[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
Wood JN, Campbell KA, Anderst JD, et al.
Child Abuse Pediatrics Research Network: The CAPNET Core Data Project. Acad Pediatr. 2023 Mar;23(2):402-409. PMID: 35840086
“We conducted a cross-sectional study of children <10 years old who underwent an evaluation (in-person or remote) by a child abuse pediatrician (CAP) due to concerns for physical abuse at ten CAPNET hospital systems from February 2021 through December 2021. Among 3667 patients with 3721 encounters, 69.4% were <3 years old; 44.3% <1 year old, 59.1% male; 27.1% Black; 57.8% White, 17.0% Hispanic; and 71.0 % had public insurance. The highest level of care was outpatient/emergency department in 60.7%, inpatient unit in 28.0% and intensive care in 11.4%. CAPs performed 79.1% in-person consultations and 20.9% remote consultations. Overall, the most frequent injuries were bruises (35.2%), fractures (29.0%), and traumatic brain injuries (TBI) (16.2%). Abdominal (1.2%) and spine injuries (1.6%) were uncommon. TBI was diagnosed in 30.6% of infants but only 8.4% of 1-year old children. In 68.2% of cases a report to child protective services (CPS) was made prior to CAP consultation; in 12.4% a report was made after CAP consultation. CAPs reported no concern for abuse in 43.0% of cases and mild/intermediate concern in 22.3%. Only 14.2% were categorized as definite abuse.”
Kayton ML, Staab V, Stahl B, Tan K, Russo L, Verney M, et al.
Health Inequities in Pediatric Trauma. Children (Basel, Switzerland). 2023;10(2). PMID: 36832472
“This review article highlights the disparities evident in pediatric trauma care in the United States including access to care, gun violence, child abuse, head trauma, burn injuries, and orthopedic trauma…trauma care for children should be designed with a focus on equity for all children.”
Garner JB, Self-Brown S, Emery V, Wootten K, Tiwari A.
COVID-19 and Caregiver Risk Factors for Child Maltreatment: The Pandemic in Review. Trauma Violence Abuse. 2023:15248380231158609. PMID: 36935570
From a research review, “Four previously well-established risk factors for CM [child maltreatment] perpetration continued to persist during the pandemic, including stress, parental mental health, financial concerns, and parental substance use…Several additional emerging and understudied risk factors were also identified, such as food insecurity and parental education…Going forward, practitioners and researchers should (a) strengthen the identification process for families at greatest risk for CM, and particularly those vulnerable to pandemic-related stressors; and (b) augment delivery of CM prevention strategies and evidence-based programs to fit the pandemic context.”
Cappa C, Vlamings L.
Introduction to the special issue of Child Abuse & Neglect: Street-connected children. Child Abuse Negl. 2023:106146. PMID: 36963985
Street-connected children “are those who depend on the streets to live and/or work, whether alone, with peers or with family. The definition also includes children who have formed strong connections with public spaces and for whom the street plays a vital role in their everyday lives and identities…primary risk factors leading to street situations include a child's history of experiencing neglect and abuse, family conflict and disintegration, abject poverty as well as urbanization and the search for independence…these children experience recurrent and extensive stigmatization, social exclusion, and discrimination, which impact their health and well-being, including through heightened prevalence of HIV and sexually transmitted infections, post-traumatic stress disorder, substance use and negative health outcomes.” This special issue of Child Abuse & Neglect discusses the challenges faced by street-connected children and how we can respond.
Kautz-Turnbull C, Rockhold M, Handley ED, et al.
Adverse childhood experiences in children with fetal alcohol spectrum disorders and their effects on behavior. Alcohol Clin Exp Res. 2023 Mar;47(3):577-588. PMID: 36811189
From a survey of 87 caregivers of children aged 3-12 years with fetal alcohol spectrum disorder, on average caregivers reported 3.10 ACEs experienced by their children, with the most frequent being living with a household member with a mental health disorder or a substance use disorder. Higher ACEs were associated with increased problem behaviors.
Mankad K, Sidpra J, Mirsky DM, et al.
