorexia nervosa, but most trauma types are associated with binge eating disorder. Therefore, the relationship between trauma and binge eating disorder may function differently than other eating disorders.”
Horvath S, Cox S, Tabone J, et. al.
Binge eating in patients pursuing bariatric surgery: understanding relationships with food insecurity and adverse childhood experiences. Surg Obes Relat Dis. 2022 Nov 12:S1550-7289(22)00756-0. PMID: 36528545
In a survey of 366 adults seeking surgery for obesity, childhood experiences of abuse and/or neglect were associated with binge eating, and a history of food insecurity strengthened this relationship. Authors suggest that healthcare providers should include assessments of both ACEs and food insecurity to identify patients who may be at risk for disordered eating prior to or after surgery, as they may require additional support.
Lampe A, Nolte T, Schmid M, et. al.
Gender-Specific Significance of Peer Abuse during Childhood and Adolescence on Physical and Mental Health in Adulthood-Results from a Cross-Sectional Study in a Sample of Hospital Patients. Int J Environ Res Public Health. 2022;19(23). PMID: 36498082
From a survey of 2392 Austrian general hospital patients, “Women reported more emotional PA [peer abuse] (13.1% vs. 9.4%), while men reported more physical PA (8.3% vs. 5.2%). PA was associated with a higher likelihood for depression (OR = 2.6), somatization [vague body symptoms] (OR = 2.1), as well as worse physical health (OR = 2.1) in women but not in men.”
Guiney H, Caspi A, Ambler A, et al.
Childhood sexual abuse and pervasive problems across multiple life domains: Findings from a five-decade study. Dev Psychopathol. 2022:1-17. PMID: 36562290
“In 937 individuals followed from birth to age 45 years, we assessed associations between CSA [childhood sexual abuse] (retrospectively reported at age 26 years) and the experience of 22 adverse outcomes in seven domains…After adjusting for confounders, CSA survivors were more likely than their peers to experience internalizing, externalizing, and thought disorders, suicide attempts, health risk behaviors, systemic inflammation, poor oral health, sexually transmitted diseases, high-conflict relationships, benefit use, financial difficulties, antisocial behavior, and cumulative problems across multiple domains in adulthood. In sum, CSA was associated with multiple persistent problems across adulthood, even after adjusting for confounding life stressors, and the risk for particular problems incremented with CSA severity. The higher risk for most specific problems was small to moderate, but the cumulative long-term effects across multiple domains reflect considerable individual and societal burden.”
Easton SD, Kong J, McKetchnie SM.
Brief Report: Child Sexual Abuse and Somatic Symptoms in Older Adulthood for Men. J Child Sex Abus. 2022;31(8):987-97. PMID: 36398798
“Somatic symptom disorders are often misdiagnosed or minimized among men, especially in middle and older adulthood.” From a Wisconsin study of middle- and late-adulthood men with a history of childhood sexual abuse (CSA) and a matched control group, and controlling for multiple variables, both groups had the same incidence of somatic symptoms, but symptoms in the maltreated group were more severe. “Healthcare providers should include CSA in assessments for men. Because contemporary somatic symptoms may represent unresolved early life course trauma, mental health support services should be expanded for this population.”
O'Leary C, Edwards V, Hardcastle KA, et. al.
Adverse Childhood Experiences (ACEs) in Adults with Cystic Fibrosis. Psychol Res Behav Manag. 2022 Jun 28;15:1601-1605. PMID: 35789731
Of 80 patients seen at a Welsh adult cystic fibrosis clinic, “In this sample, 78% reported at least one type of childhood adversity and 14% experienced four or more ACEs. Parental divorce or separation and verbal abuse were the most frequently reported ACEs. Illness-related trauma in childhood was also prevalent with 64% reporting having experienced a painful or frightening medical procedure and 28% feeling forced to have a treatment or a procedure.”
Carney JR, Miller-Graff LE, Napier TR, Howell KH.
Elucidating the relations between ACEs, age of exposure to adversity, and adult PTSS severity in pregnant women. Child Abuse Negl. 2022;136:105995. PMID: 36566706
In 137 pregnant women exposed to recent IPV, “Results suggest that for pregnant women exposed to high levels of trauma, polyvictimization and particularly experiencing multiple types of childhood maltreatment have stronger predictive validity for PTSS than household dysfunction. Cumulative victimization may be more influential than age of exposure to adversity.”
Gnanamanickam ES, Brown DS, Armfield JM, Segal L.
Excess hospital costs incurred by individuals with child abuse and neglect history in South Australia: A birth-cohort study. Prev Med. 2022:107378. PMID: 36493867
“We aimed to estimate the additional public hospital costs for emergency department visits and admitted patient hospitalizations, for persons with reported child protection concerns, from birth to 31 years and modelled to age 65, using linked hospital data from 2003 to 2017 for a population birth-cohort of all individuals born in South Australia from 1986 to 2017…excess costs were estimated at AU$415 million, a 27% cost impost. There is a considerable hospital cost penalty associated with persons with reported child protection concerns, especially from adolescence into adulthood, highlighting an opportunity for cost savings by preventive investment in effective early-in-life interventions.”
