[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
Gilchrist SA, Stanfield J, Tan MAM, et al.
Changes in Pediatric Non-accidental Trauma Emergency Department Visits During and Following the COVID-19 Lockdown. Am Surg. 2023 May 8:31348231173951. PMID: 37155157
Using data from a level 1 pediatric trauma registry, while there was a decline in pediatric non-accidental trauma (NAT) in 2020, compared with 2019 and 2021, the injury severity score also increased in 2020 compared to 2019 and 2021. “The pediatric population is at risk of more severe abuse during times of familial stress. We need increased awareness that periods of vulnerability to NAT exist.”
Côté-Corriveau G, Luu TM, Lewin A, et al.
Hospitalization for child maltreatment and other types of injury during the COVID-19 pandemic. Child Abuse Negl. 2023;140:106186. PMID: 37060690
From a review of injuries to children aged 0-4 years in Quebec area hospitals before and during the pandemic, while maltreatment and even unintentional injuries decreased during lockdown, there was a significant increase in injuries from falls involving another person and mechanical force injuries involving another person. “Hospitalizations for child maltreatment may have been misclassified as unintentional injuries involving another person during the pandemic. Children admitted for these types of unintentional injuries may benefit from closer assessment to rule out maltreatment.”
Raffa BJ, Schilling S, Henry MK, et al.
Ingestion of Illicit Substances by Young Children Before and During the COVID-19 Pandemic. JAMA network open. 2023;6(4):e239549. PMID: 37083660
Using data from 46 tertiary care children’s hospitals, among 7659 children presenting with ingestions 2017-2021, mean age 2.2 years, there was a 25.6% immediate increase in overall ingestions at the onset of the pandemic compared with the prepandemic period, which was attributed to cannabis, opioid, and ethanol ingestions. There was a 1.8% sustained monthly relative increase compared with prepandemic trends in overall ingestions due to opioids. There was no association between medicinal or recreational cannabis legalization and the rate of cannabis ingestion encounters. “Additional studies are needed…to identify interventions to prevent ingestions in face of such stress, such as improved parental mental health and substance treatment services, accessible childcare, and increased substance storage education.”
Hect JL, Almast A, Simon D, Shoemaker S, McDowell MM.
Prevalence, severity, and neurosurgical management of abusive head trauma during the COVID-19 pandemic. J Neurosurg Pediatr. 2023:1-7. PMID: 37021756
Of 2181 children seen 2018-2021 with traumatic head injuries at Children’s Hospital Pittsburgh, the prevalence of abusive head trauma or the need for neurosurgery did not change during the pandemic, and there was no difference in terms of sex, age, or race. However, the mortality for abusive head trauma was 4.8 times higher during lockdown, returning to baseline afterwards. Primary contributor to mortality was ischemic brain injury (brain injury due to lack of oxygen, reflecting a more serious injury).
Biswas A, Krishnan P, Albalkhi I, Mankad K, Shroff M.
Imaging of Abusive Head Trauma in Children. Neuroimaging Clin N Am. 2023;33(2):357-73. PMID: 36965952
“In this article, we describe relevant anatomy, mechanisms of injury, and imaging findings of abusive head trauma (AHT). We also briefly address certain mimics of AHT, controversies, pearls, and pitfalls. Concepts of injury, its evolution, and complex nature of certain cases are highlighted with the help of case vignettes.”
Bennett CV, Hollén L, Wilkins D, Emond A, Kemp A.
The impact of a clinical prediction tool (BuRN-Tool) for child maltreatment on social care outcomes for children attending hospital with a burn or scald injury. Burns. 2023 Jun;49(4):941-950. PMID: 35987740
“Burns are common childhood injuries and 10-20% are associated with maltreatment…Children with a BuRN-Tool-score ≥ 3 but no safety contact/referral, and those who had a contact/referral but no action taken, were significantly more likely than those scoring <3 to have new safety involvement within six months following the burn. The BuRN-Tool-score ≥ 3 has the potential to alert clinicians to maltreatment concerns.”