International Consensus Statement on the Radiological Screening of Contact Children in the Context of Suspected Child Physical Abuse. JAMA Pediatr. 2023 May 1;177(5):526-533. PMID: 36877504
“This consensus statement is supported by a systematic review of the literature and the clinical opinion of an internationally recognized group of 26 experts…Contacts are defined as the asymptomatic siblings, cohabiting children, or children under the same care as an index child with suspected child physical abuse. All contact children should undergo a thorough physical examination and a history elicited prior to imaging. Contact children younger than 12 months should have neuroimaging, the preferred modality for which is magnetic resonance imaging, and skeletal survey. Contact children aged 12 to 24 months should undergo skeletal survey. No routine imaging is indicated in asymptomatic children older than 24 months.
Talmon A, Ditzer J, Talmon A, Tsur N.
Maltreatment in Daycare Settings: A Review of Empirical Studies in the Field. Trauma Violence Abuse. 2023:15248380231155528. PMID: 36869785
“Daycare maltreatment refers to abusive and/or neglectful acts perpetrated by teachers, directors, non-professionals or volunteers, family members of staff, and peers in a daycare setting.” From a research review, “reports of daycare maltreatment are characterized by early age of abused children, referring mainly to sexual, physical, and emotional abuse. The majority of these manuscripts reported caregivers' and teachers' abuse, while peer victimization was reported much less. In addition, the findings demonstrated a higher representation of female perpetrators compared to abuse in other scenarios…a well-validated measure for assessment of daycare maltreatment seems to be lacking.”
Bennett A, Clement A, Walton R, Jackson Y, Gabrielli J.
Youth Reported Perpetrators of Victimization Within a Foster Care Sample. Child Maltreat. 2023:10775595231163452. PMID: 36907656
“503 youth in foster care (ages 8-21 years) reported on experiences of physical, sexual, and psychological abuse. Biological caregivers were commonly endorsed perpetrators of physical and psychological abuse, though youth also reported high levels of peer victimization. For sexual abuse, non-related adults were commonly reported perpetrators, however, youth reported higher levels of victimization from peers. Older youth and youth residing in residential care reported higher numbers of perpetrators; girls reported more perpetrators of psychological and sexual abuse as compared to boys…number of perpetrators differed across abuse severity levels. Perpetrator count and type may be important features of victimization experiences.”
Langevin R, Marshall C, Wallace A, et al.
Disentangling the Associations Between Attention Deficit Hyperactivity Disorder and Child Sexual Abuse: A Systematic Review.
Trauma Violence Abuse. 2023;24(2):369-89. PMID: 34238078
Authors point out in this research review that while most studies identified a significant association between child sexual abuse and ADHD, due to lack of study quality and design, with many unlooked at factors, the nature of the association is still unclear.
Segal L, Dawe S, Nguyen H, et al.
Child protection system involvement in children of incarcerated mothers: A linked data study. Child Abuse Negl. 2023;139:106126. PMID: 36889149
For 2637 Australian mothers entering prison and their 6680 children, compared to a control group without maternal incarceration, children with incarcerated mothers were 7.06 times more likely to have a CPS substantiated maltreatment, and 12.89 times more likely to be placed in out-of-home care. “Maternal incarceration is a warning flag for a child at high risk of serious child protection concerns…This population should be a priority for trauma-informed family support services.”
Clark MT, Littlemore J, Taylor J, Debelle G.
Child abuse linked to faith or belief: working towards recognition in practice. Nurs Child Young People. 2023 May 4;35(3):34-42. PMID: 36254528
“Child abuse linked to faith or belief (CALFB) is a worldwide issue that is linked to serious short-term and long-term consequences and even death. Children affected by CALFB may have undergone multiple abuses - such as ritual starvation, beatings, burns, stabbings and drowning - prompting concern in hospitals, schools and communities, including in emergency and primary care settings…This article examines medical evidence and psychosocial indicators of this form of abuse and explains the metaphorical language and thoughts associated with reported beliefs.”
Adult Manifestations of Child Abuse
Chen Y, Shan Y, Lin K, et al.
Association Between Child Abuse and Risk of Adult Coronary Heart Disease: A Systematic Review and Meta-Analysis. Am J Prev Med. 2023 Mar 5:S0749-3797(23)00118-6. PMID: 36878413
From a pooled estimate of 10 studies with a sample size of 343,371 adults, child abuse was associated with a 1.5 times increased risk of adult coronary heart disease, consistent across abuse subtypes and sex. “This study advocates further research on biological mechanisms linking child abuse to coronary heart disease as well as improvement in…targeted prevention approaches.”