Garbutt K, Rennoldson M, Gregson M.
Shame and Self-Compassion Connect Childhood Experience of Adversity With Harm Inflicted on the Self and Others. J Interpers Violence. 2022:8862605221141866. PMID: 36541192
Using the model of the four dimensions of shame via a survey of 1111 community and incarcerated adults, authors describe the varying roles that ACEs, shame, and self-compassion had in affecting the relationship between ACEs and harm to self and others.
Katz P, Patterson SL, DeQuattro K, et al.
The association of trauma with self-reported flares and disease activity in systemic lupus erythematosus (SLE). Rheumatology (Oxford). 2022 Dec 8:keac690. PMID: 36477308
For 252 adult patients with Systemic Lupus, 63.4% reported ≥1 trauma exposure. Any traumatic event, excluding illness, doubled the odds of a flare (OR 2.27) and was associated with significantly higher symptoms scores. Adjusted odds of any flare and flare requiring medical care were significantly elevated for those with both trauma (OR 5.91) and ACE exposures (OR 4.69) or both exposures. “Identifying mechanisms of associations between trauma and disease activity and flares, as well as interventions to mitigate the effects of trauma exposures is critical, given the high rates of trauma exposures.”
Ford K, Hughes K, Cresswell K, Griffith N, Bellis MA.
Associations between Adverse Childhood Experiences (ACEs) and Lifetime Experience of Car Crashes and Burns: A Cross-Sectional Study. Int J Environ Res Public Health. 2022;19(23). PMID: 36498109
“Using a cross-sectional sample of the adult general public (n = 4783) in Wales (national) and England (Bolton Local Authority), we identify relationships between ACE exposure and experience of car crashes and burns requiring medical attention across the life course. Individuals who had experienced 4+ ACEs were at significantly increased odds of having ever had each outcome measured. Furthermore, compared to those with no ACEs, those with 4+ were around two times more likely to report having had multiple (i.e., 2+) car crashes and over four times more likely to report having had burns multiple times.”
Adolescents
Yip T, Feng Y, Lorenzo K, El-Sheikh M.
Ethnic/racial discrimination and academic grades among adolescents: moderation by sleep regularity. J Sleep Res. 2022:e13798. PMID: 36578265
For 265 9th grade students, those with poor sleep regularity showed a significant association between discrimination and grades, while there was no such association in those with moderate to high sleep regularity. “This study underscores the importance of sleep regularity for adolescents' academic achievement.”
Krause KH, DeGue S, Kilmer G, Niolon PH.
Prevalence and Correlates of Non-Dating Sexual Violence, Sexual Dating Violence, and Physical Dating Violence Victimization among U.S. High School Students during the COVID-19 Pandemic: Adolescent Behaviors and Experiences Survey, United States, 2021. J Interpers Violence. 2022:8862605221140038. PMID: 36519711
In a 2021 national survey of 7701 US high school students, “Among female students, 8.0% experienced non-dating sexual violence; 12.5% sexual dating violence; and 7.7% physical dating violence. Among male students, 2.2% experienced non-dating sexual violence; 2.4% sexual dating violence; and 4.9% physical dating violence…abuse by a parent, hunger, and homelessness created vulnerability that may have increased the likelihood that adolescents would be exposed to risky peer or dating relationships.”
Tabb LP, Rich JA, Waite D, et. al.
Examining Associations between Adverse Childhood Experiences and Posttraumatic Stress Disorder Symptoms among Young Survivors of Urban Violence. J Urban Health. 2022 Aug;99(4):669-679. PMID: 35699886
Of 147 survivors aged 18-33 of intentional injury (stab wound, gunshot wound, or blunt force trauma, not IPV or sexual assault) seen at level ! trauma centers in Philadelphia 2014-2019, 90% reported at least one ACE. Higher levels of ACEs were associated with increased risk for PTSD as well as higher levels of PTSD symptoms, with emotional neglect being the strongest ACE indicator. “This study confirms that young survivors of violence are at high risk of both childhood adversity and PTSD. It is essential to provide resources to survivors of urban violence…Hospital-based violence intervention programs have been shown to decrease symptoms of trauma.”
McGill L, McElvaney R.
Adult and Adolescent Disclosures of Child Sexual Abuse: A Comparative Analysis. J Interpers Violence. 2023;38(1-2):Np1163-np86. PMID: 35481775
Authors interviewed 20 adolescents and 10 adults about their experiences of disclosure of childhood sexual abuse. “Themes that were found to be common to both samples included pressure cooker effect, telling would make it worse, and self-blame. Themes that were found to be more prevalent in the adolescent sample included police/court involvement, concern for other children, being asked, and peer influence. It is suggested that such potential differences reflect the changing social context over the past few decades which is characterised by increased awareness of sexual abuse as a crime and risks of offender recidivism.”