Adebiyi E, Pietri-Toro J, Awujoola A, Gwynn L.
Association of Adverse Childhood Experiences with Heart Conditions in Children: Insight from the 2019-2020 National Survey of Children's Health. Children (Basel, Switzerland). 2023;10(3). PMID: 36980044
From a national survey, there are “an estimated 780,000 (1.13%) children living with heart conditions in the U.S…several ACEs, including household economic hardship, parental/guardian's alcohol/drug abuse, severe mental health illness of parents/guardians, racial/ethnic discrimination, exposure to neighborhood violence, and accumulation of two or more ACEs, were significantly associated with heart diseases among children. Though two or more ACEs did not have a significant association with the severity of heart condition, it was significantly associated with caregiver reports of undesirable overall health status.”
Anto M, Shipley SC, Massey S, Szperka CL.
Adverse Childhood Experiences Are Associated With Seizures in Children: A Cross-sectional Analysis. Neurol Clin Pract. 2023;13(2):e200136. PMID: 37064581
From a national children’s survey, 0.63% of participants had a current diagnosis of epilepsy or seizure disorder. “As the number of ACEs increased, odds of current epilepsy or seizure disorder diagnosis increased by 1.14. Five different ACE exposures demonstrated a high association with a current diagnosis of epilepsy or seizure disorder: food/housing insecurity, witnessing domestic violence, household mental illness, neighborhood violence, and parent/guardian incarceration.”
Gladieux M, Gimness N, Rodriguez B, Liu J.
Adverse Childhood Experiences (ACEs) and Environmental Exposures on Neurocognitive Outcomes in Children: Empirical Evidence, Potential Mechanisms, and Implications. Toxics. 2023;11(3). PMID: 36977024
Authors review how the relationship between ACEs and environmental exposures (air pollution, lead exposure, second-hand smoke, other chemicals) interact to cause adverse outcomes in children's neurocognitive development. These cognitive outcomes include learning disabilities, lowered IQ, memory and attention problems, and overall poor educational outcomes.
Higgins DJ, Mathews B, Pacella R, et al.
The prevalence and nature of multi-type child maltreatment in Australia. Med J Aust. 2023;218 Suppl 6:S19-s25. PMID: 37004183
From a random phone survey of 8503 Australians aged 16 and older, 62.2% reported one or more of 5 child maltreatment types (physical abuse, sexual abuse, emotional abuse, neglect, or exposure to domestic violence). 22.8% reported one ACE, 39.4% 2 or more, and 3.5% all five, with exposure to domestic violence most often present in multi-type maltreatment. Multi-type maltreatment was more common for gender diverse participants (66.1%) and women (43.2%) than for men (34.9%). Family-related adverse childhood experiences - especially mental illness and alcohol or substance misuse - increased risk for multi-type child maltreatment.
Elklit A, Murphy S, Skovgaard C, Lausten M.
Physical violence against children with disabilities: A Danish national birth cohort prospective study. European journal of psychotraumatology. 2023;14(1):2173764. PMID: 37052095
Using a large Danish registry and following children until age 18, “We identified 12,830 cases of reported physical violence (2.25% of the population) towards children and adolescents. Children with disabilities were overrepresented, as were boys and ethnic minorities. After controlling for risk factors, four disabilities had heightened risk for criminal violence: ADHD, brain injury, speech, and physical disabilities…parental history of violence, family break-up, out-of-home placement, and parental unemployment contributed especially to the violence. Having several disabilities increased the risk of violence.”
Palmer L, Font S, Rebbe R, Putnam-Hornstein E.
