[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
Baab SM, Lawsing JF, Macalino CS, Springer JH, Cline DM.
Nonaccidental Pediatric Trauma: Which Traditional Clues Predict Abuse? Pediatr Emerg Care. 2023 Sep 1;39(9):641-645. PMID: 37463155
Of 109 suspected child nonaccidental trauma (NAT) patients, the only independent variable found for likely abuse (8.65 times more likely) was a history incongruent with injuries. However, after review of prior records for these patients, in only 2 of 109 cases (1.8%) was there a prior visit where NAT could have been suspected using this criterion.
Fredin B, Letson MM, Rust SW, Crichton KG.
Physical abuse re-reporting during the COVID-19 pandemic: The kids are not okay. Child Abuse Negl. 2023 Aug 11;145:106393. PMID: 37573798
Of 238 children from one pediatric hospital with suspected child physical abuse re-reports made during the pandemic, males were younger than females (mean years 8.5 vs. 11.0), and males were 2.61 times more likely to have observable injuries. Reports of child abuse made by behavioral health specialists quadrupled during this time.
Samuel D, O'Malley F, Brink FW, et al.
Characterizing child maltreatment fatalities among child victims with disabilities in the United States, 2010-2019. Child Abuse Negl. 2023 Oct;144:106354. PMID: 37517210
Of 106 fatalities of children with disabilities due to maltreatment, “The average age of the victims was 5.9 years old and 74.6 % were male. The most frequent suspected perpetrators of maltreatment-related fatalities were biological mothers (35.2 %), and most perpetrators were White (55.7 %). Analyses showed a statistically significant relationship between fatalities caused by neglect and diagnoses of attention deficit hyperactivity disorder, autism spectrum disorder, cerebral palsy, and/or traumatic brain injury…To decrease the likelihood of abuse of disabled children, healthcare practitioners and caseworkers should work together to create strategies to help caregivers cope with the financial, mental, and physical stress that comes with raising children with disabilities.”
Hofheimer JA, McGrath M, Musci R, et al.
Assessment of Psychosocial and Neonatal Risk Factors for Trajectories of Behavioral Dysregulation Among Young Children From 18 to 72 Months of Age. JAMA Netw Open. 2023 Apr 3;6(4):e2310059. PMID: 37099294
“Emotional and behavioral dysregulation during early childhood are associated with severe psychiatric, behavioral, and cognitive disorders through adulthood. Identifying the earliest antecedents of persisting emotional and behavioral dysregulation can inform risk detection practices and targeted interventions to promote adaptive developmental trajectories among at-risk children.” In this study of 3934 mother-child pairs, risk factors of high dysregulation trajectories included maternal psychological challenges, being born pre-term, and prenatal substance exposure.
Dube SR, Li ET, Fiorini G, Lin C, Singh N, Khamisa K, et al.
Childhood verbal abuse as a child maltreatment subtype: A systematic review of the current evidence. Child Abuse Negl. 2023;144:106394. PMID: 37586139
While childhood verbal abuse (CVA) is a key attribute of emotional abuse, CVA is not recognized as its own form of maltreatment. Authors make the case for this, citing negative speech volume, tone, and speech content, and their immediate impact, as factors shown to be “associated with a range of internalizing and externalizing outcomes across the lifespan.”
Hooley G, Garcia SE.
Emergency department evaluation and management of nonaccidental trauma in pediatric patients. Pediatric emergency medicine practice. 2023;20(9):1-20. PMID: 37606603
This issue of the journal covers risk factors; sentinel injuries; clinical decision rules, historical features, and physical examination findings; recommendations for when screening laboratory and radiology studies are indicated and which studies should be ordered; recommendations for which specialists and organizations to involve to help ensure appropriate care and follow-up; and guidance for documentation and reporting.
Lewis KN, McKelvey LM, Zhang D, et al.