Dempster KS, O'Leary DD, MacNeil AJ, Wade TJ.
Childhood household dysfunction is associated with reduced left ventricular mass in young adulthood. Am J Physiol Heart Circ Physiol. 2023 Jun 1;324(6):H791-H803. PMID: 36961488
217 healthy young adults, average age 22.6 years, participated in a study of cardiac function. “We identified experiencing any childhood household dysfunction was associated with lower LVM [left ventricular mass] in young adults independent of sex, recent life stress, BMI and height, smoking, physical activity, and inflammation…Likewise, a negative effect on EF [ejection fraction, a measure of heart function] independent of covariates was observed in individuals who experienced ≥4 ACEs. As such, alterations in LVM and EF may be perpetuated through a toxic home environment, promoting left ventricular underdevelopment in young adulthood, the effect of which in midlife and beyond requires additional investigation.”
Souama C, Lamers F, Milaneschi Y, et al.
Depression, cardiometabolic disease, and their co-occurrence after childhood maltreatment: an individual participant data meta-analysis including over 200,000 participants. BMC Med. 2023;21(1):93. PMID: 36907864
Using data from a meta-analysis on 13 international observational studies (N = 217,929), adults with a history of childhood maltreatment suffered more often from depression and cardiometabolic disease than their non-exposed peers. These adults are also three times more likely to have both depression and cardiometabolic disease. “Associations remained significant after additionally adjusting for lifestyle factors, and were present in both males and females, and for all maltreatment types.”
Hong A, Zhou S, Yang C, Liu X, Su S, Wang Z.
Impact of childhood trauma on the abnormal functional connectivity of brain regions in the fear network model of panic disorder. J Affect Disord. 2023;329:500-10. PMID: 36858271
“People who have suffered childhood trauma may be more susceptible to panic disorder (PD)…the brain regions involved in the fear network model (FNM) of PD highly overlap with the brain regions affected by childhood trauma…62 patients with PD who had suffered high and low levels of childhood trauma were found to exhibit different pathological alterations in the FNM, suggesting that childhood trauma may be an important risk factor for the development of PD symptoms.”
Dugan SA, Karavolos K, Zhang Y, et al.
Childhood Sexual Abuse and Pelvic Floor Dysfunction in Midlife Women in the Study of Women's Health Across the Nation. J Womens Health (Larchmt). 2023;32(3):293-9. PMID: 36735600
From a national study with 2068 US women, those with a history of childhood sexual abuse (CSA) were 1.48 times more likely to report pain with sexual activity. Urgency urinary incontinence was not associated with CSA.
Moog NK, Cummings PD, Jackson KL, et al.
Intergenerational transmission of the effects of maternal exposure to childhood maltreatment in the USA: a retrospective cohort study. The Lancet Public health. 2023;8(3):e226-e37. PMID: 36841563
“Of 3954 mothers in the study, 44% had experienced exposure to abuse or neglect during their childhood. After adjustment, mothers who experienced childhood maltreatment were more likely to have children with internalising problems in the clinical range (odds ratio [OR] 2·70), autism spectrum disorder (1·70), ADHD (2·09), and asthma (1·54). In female offspring, maternal childhood maltreatment was associated with a higher prevalence of obesity (1·69)…Exposure to multiple forms of maltreatment across all subtypes of maternal childhood maltreatment was associated with the highest risk increases for most offspring health outcomes, suggesting a dose-response relationship.”
Shin SH, Kim YK.
Early Life Stress, Neuroinflammation, and Psychiatric Illness of Adulthood. Advances in experimental medicine and biology. 2023;1411:105-34. PMID: 36949308
In this book chapter, authors “discuss the link between the experience of stress in early life and lifelong alterations in the immune system, which subsequently lead to the development of various psychiatric illnesses.”
Subramanian I, McDaniels B, Farahnik J, Mischley LK.
Childhood Trauma and Parkinson Disease: Associations of Adverse Childhood Experiences, Disease Severity, and Quality of Life. Neurol Clin Pract. 2023;13(2):e200124. PMID: 36891464
From an internet survey of 900 adults with Parkinson’s Disease, with a 79% response, “Individuals with ACE scores 4 or higher reported greater symptom severity for 45% of the variables tested, including apathy, muscle pain, daytime sleepiness, restless leg syndrome, depression, fatigue, comprehension, and anxiety compared with individuals with trauma scores of zero…While the associations were statistically significant, the impact of trauma was less robust than previously described predictors of severity, such as diet, exercise, and social connection.”