Kovács-Tóth B, Oláh B, Kuritárné Szabó I, Túry F.
Adverse childhood experiences increase the risk for eating disorders among adolescents. Frontiers in psychology. 2022;13:1063693. PMID: 36578685
Of 432 Hungarian adolescents aged 12-17 years, “Adolescents who had undergone four or more ACEs were 5.7 times more likely to be in the high eating disorder risk group than those who did not report any ACEs. Cumulative maltreatment showed a greater association with overall risk for eating disorders than cumulative family dysfunction. There is an increased risk of eating disorders from emotional maltreatment (odds ratio = 3.475), physical maltreatment (OR = 3.440), sexual maltreatment (OR = 10.973), and emotional neglect (OR = 3.331). Dysfunctional family circumstances revealed an association with household mental illness (OR = 3.401).”
Jenkins JH, Sanchez G, Miller EA, et al.
Depression and anxiety among multiethnic middle school students: Age, gender, and sociocultural environment. Int J Soc Psychiatry. 2022:207640221140282. PMID: 36529994
From interviews with 75 ethnically diverse US middle school students, mean age 11.2 years, “Ethnographic interviews revealed contexts associated with girls' experiences of depression and anxiety, including gender-based violence in both school and home environments. Salient for girls and boys alike were worries about consequences of COVID-19 for family with respect to illness, death, job loss, and economic hardship. Fears over student perceptions of intensified discrimination and racism in school and community were prominent. These problems were experienced by students as barriers to educational engagement.”
Holcombe EA, Jones MS, Lehmann PS, Meldrum RC.
Differential Exposure to Adverse Childhood Experiences Among Florida High School Students: The Intersection of Race, Ethnicity, and Gender. J Adolesc Health. 2022 Dec 15:S1054-139X(22)00773-X. PMID: 36528515
From a survey of over 20,000 Florida high school students, “our analysis suggests that many racial and ethnic minority groups as well as females experience multiple ACEs, and that it is imperative that scholars consider the intersectionality of gender and race/ethnicity in ACE exposure among adolescents.” Native American female adolescents represented the group at greatest risk of high exposure to ACEs, with more than 50% reporting 4+ ACEs.
Domestic Violence – Effects on Children
Butala N, Asnes A, Gaither J, et. al.
Child safety assessments during a caregiver's evaluation in emergency departments after intimate partner violence. Acad Emerg Med. 2023 Jan;30(1):23-31. PMID: 36300559
From a chart review of adult patients presenting to 3 Connecticut Eds in 2019 for IPV, child safety assessments were completed in 78.2% of encounters, moreso if SW was involved. Of the 107 children for whom the nature of exposure was known, 9.3% were physically involved and 24.2% were direct witnesses to the violence. CPS reports were made in 52.4% of the encounters in which children lived in the home.
Xyrakis N, Aquilina B, McNiece E, et al.
Interparental Coercive Control and Child and Family Outcomes: A Systematic Review. Trauma Violence Abuse. 2022:15248380221139243. PMID: 36573654
“Coercive control (CC) is a core facet of intimate partner violence (IPV) and involves asserting power, dominance, and control over another person.” From a research review, “CC was associated with increased parental psychopathology, poorer family functioning, harsher parenting and higher levels of child abuse, strained parent-child relationships, children used as tools and co-victims of CC, increased risk of child internalizing and externalizing problems, limited socializing opportunities, increased bullying, poorer perinatal outcomes, limited access to healthcare, and increased risk of child mortality. Evidence identified CC as a unique contributor to adverse child wellbeing outcomes, independent of exposure to IPV more broadly.”
Skafida V, Devaney J.
Risk and protective factors for children's psychopathology in the context of domestic violence - A study using nationally representative longitudinal survey data. Child Abuse Negl. 2022;135:105991. PMID: 36527984
From a long term national Scottish study of 2554 children, domestic violence exposure predicted higher internalising and externalising behaviours and lower prosocial skills. However, children with a strong mother-child bond had lower odds of internalising and externalising symptoms, and were over 4 times more likely to manifest prosocial skills. “Our findings suggest mothers need support to in turn support children in the context of domestic violence.”
Slep AMS, Rhoades KA, Lorber MF, Heyman RE.
Glimpsing the Iceberg: Parent-Child Physical Aggression and Abuse. Child Maltreat. 2022:10775595221112921. PMID: 36469944
“An anonymous, computer-based assessment was administered to nearly 40,000 parents of more than 60,000 children in the United States Air Force, which included a detailed assessment on up to four minor children of aggression and its impact. The survey was the largest of its type ever conducted in the United States…Approximately 39% of children experienced corporal punishment, peaking at three years of age, and 7% experienced physical abuse, peaking at age six. About 45% of parents reported perpetrating corporal punishment and 8% abuse; these rates were higher in multi-child families and most often involved more than one child. Parent gender was not associated with physical aggression or abuse.”
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