Risks of adverse childhood experiences on healthcare utilization and outcomes in early childhood. Child Abuse Negl. 2023;145:106396. PMID: 37573799
Of 1647 children aged 3-5 years from low income families, Family Map Inventory (FMI) screening scores (which include ACEs) were 32.4% - 0, 31.7% - 1, 19.7% - 2, and 16.3% - 3+. Higher scores were associated with greater use of non-preventive outpatient visits, filled prescriptions, and overall use of healthcare. Incidences of adjustment disorders were 4 times and attention-deficit conducts were 2 times higher among children with the highest FMI-ACE scores than those with zero FMI-ACEs.
Wade C.
Trajectories for children and young people who experience out of home care: Examining the influences of pre-care characteristics on later wellbeing and placement stability. Child Abuse Negl. 2023:106398. PMID: 37612203
In this analysis of children in out-of-home care, “Children who were older at entry to care (mean 7.6 years) showed the poorest socio-emotional and cognitive functioning at Wave 2, and despite improvements by Wave 4, the poor starting point may explain why their cognitive functioning scores never catch up to children entering care younger (mean 1.5 years). Younger on entry children who also tended to come from less socio-economically disadvantaged backgrounds showed the most positive cognitive and socio-emotional functioning over study waves…Placement changes between waves were lowest for children who entered care younger.”
Kim H, Song EJ, Windsor L.
Longitudinal changes in the county-level relationship between opioid prescriptions and child maltreatment reports, United States, 2009-2018. Am J Orthopsychiatry. 2023;93(5):375-88. PMID: 37184964
Combining multiple national databases, “the county-level relationship between opioid prescriptions and county maltreatment reports was four times as strong in 2018 as it had been in 2012. This trend was also observed within all subgroups of child age and sex. By type, this trend was somewhat more pronounced for neglect, but somewhat less for sexual abuse. Our findings suggest a growing need for greater efforts to prevent child maltreatment in communities with high opioid prescription rates.”
Klebanov B, Tsur N, Katz C.
"Many bad things had been happening to me": Children's perceptions and experiences of polyvictimization in the context of child physical abuse. Child Abuse Negl. 2023;145:106429. PMID: 37683405
From forensic interviews with 117 children aged 5-14, authors note the importance of the interview as a means of revealing the entire burden of polyvictimization instead of focusing on the physical abuse alone, understanding the context of how children view the abuse and how they cope, and aspects of self-blame and negative self-image to be addressed in treatment.
Adult Manifestations of Child Abuse
Bigio B, Sagi Y, Barnhill O, et al.
Epigenetic embedding of childhood adversity: mitochondrial metabolism and neurobiology of stress-related CNS diseases. Front Mol Neurosci. 2023;16:1183184. PMID: 37564785
Authors discuss “emerging epigenetic mechanisms underlying the long and winding road from adverse childhood experiences to adult physiology and brain functions…while it is not possible to ‘roll back the clock’, deeper understanding of the biological pathways and mechanisms through which stress produces a lifelong vulnerability to altered mitochondrial metabolism can provide a path for compensatory neuroplasticity.”
Kalin NH.
Early-life Adversity and Genetics Associated With the Risk to Develop Psychiatric Illnesses. Am J Psychiatry. 2023;180(8):525-7. PMID: 37525597
“The factors that determine the risk for most psychiatric disorders are present early in life even though the symptoms of these disorders may not emerge until later childhood, adolescence, or adulthood. This issue of the Journal pursues this neurodevelopmental theme by focusing on early-life factors that confer the risk for the later development of psychopathology.” Table of Contents
Harkness KL, Chakrabarty T, Rizvi SJ, et al.
The Differential Relation of Emotional, Physical, and Sexual Abuse Histories to Antidepressant Treatment Remission and Persistence of Anhedonia in Major Depression: A CAN-BIND-1 Report. Can J Psychiatry. 2023;68(8):586-95. PMID: 36785892
Of 164 individuals being treated for depression, “We identify emotional maltreatment as a specific early exposure that places patients at the greatest risk for nonremission following pharmacological treatment. Further, we suggest that anhedonia [lack of ability to feel pleasure] is a key symptom domain driving nonremission in patients with particular maltreatment histories.”
Crede M, Tynan M, Harms PD, Lester PB.