Lifetime rates and types of subsequent child protection system contact following a first report of neglect. PLoS One. 2023;18(4):e0283534. PMID: 37043442
“An estimated 1 in 3 U.S. children will be the subject of a child protective services (CPS) investigation during their lifetime, typically for allegations of neglect.” In this study of children born in California in 2000 who were first investigated by CPS for neglect allegations alone (no co-occurring abuse) and not permanently separated from their families of origin, “64% were re-referred to CPS by age 18 and 16% experienced a subsequent removal. Four out of five children initially investigated as infants had one or more subsequent CPS referrals during childhood…more than half of children re-referred were reported for allegations of physical or sexual abuse, indicating that abuse risk was either missed during the initial CPS investigation or escalated afterward. The failure to address maltreatment risks when children first present to the system is a complex problem with no easy solution.”
Ferro RA, DiFatta R, Khan KN, et al.
When Adverse Childhood Experiences Present to a Statewide Child Psychiatry Access Program. J Behav Health Serv Res. 2023 Jul;50(3):400-412. PMID: 37002438
In a review of children referred by their pediatric primary care providers (PCP) to a state child psychiatry access program (CPAP), referred children who had ACEs were more often already receiving medication, receiving more than one medication, and had been given more than one mental health diagnosis. “Patients with ACEs for whom PCPs sought CPAP support were experiencing more clinically severe and complex mental health concerns.”
Wood GJ, Smith JAS, Gall JA.
The optimal timing of forensic evidence collection following paediatric sexual assault. J Forensic Leg Med. 2023;95:102499. PMID: 36889049
In a review of 122 cases of pediatric sexual assault, with 562 forensic specimens collected, 27% were positive for foreign DNA, spermatozoa, semen or saliva. Foreign DNA and spermatozoa were much more likely to be found in the first 24 hours. “Foreign DNA was not identified beyond 48 h post assault and spermatozoa were not identified beyond 36 h. Saliva and semen were not identified beyond 24 h… Our results highlight the importance of collecting forensic specimens as a matter of urgency, regardless of age, within the first 48 h post assault.”
Nash K, Minhas S, Metheny N, et al.
Association between childhood maltreatment and atopy in the UK: A population based retrospective cohort study. EClinicalMedicine. 2022 Nov 14;53:101730. PMID: 36467451
From a large UK study of children in general care practices who experienced maltreatment, and matched controls, those with maltreatment were 42% more likely to subsequently develop asthma, and 14% more likely to develop allergic skin, eye and nose conditions.
Barnea O, Cohen N, Hindi I, Katz C.
Noticing the unutilized resource of siblinghood: Key conclusions from a scoping review about siblings in out-of-home placements. Child Abuse Negl. 2023;141:106192. PMID: 37116451
“Sibling bonds are often the most enduring relationship in an individual's life span. The out-of-home placement of siblings is widespread and may significantly influence children's journeys and wellbeing…the welfare system struggles to address a child as a part of a sibling group and an extensive and multilayered relational network; hence, siblinghood is an unutilized resource in out-of-home placements. Future directions for practice, policy and research are included and discussed.”
Adult Manifestations of Child Abuse
Pacella R, Nation A, Mathews B, et al.
Child maltreatment and health service use: findings of the Australian Child Maltreatment Study. Med J Aust. 2023;218 Suppl 6:S40-s6. PMID: 37004185
From a random phone survey of 8503 Australians aged 16 and older, respondents who had experienced child maltreatment were significantly more likely than those who had not to report a hospital admission during the preceding twelve months (adjusted odds ratio [aOR], 1.39), particularly admission with a mental disorder (aOR, 2.4), six or more visits to general practitioners (aOR, 2.37) and consultation with a mental health nurse (aOR, 2.67), psychologist (aOR, 2.40), or psychiatrist (aOR, 3.02). People who reported three or more maltreatment types were generally most likely to report greater health service use.
Scott JG, Malacova E, Mathews B, et al.
The association between child maltreatment and mental disorders in the Australian Child Maltreatment Study. Med J Aust. 2023;218 Suppl 6:S26-s33. PMID: 37004186
From the same national adult Australian survey as above, 38.0% met criteria for a mental disorder. Participants who had experienced childhood maltreatment had increased risk of any mental disorder (odds ratio [OR] 2.82), generalized anxiety disorder (OR 3.14), major depressive disorder (OR 3.19) severe alcohol use disorder (OR 2.62), and post-traumatic stress disorder (OR 4.60). “Associations between experiences of child maltreatment and mental disorders were strongest for sexual abuse, emotional abuse and multi-type maltreatment. The strength of the associations did not differ by gender. Adjustment for childhood and current financial hardship and for current socio-economic status did not significantly attenuate the associations.”