Zhou Z, Lo CKM, Chan KL, Chung RSY, Pell JP, Minnis H, et al. Child maltreatment and telomere length in middle and older age: retrospective cohort study of 141 748 UK Biobank participants. Br J Psychiatry. 2023:1-5. PMID: 36946056
From a large study, child maltreatment was associated with shorter telomere length in middle- and older-aged adults, independent of sociodemographic and mental health factors. The shortest lengths were in those with 3+ ACEs. Results for those with 1 ACE were the same as for 0 ACEs. Physical and sexual abuse were independently associated with shorter telomere length.
Na PJ, Fischer IC, Shear KM, Pietrzak RH.
Prevalence, Correlates, and Psychiatric Burden of Prolonged Grief Disorder in U.S. Military Veterans: Results From a Nationally Representative Study. Am J Geriatr Psychiatry. 2023 Feb 14:S1064-7481(23)00180-X. PMID: 36878740
Of 2441 US veterans, 7.3% screened positive for prolonged grief disorder (PGD). “The strongest correlates of PGD were adverse childhood experiences, female sex, non-natural causes of death, knowing someone who died from coronavirus disease 2019, and number of close losses. After adjusting for sociodemographic, military, and trauma variables, veterans with PGD were 5-to-9 times more likely to screen positive for post-traumatic stress disorder, major depressive disorder, and generalized anxiety disorder. After additional adjustment for current psychiatric and substance use disorders, they were 2-3 times more likely to endorse suicidal thoughts and behaviors.”
Olgiati P, Fanelli G, Serretti A.
Clinical correlates and prognostic implications of severe suicidal ideation in major depressive disorder. Int Clin Psychopharmacol. 2023 Feb 27:e000461. PMID: 36853754
For 249 outpatients with major depressive disorder (MDD) and suicidal ideation (SI), patients with severe SI (36%) were younger at disease onset, more severely depressed, had more lifetime suicidal behavior and psychiatric comorbidities (panic disorder, PTSD), and a history of childhood maltreatment (neglect, emotional abuse, physical abuse, sexual abuse) than those experiencing low-moderate SI. The occurrence of serious lifetime suicidal behavior was predicted by SI severity (Odds ratio 2.18), bipolar score (1.36), and childhood sexual abuse (2.35). “These results emphasise the importance of assessing childhood maltreatment and bipolar liability in MDD to estimate suicidal behaviour risk.”
Benz ABE, Dimitroff SJ, Jeggle C, et al.
Increased empathic distress in adults is associated with higher levels of childhood maltreatment. Scientific reports. 2023;13(1):4087. PMID: 36906595
Of 228 adults mean age 30.51 years and 83% female, “increased levels of emotional, physical, and sexual abuse, and emotional and physical neglect were positively correlated with personal distress in response to others' suffering. Likewise, higher parental overprotection and lower parental care were related to higher personal distress. While participants with higher levels of early life adversity tended to donate more money on a merely descriptive level, only higher levels of sexual abuse were significantly related to larger donations.”
Adolescents
Miller M, Jones V, Walter C, Manning Ryan L.
Epidemiology of Injuries to Early Adolescents from Family Violence Evaluated in an Urban Pediatric Emergency Department. Pediatr Emerg Care. 2023 Mar 1;39(3):113-119. PMID: 36728739
“Of 819 youth aged 10 to 15 years evaluated for a violence-related injury, 54.7% involved a family member. Of these, most involved parents/guardians (76.6%), and occurred at home (83.9%). Most patients were girls (54.0%), and Black/African American (84.4%). Most youth were transported to the hospital by police (66.7%). Overall, alcohol, drugs, and weapons were involved in 10.0%, 6.5%, and 10.7% of events, respectively, and their involvement significantly increased during the pandemic period to 18.8%, 14.9%, and 23.8%. Most patients (98.7%) were discharged from the ED. “More than half of violence-related injuries treated in the ED in this population resulted from family violence. Family violence is a prevalent and possibly underrecognized cause of injuries during adolescence.”