Clarifying the association between adverse childhood experiences and postdeployment posttraumatic stress disorder symptom severity: A meta-analysis and large-sample investigation. J Trauma Stress. 2023 Aug;36(4):700-711. PMID: 37282808
Authors review the research showing an association between ACEs and and increased severity of PTSD symptoms in military personnel with combat exposure.
de Bles NJ, Pütz LEH, Rius Ottenheim N, et al.
Childhood trauma and anger in adults with and without depressive and anxiety disorders. Acta Psychiatr Scand. 2023;148(3):288-301. PMID: 37430486
Of 2271 Dutch adults, average age 42.1 years, and 66.2% female, “Childhood trauma showed a dose-response association with all anger constructs…all types of childhood trauma except for sexual abuse were associated with higher levels of trait anger, and a higher prevalence of anger attacks and antisocial personality traits in adulthood…Focus on childhood traumatic experiences and adulthood anger may help to enhance the effectiveness of treatment for patients with depressive and anxiety disorders.”
Testa A, Jacobs B, Zhang L, et al.
Adverse childhood experiences and prescription opioid use during pregnancy: an analysis of the North and South Dakota PRAMS, 2019-2020. BMC Pregnancy Childbirth. 2023;23(1):602. PMID: 37612614
Of 2999 pregnant individuals from North and South Dakota, “The prevalence of prescription opioid use increases alongside more ACE exposure. Compared to those with no ACEs, recent mothers with three or more ACEs have a 2.4 greater odds of prescription opioid use during pregnancy…The findings suggest the need for additional research to understand better the link between ACEs and prescription opioid use during pregnancy, as well as how to support those with ACEs exposure in a trauma-informed manner to reduce the risk of subsequent substance use.”
Asheh AM, Courchesne-Krak N, Kepner W, Marienfeld C.
Adverse Childhood Experiences Are Associated With History of Overdose Among Patients Presenting for Outpatient Addiction Care. J Addict Med. 2023 May-Jun 01;17(3):333-338. PMID: 37267182
For 115 adults being treated as outpatients for both mental health and addiction concerns, 22.6% reported an overdose in the past. Those with overdose history had a mean ACE score of 4.9 vs. 2.3 without overdose.
Bürgin D, Clemens V, Witt A, Sachser C, Jud A, Brähler E, et al.
Adverse childhood experiences increase the risk for low perceived social participation and health-related quality of life in a large-scale population-based study in Germany. Child Abuse Negl. 2023;144:106382. PMID: 37527561
Of 2531 adults as a representative German population sample, mean age 48.7 years, 51% women, “This study shows people exposed to ACEs to have a higher risk for lower perceived social participation and lower health-related QoL… Reduction of chronic stress, fostering of social support, and educational and vocational interventions are discussed to enable those with precarious starting conditions to partake in society.”
D'Arcy-Bewick S, Turiano N, Sutin AR, et al.
Adverse childhood experiences and all-cause mortality risk in adulthood. Child Abuse Negl. 2023;144:106386. PMID: 37542995
For 6319 midlife adults, and regardless of sex, “ACEs may be cumulatively associated with increased mortality risk, such that each individual ACE increases risk. Physical abuse may be an important ACE type within a mortality risk context.”
Hayes DK, Wiltz JL, Fang J, Loustalot F.
Less than ideal cardiovascular health among adults is associated with experiencing adverse childhood events. Prev Med. 2023 Apr;169:107457. PMID: 36813249
“Ideal cardiovascular health (CVH) is associated with a lower risk of heart disease and stroke while adverse childhood events (ACEs) are related to health behaviors (e.g., smoking, unhealthy diet) and conditions (e.g., hypertension, diabetes) associated with CVH…among 86,584 adults ≥18 years from 20 states…just 1 in 9 report ideal CVH. At least one ACE was reported in nearly two-thirds of adults and about 1 in 5 reported ≥4 ACEs. This study demonstrates the disproportionate burden for those reporting ≥4 ACEs having both poor and intermediate CVH.”
Keirns BH, Keirns NG, Tsotsoros CE, et al.