Lawrence DM, Hunt A, Mathews B, et al.
The association between child maltreatment and health risk behaviours and conditions throughout life in the Australian Child Maltreatment Study. Med J Aust. 2023;218 Suppl 6:S34-s9. PMID: 37004181
From the same Australian adult national survey, “All five types of child maltreatment were associated with increased rates of all of the health risk behaviours and conditions that we considered…Sexual abuse and emotional abuse were associated with the highest odds of health risk behaviours and conditions. Cannabis dependence, self-harm, and suicide attempts were most strongly associated with child maltreatment. Experiencing more than one type of child maltreatment was associated with higher rates of health risk behaviours and conditions than experiencing one type of child maltreatment.”
Grummitt L, Barrett E, Kelly E, Newton N.
An Umbrella Review of the Links Between ACEs and Substance Misuse: Where Do We Go from Here? Subst Abuse Rehabil. 2022 Nov 15;13:83-100. PMID: 36411791
From a research review, “Results overwhelmingly demonstrated an elevated risk of substance misuse or disorder among adolescents and adults exposed to ACEs. Research on the mechanisms that explain this link highlights a multitude of potential intervention targets, with childhood stress propelling a cascade of effects across endocrine, neurobiological, immune, metabolic, and nervous systems, impacting psychosocial and cognitive functioning.” Authors note critical directions for future research, practice and public policy.
Broekhof R, Nordahl HM, Tanum L, Selvik SG.
Adverse childhood experiences and their association with substance use disorders in adulthood. Addictive behaviors reports. 2023;17:100488. PMID: 37077505
From a national Norwegian patient registry, “Adults with any history of ACEs have a 4.3-fold higher likelihood of developing a substance use disorder. Female adults had a 5.9-fold higher likelihood of developing an alcohol use disorder. Emotional neglect, sexual abuse and physical abuse were the strongest individual ACE predictors for this association. Male adults had a 5.0-fold higher likelihood of developing an illicit drug use disorder (for example stimulants such as cocaine, inhibiter such as opioids, cannabinoids and multiple drugs). Physical abuse, parental divorce and witnessed violence were the strongest individual ACE predictors for this association.”
Gao S, Assink M, Bi C, Chan KL.
Child Maltreatment as a Risk Factor for Rejection Sensitivity: A Three-Level Meta-Analytic Review. Trauma Violence Abuse. 2023:15248380231162979. PMID: 37036152
From a research review, childhood abuse was significantly and positively related to rejection sensitivity later in life, stronger for emotional abuse than physical abuse, and stable across age and gender. “People with high levels of rejection sensitivity tend to anxiously expect, readily perceive, and overreact to social rejection…Intervention efforts tailored to the needs of individual victims may be more effective than general interventions offered to victims of all types of child maltreatment.”
Kinney-Huang M, Leibovitz T, Harkness KL, Bowie CR.
Childhood Adversity, Cognition, and Response to Cognitive Remediation in Major Depressive Disorder. J Nerv Ment Dis. 2023;211(5):362-8. PMID: 36805563
“Cognitive impairment is experienced by many individuals with major depressive disorder (MDD) and is significantly related to sustained disability…of 39 individuals who completed cognitive remediation, childhood adversity (CA), repeated depressive episodes, and earlier age at diagnosis were associated with poorer cognition. We did not observe a difference in treatment response based on CA. Findings suggest that CA is an important variable to consider when examining the expression of depressive illness and areas for intervention.”
Warhaftig G, Almeida D, Turecki G.
