[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!! — Jane Stevens]
Child Abuse
Vermeulen S, Alink LRA, van Berkel SR.
Child Maltreatment During School and Childcare Closure Due to the COVID-19 Pandemic. Child Maltreat. 2022 Feb 1:10775595211064885. PMID: 35105228
“Based on reports of Dutch childcare professionals and school teachers (N = 444)…The prevalence of emotional neglect was found to be three times higher during the lockdown compared to a period without lockdown…reflected in overall emotional neglect as well as for educational neglect and witnessing domestic violence. No significant differences were found for other types of child maltreatment. Most of the reported cases of maltreatment were already problematic before the lockdown and became worse…the closure of schools and childcare settings may have enormous negative consequences for vulnerable children.”
Machlin L, Gruhn MA, Miller AB, et. al.
Predictors of family violence in North Carolina following initial COVID-19 stay-at-home orders. Child Abuse Negl. 2021 Oct 25:105376. PMID: 34728100
For 120 North Carolina families with children aged 4-11 who completed weekly surveys, “results clearly demonstrate that high levels of family violence occurred following the stay-at-home orders, especially in families with higher baseline violence, higher caregiver emotional reactivity, and caregiver un/under-employment…vulnerable families may…need additional support in moments of crisis.”
Malige A, Deemer A, Sobel AD.
The Effect of COVID-19 on Pediatric Traumatic Orthopaedic Injuries: A Database Study. J Am Acad Orthop Surg Glob Res Rev. 2022 Feb 11;6(2). PMID: 35148285
For 1112 children with orthopedic injuries seen during the pandemic at Pennsylvania trauma hospitals, compared to pre-pandemic data, more injuries occurred at home (54.9% vs. 44.7%) and fewer at sporting areas, parks, pools and schools. Injuries caused by child abuse were more prevalent during the pandemic (11.0% vs. 5.6%), and injured children had longer mean hospital length of stay, higher mean number of ICU days, and higher mortality rate (3.8% vs. 1.3%).
Marr MC, Gerson R, Lee M, et. al.
Trauma Exposure and Suicidality in a Pediatric Emergency Psychiatric Population. Pediatr Emerg Care. 2022 Feb 1;38(2):e719-e723. PMID: 35100769
Of 861 youth who presented to a dedicated child psychiatric emergency department during a 1-year period, 52% reported at least one type of trauma exposure. Emotional abuse, physical abuse, sexual abuse/assault, and bullying were associated with suicidality. Total number of trauma exposures were associated with suicide attempts. After adjusting for sociodemographic characteristics, children who reported a history of emotional abuse had 3.2-fold increased odds of attempted suicide.
Cuartas J, Weissman DG, Sheridan MA, et. al.
Corporal Punishment and Elevated Neural Response to Threat in Children. Child Dev. 2021 May; 92(3):821-832. PMID: 33835477
For 40 children who were spanked (mean age 11.4 years) compared to 107 who were not spanked, and for whom none of the participants had experienced child physical or sexual abuse, brain scans of those who had been spanked showed increased brain activation in response to seeing fearful faces relative to neutral faces. “Spanking may alter neural responses to environmental threats in a manner similar to more severe forms of maltreatment.” Overreaction to threats may result in behavioral consequences.
Sonagra M, Jones J, McGill M, Gmuca S.
Exploring the intersection of adverse childhood experiences, pediatric chronic pain, and rheumatic disease. Pediatr Rheumatol Online J. 2022 Feb 14;20(1):14. PMID: 35164793
Of 412 patients seen at a pediatric rheumatology pain clinic, “more than 75% reported at least one ACE. Most frequent included history of mental illness in a first degree relative (56%) and parental divorce or separation (20%). Those with ≥2 ACEs had more somatic [physical] symptoms, worse functional disability, and a higher proportion of mental health conditions. There appeared to be a dose dependent interaction between ACEs and functional disability.”
Lin SX, Bresnahan M, Amsel L, et. al.