Adverse Childhood Experiences and Obesity Linked to Indicators of Gut Permeability and Inflammation in Adult Women. Physiol Behav. 2023:114319. PMID: 37562704
“Gut permeability may increase cardiovascular disease risk by allowing bacterial components (e.g., lipopolysaccharides) to enter the bloodstream, leading to low-grade inflammation. People with adverse childhood experiences (ACEs) consistently display evidence of chronic inflammation, but the source of this inflammation, and whether gut permeability may contribute, is unknown.” In this study of 79 women, aged 18-84 years, free of cardiometabolic diseases and inflammatory conditions, and not regularly taking anti-inflammatory medications, “ACE status and obesity were independently associated with evidence of gut permeability and systemic inflammation.”
Kumsta R.
The role of stress in the biological embedding of experience. Psychoneuroendocrinology. 2023;156:106364. PMID: 37586308
“This review summarises evidence showing that experience of early adversity in the form of childhood abuse or neglect and exposure to severe institutional deprivation influences multiple interconnected bio-behavioural, physiological and cellular processes. This paper focusses on dysregulations of hormonal stress regulation, altered DNA methylation pattern, changes to transcriptomic profiles in the context of stress-immune interplay, and mitochondrial biology.”
Simon L, Admon R.
From childhood adversity to latent stress vulnerability in adulthood: the mediating roles of sleep disturbances and HPA axis dysfunction. Neuropsychopharmacology. 2023;48(10):1425-35. PMID: 37391592
“Childhood adversity is a prominent predisposing risk factor for latent stress vulnerability, expressed as an elevated likelihood of developing stress-related psychopathology upon subsequent exposure to trauma in adulthood. Sleep disturbances have emerged as one of the most pronounced maladaptive behavioral outcomes of childhood adversity and are also a highly prevalent core feature of stress-related psychopathology…the current review addresses the notion that childhood adversity-induced sleep disturbances may play a causal role in elevating individuals' stress vulnerability in adulthood…Next, we present evidence to support the contribution of the hypothalamic-pituitary-adrenal (HPA) axis to these associations, stemming from its critical role in stress and sleep regulatory pathways…sleep disturbances and HPA axis dysfunction reinforce each other, leading to elevated stress vulnerability.”
Nicolson KP, Mills SEE, Senaratne DNS, Colvin LA, Smith BH.
What is the association between childhood adversity and subsequent chronic pain in adulthood? A systematic review. BJA Open. 2023;6:100139. PMID: 37588177
From a research review including 196,130 patients, “There were consistent associations between adverse childhood experiences and chronic pain in adulthood, with a 'dose'-dependent relationship. Poor mental health was found to mediate the detrimental connection between adverse childhood experiences and chronic pain…Adverse childhood experiences should be considered in patient assessment, and early intervention to prevent adverse childhood experiences may help reduce the genesis of chronic pain.”
Pierce J, Harte SE, Afari N, Bradley CS, Griffith JW, Kim J, et al.
Mediators of the association between childhood trauma and pain sensitivity in adulthood: a Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research. Pain. 2023;164(9):1995-2008. PMID: 37144687
“Our findings suggest that sexual and nonsexual violent trauma during childhood are indirectly associated with pain sensitivity among adult patients with urogenital chronic pelvic pain syndrome. Heightened generalized sensory sensitivity played a unique role in conveying these effects, highlighting the need for clinicians and researchers to recognize the importance of physiological sensitivity to the pain experience for individuals with a history of childhood trauma.”
Njoroge A, Shariff MA, Khan HW, et al.
Assessment of Adverse Childhood Experiences in the South Bronx on the Risk of Developing Chronic Disease as Adults. Cureus. 2023;15(8):e43078. PMID: 37680403
For 454 adults seen at a primary care clinic in the South Bronx, with average age 53.1 years, 30% reported 4+ ACEs. There was a significant relationship between total and specific ACEs and chronic illness, including hyperlipidemia, hypertension, diabetes, mental illness, and substance use. “Such data elucidates the need for physicians to prioritize and incorporate social services, education, physical environment, and nutritional access in overall patient well-being.”
Amos RLM, Cresswell K, Hughes K, Bellis MA.