Early life adversity across different cell-types in the brain. Neurosci Biobehav Rev. 2023;148:105113. PMID: 36863603
“In this review we will gather recent findings describing morphological, transcriptional and epigenetic alterations within neurons, glia and perineuronal nets and their associated cellular subpopulations. The findings reviewed and summarized here highlight important mechanisms underlying ELA [early life adversity] and point to therapeutic approaches for ELA and related psychopathologies later in life.”
Nevarez-Brewster M, Aran Ö, Narayan AJ, et al.
Adverse and Benevolent Childhood Experiences Predict Prenatal Sleep Quality. Adversity and resilience science. 2022;3(4):391-402. PMID: 36968335
Of 164 pregnant individuals, “Higher levels of ACEs predicted poorer prenatal sleep quality throughout pregnancy, while higher levels of BCEs [benevolent childhood experiences] predicted better sleep quality throughout pregnancy. Examination of ACEs subtypes revealed that maltreatment predicted poor sleep quality, while household dysfunction was not significantly associated. Associations remained after covarying for socioeconomic status and current stressful life events.”
Saadedine M, Faubion S, Kingsberg S, et al.
Adverse childhood experiences and sexual dysfunction in midlife women: Is there a link? J Sex Med. 2023 Apr 27:qdad053. PMID: 37105936
Of 1572 women with mean age of 53.2 years, 59% reported having at least 1 ACE. “When compared with no ACEs, a history of ≥4 ACEs significantly increased the odds of not being sexually active (odds ratio 1.83). Among sexually active women, the proportion of women with female sexual dysfunction increased sequentially as the number of ACEs increased…The sexual dysfunction in women with ACEs seems to be independent of other factors that potentially affect female sexual function in midlife.”
Stewart A, Ko J, Salvesen von Essen B, et al.
Association of Mental Health Conditions, Recent Stressful Life Events, and Adverse Childhood Experiences with Postpartum Substance Use - Seven States, 2019-2020. MMWR Morb Mortal Wkly Rep. 2023;72(16):416-20. PMID: 37079476
In a survey of individuals in seven states with high opioid overdose mortality rates who were recontacted 9-10 months after giving birth in 2019, “Overall, 25.6% of respondents reported postpartum substance use, and 5.9% reported polysubstance use. The following conditions were associated with higher substance and polysubstance use prevalence in postpartum women: depressive symptoms, depression, anxiety, adverse childhood experiences, and stressful life events. Substance use prevalence was higher among women who experienced six or more stressful life events during the year preceding the birth (67.1%) or four adverse childhood experiences related to household dysfunction (57.9%)…Clinical and community- and systems-level interventions to improve postpartum health can include screening and treatment for depression, anxiety, and substance use disorders during the postpartum period.”
O'Leary E, Millar SR, Perry IJ, Phillips CM.
Association of adverse childhood experiences with lipid profiles and atherogenic risk indices in a middle-to-older aged population. SSM - population health. 2023;22:101393. PMID: 37090689
From a study of 1820 Irish adults, ACE history (reported by 23% of sample), in particular childhood exposure to household dysfunction, was associated with later-life non-optimal levels of triglycerides and HDL-C, and approximately twice the risk of pro-atherogenic risk indices (fatty deposits in arteries).
Rohr JC, Bourassa KA, Thompson DS, et al.
History of childhood physical abuse is associated with gut microbiota diversity among adult psychiatric inpatients. J Affect Disord. 2023;331:50-6. PMID: 36933668
Of 105 adult psychiatric inpatients, “history of childhood physical abuse was uniquely associated with abundance of distinct bacterial taxa associated with inflammation…This study did not account for dietary differences, though diet was highly restricted as all participants were psychiatric inpatients…These findings suggest that early childhood adverse events may have long-conferred systemic consequences. Future efforts may target the gut microbiota for the prevention and/or treatment of psychiatric and medical risk associated with traumatic life events.”
Adolescents
Carnelius F, Dennhag I.