Ganpo-Nkwenkwa NS, Wakeman DS, Pierson L, et al.
Long-term functional, psychological, emotional, and social outcomes in pediatric victims of violence. J Pediatr Surg. 2023;58(4):774-81. PMID: 35961819
Of 270 pediatric patients treated for a violent traumatic injury, 24 over age 18 agreed to participate in a study a median of 6.7 years later. 45.8% reported substance use in the past 30 days, 41.7% screened positive for PTSD, and 62.5% requested resources and/or referral for medical care. “Many individuals who survive violent injuries as children continued to experience negative physical and mental outcomes extending into adulthood that required ongoing medical and psychological support. Further resources are needed to better understand the long-term effects of violent injury and to care for the complex needs of this population.”
Nooner KB, Meiers G, Treadwell T, Butler LB.
Changes in Electroencephalography Alpha Associated With Childhood Neglect and Adolescent Alcohol Use. Child Maltreat. 2023;28(2):297-306. PMID: 35503002
Of 53 adolescents aged 12-14 years recruited from the Dept. of Social Services (DSS), both DSS and self-reported higher degree of neglect in year 1 were associated with certain brain changes, which in year 2 were associated with lower self-efficacy (confidence in the ability to exert control over one’s self) to alcohol use temptation.
Lateef R, Alaggia R, Collin-Vézina D, McElvaney R.
The Legacy of Shame following Childhood Sexual Abuse Disclosures. J Child Sex Abus. 2023;32(2):184-203. PMID: 36656278
11 childhood sexual abuse survivors aged 14-25 years were interviewed about their disclosure experiences, including 1) struggles with identifying as a sexual abuse survivor; 2) manifestations of shame; 3) shaming responses to disclosures; and 4) strategies to overcome shame.”
Norton EO, Hailemeskel R, Bravo AJ, et al.
Childhood Traumatic Experiences and Negative Alcohol-Related Consequences in Adulthood: A Cross-Cultural Examination of Distress Tolerance and Drinking to Cope. Subst Use Misuse. 2023:1-8. PMID: 36935590
Of 3753 Canadian college students from seven countries, “higher endorsement of ACEs was associated with lower distress tolerance, which in turn was associated with higher drinking to cope, which in turn was associated with more negative alcohol-related consequences. These effects were invariant across countries and gender groups…intervening on distress tolerance and drinking motives could mitigate downstream alcohol-related consequences.”
Baiden P, Cavazos-Rehg P, Szlyk HS, et al.
Association between Sexual Violence Victimization and Electronic Vaping Product Use among Adolescents. Subst Use Misuse. 2023;58(5):637-48. PMID: 36803403
From a large adolescent national survey, 10.8% reported sexual violence within the last month, which was associated with a 1.52 times higher odds of electronic vaping product use. Other risk factors for vaping included cyberbullying victimization and symptoms of depression.
Nagata JM, Trompeter N, Singh G, et al.
Adverse childhood experiences and early adolescent cyberbullying in the United States.J Adolesc. 2023 Apr;95(3):609-616. PMID: 36443937
From a large early adolescent national study, 81.3% reported at least one ACE, and 9.6% reported cyberbullying victimization. In general, there was a dose-response relationship between the number of ACEs and cyberbullying victimization, with 2 (adjusted odds ratio [AOR]: 1.45), three (2.08), and four or more (2.37) ACEs associated with cyberbullying victimization. Sexual abuse (2.27), physical neglect (1.61), and household mental health problems (1.39) had the strongest associations with cyberbullying victimization.
Russotti J, Font SA, Toth SL, Noll JG.
Developmental pathways from child maltreatment to adolescent pregnancy: A multiple mediational model. Dev Psychopathol. 2023;35(1):142-56. PMID: 35074030
“Adolescents who experience pregnancy following child maltreatment are not a homogenous group and a diversity of explanatory pathways may exist. In the current study, two pre-pregnancy constructs – substance use and pregnancy desires/lower perceived difficulties – emerged as statistically significant and unique pathways to subsequent adolescent pregnancy…Notably, maltreated adolescents may be especially vulnerable to experiencing enhanced pregnancy desire or distorted pregnancy expectations, as pregnancy/parenthood may be viewed by the adolescent as a potential healing opportunity to cope with emotional deprivation or interpersonal dysfunction present in their abusive settings.”
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