ACEtimation-The Combined Effect of Adverse Childhood Experiences on Violence, Health-Harming Behaviors, and Mental Ill-Health: Findings across England and Wales. Int J Environ Res Public Health. 2023;20(17). PMID: 37681773
Of 21,716 adults aged 18-69 years in England and Wales, 56.6% female, “Exposure to child maltreatment and household dysfunction in isolation were strong predictors of…being involved in violence, engaging in health-harming behaviors, and experiencing mental ill-health…witnessing violence amplified the measured risk beyond expected levels for being a victim or perpetrator of violence.”
McDonagh D, de Vries J, Cominskey C.
The Role of Adverse Childhood Experiences on People in Opiate Agonist Treatment: The Importance of Feeling Unloved. Eur Addict Res. 2023:1-10. PMID: 37669628
Of 131 Irish adults participating in opiate agonist treatment (e.g. methadone), “While a summation of all ten ACEs predicted higher levels of PTSD, the factor "feeling unloved" as a child provided the single strongest predictor and may represent an overarching risk of PTSD and continued substance use in later life among adults in treatment for an opiate use disorder.”
Gibbs V, Hudson J, Pellicano E.
The Extent and Nature of Autistic People's Violence Experiences During Adulthood: A Cross-sectional Study of Victimisation. J Autism Dev Disord. 2023 Sep;53(9):3509-3524. PMID: 35821545
“Autistic (n = 118) and non-autistic (n = 110) adults completed a questionnaire about their experiences of sexual harassment, stalking, sexual violence and physical violence since the age of 15. Autistic adults reported higher rates of all violence types, multiple forms of violence and repeated instances of the same type of violence. Typical gender differences in the patterns of violence (more physical violence reported by men and more sexual violence reported by women) were apparent in the non-autistic but not the autistic group. Findings add to the limited research in this area and highlight the need to identify risk and protective factors.”
Moorman J, Romano E.
The experience of childhood sexual abuse: An exploratory description of psychological and adaptive functioning in Canadian men. Child Abuse Negl. 2023;145:106402. PMID: 37603934
Of 69 Canadian men aged 25-60 years who experienced childhood sexual abuse (CSA) compared to a control group, “CSA men were an average of 8.5 years old at abuse onset. Most (62.3 %) had disclosed their CSA experience, waiting an average of 13.6 years before disclosure. After controlling for covariates (i.e., other types of maltreatment, non-maltreatment adversities, education, income), results indicated a significant association between CSA and men's psychological functioning [cognition and learning, motivation, social and emotional dimensions, context and learning], but not their adaptive functioning [a person's ability to cope with the demands of everyday life and adapt to changing situations].”
Mamun A, Biswas T, Scott J, et al.
Adverse childhood experiences, the risk of pregnancy complications and adverse pregnancy outcomes: a systematic review and meta-analysis. BMJ Open. 2023;13(8):e063826. PMID: 37536966
“Pooled analyses showed that exposure to ACEs increased the risk of pregnancy complications (OR 1.37) and adverse pregnancy outcomes (OR 1.31). Maternal ACEs were associated with gestational diabetes mellitus (OR 1.39), antenatal depression (OR 1.59), low offspring birth weight (OR 1.27), and preterm delivery (OR 1.41)…Preventive strategies, screening and trauma-informed care need to be examined to improve maternal and child health.”
Palmisano AN, Schwartz EKC, Gueorguieva R, Sofuoglu M.
Associations between Childhood Trauma and Tobacco Use Outcomes in Adults after Overnight Abstinence. Nicotine Tob Res. 2023 Aug 11:ntad135. PMID: 37565294
Of 205 smoking adults who had a variety of tests done after a night of smoking abstinence, “Relative to those with no/minimal abuse, those with moderate/severe abuse had higher negative affect, withdrawal severity, and plasma cotinine levels [a metabolite of nicotine and marker of smoking intensity]…women were more likely than men to have urges to smoke…and have higher withdrawal severity…childhood trauma history may be a marker for smoking susceptibility and suggests that individuals [especially] with experiences of emotional and sexual abuse may require targeted forms of smoking cessation interventions.”
Comments (0)