The association between gender, sexual harassment, and self-compassion on depressive symptoms in adolescents. Nord J Psychiatry. 2023;77(3):256-65. PMID: 35736792
From a survey of 318 Swedish adolescents, “Both bullying and sexual harassment were associated with depressive symptoms, and gender patterns were observed. For boys, verbal harassment and bullying correlated with negative self-evaluation and somatic complaints. For girls, bullying correlated with all depressive symptoms. Higher levels of self-compassion were associated with less depression, and the correlation was especially strong among boys.”
Peck A, Provost S, East L, Hutchinson M.
Process mining the trajectories for adolescent-to-mother violence from longitudinal police and health service data. J Adv Nurs. 2023 Apr;79(4):1540-1552. PMID: 35864079
Of 775 Australian adolescents who had been issued a legal action for a family violence-related offence, 63% offended against mothers. “Many children and mothers were identifiable from police records in early childhood, at an average age of 35 months…dominant early childhood events were repeated exposure to parental intimate partner violence, parental drug and/or alcohol use, and neglect. During early adolescence, pathways towards adolescent-to-mother violence involved other offending, drug and/or alcohol use, and mental health service contact.”
Warner TD, Leban L, Pester DA, Walker JT.
Contextualizing Adverse Childhood Experiences: The Intersections of Individual and Community Adversity. J Youth Adolesc. 2023 Mar;52(3):570-584. PMID: 36445650
Among 13,267 youth, 51% female, 71% White, 61% and 73% were exposed to at least one individual and community ACE, respectively, while 15% of youth reported severe individual ACE exposure (≥3 ACEs) and 20% were exposed to severe (≥3) community ACEs. “All ACE exposures were associated with problem behaviors later in adolescence, but youth reporting both severe individual and community ACEs were especially at high risk for later violence, delinquency, and other health-risk behaviors…community adversity exacerbates the damaging effects of individual/ family adversity and thus should be addressed in efforts to prevent ACEs and reduce their long-term harm.” Community ACEs in this study included high poverty area, poor schools, high unemployment, high crime, residential instability, insecurity (safety), low social cohesion, and low informal social control.
Nemeth JM, Glasser AM, Hinton A, et al.
Brain Injury Is Prevalent and Precedes Tobacco Use among Youth and Young Adults Experiencing Homelessness. Int J Environ Res Public Health. 2023;20(6). PMID: 36982077
Of 96 homeless youth, average age 22, minority race 84.4%, and minority gender/sexual orientation 26.0%, 87% of participants reported at least one exposure to blunt force head trauma and 65% to brain oxygen deprivation (strangulation, choking games). Intentional injury was more common than accidental. 60.4% were classified as having acquired brain injury (ABI) using the Brain Injury Severity Assessment. ABI occurred a median of 1 to 5 years before regular tobacco use, which was used by 70% of participants.
Tindberg Y, Janson S, Jernbro C.
Unintentional Injuries Are Associated with Self-Reported Child Maltreatment among Swedish Adolescents. Int J Environ Res Public Health. 2023;20(7). PMID: 37047879
Of 4741 Swedish adolescents surveyed, with a 78.5% response rate, statistically significant associations were reported between experiences of physical, psychological, and sexual abuse, neglect, and witnessing partner violence during childhood, and unintentional injuries requiring health- or dental care during the last year (aOR between 1.39-1.77). A linear association was seen for degree of victimization and number of episodes of unintentional injuries that required care in the last year, as well as lifetime hospitalizations. “Healthcare professionals need to pay particular attention to children and adolescents who repeatedly seek healthcare services due to injurious events.”
de Vries TR, Arends I, Oldehinkel AJ, Bültmann U.
Direct and indirect associations between childhood adversity and emotional and behavioral problems at age 14: A network analytical approach. Dev Psychopathol. 2023:1-12. PMID: 37039154
Applying network analysis to a Dutch adolescent survey, “We found that bullying victimization, peer rejection, parental mental health problems, emotional abuse, and sexual abuse were the only AEs [adverse experiences] directly contributing to risk of emotional problems. Parental divorce and emotional abuse were the only AEs directly contributing to risk of behavioral problems.”
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