Adverse Childhood Experiences (ACEs) and Insufficient Sleep among U.S. Children and Adolescents. Acad Pediatr. 2022 Feb 12:S1876-2859(22)00067-5. PMID: 35167994
From a national survey of 46,209 US youth, “Approximately half of U.S. children and adolescents (ages 6-17) experienced at least one ACE and a third did not get sufficient sleep. Among those exposed to any ACE, 40.3% had insufficient sleep duration. Seven of the nine ACEs examined were significantly associated with a 20-60% increase in odds of not getting sufficient sleep. Children exposed to two or more ACEs were nearly twice as likely as those exposed to no ACEs to have insufficient sleep duration. Moreover, each individual ACE, except parental death, was significantly associated with more than one hour less sleep than recommended.”
Adult Manifestations of Child Abuse
Hendrix CL, Dilks DD, McKenna BG, et. al.
Maternal Childhood Adversity Associates With Frontoamygdala Connectivity in Neonates. Biol Psychiatry Cogn Neurosci Neuroimaging. 2021 Apr;6(4):470-478. PMID: 33495120
For 48 mother and 1 month-old child pairs, “the infant children of mothers who had themselves experienced childhood emotional neglect displayed altered brain circuitry involved in fear responses and anxiety…This effect was specific to early experiences of emotional neglect and was not explained by maternal exposure to other forms of childhood maltreatment or by maternal distress during pregnancy.”
Joshi D, Raina P, Tonmyr L, MacMillan HL, Gonzalez A.
Prevalence of adverse childhood experiences among individuals aged 45 to 85 years: a cross-sectional analysis of the Canadian Longitudinal Study on Aging. CMAJ Open. 2021 Mar 2;9(1):E158-E166. PMID: 33653771
Of 44,817 Canadian adults aged 45-85, 61.6% reported exposure to at least 1 ACE. “Exposure to physical abuse (25.7%), intimate partner violence (22.4%) and emotional abuse (21.8%) were the most prevalent types of ACEs…Reporting for many ACEs was higher among women and those of non-heterosexual orientation.”
Lin L, Sun W, Lu C, Chen W, Guo VY.
Adverse childhood experiences and handgrip strength among middle-aged and older adults: a cross-sectional study in China. BMC Geriatr. 2022 Feb 12;22(1):118. PMID: 35148695
Of 7209 Chinese adults aged 45 years or older from 28 provinces, 31.3% reported 3+ ACEs. Exposure to 3+ ACEs, compared to those with 0 ACEs, and after adjusting for for age, sex, marital status, ethnicity, area of residence, smoking and drinking status, body mass index, hypertension, dyslipidaemia, diabetes mellitus, cardiovascular disease, arthritis, hip fracture, and memory-related disease, was negatively associated with continuous hand grip strength, and positively associated with low muscle strength, for both men and women.
Hardcastle K, Ford K, Bellis MA.
Maternal adverse childhood experiences and their association with preterm birth: secondary analysis of data from universal health visiting. BMC Pregnancy Childbirth. 2022 Feb 16;22(1):129. PMID: 35172776
From a study of Welsh pregnant women, half of all mothers sampled had experienced at least one ACE. “Preterm birth was significantly independently associated with retrospective reports of childhood sexual abuse (adjusted odds ratio [AOR] = 3.83), neglect (AOR = 7.60) and overall ACE exposure (AOR = 2.67).”
Yang Q, Þórðardóttir EB, Hauksdóttir A, et. al.
Association between adverse childhood experiences and premenstrual disorders: a cross-sectional analysis of 11,973 women. BMC Med. 2022 Feb 21;20(1):60. PMID: 35184745
From a large national survey of Icelandic women, mean age 34.0 years, 27% met probably criteria for PMD (pre-menstrual disorders) - 21% PMS (pre-menstrual syndrome) and 6% for PMDD (pre-menstrual dysphoric disorder). PMDs were positively linearly associated with number of ACEs, with PMDs 2.46 times more likely in women with 4+ ACEs compared to those with 0 ACEs.
Daníelsdóttir HB, Aspelund T, Thordardottir EB, et. al.
Adverse childhood experiences and resilience among adult women: A population-based study. Elife. 2022 Feb 1;11:e71770. PMID: 35101173
From a large study of Icelandic female adults aged 18-69, number of ACEs was inversely associated with adult resilience in a dose-dependent manner. “Specific ACEs including emotional neglect, bullying, sexual abuse and mental illness of household member were consistently associated with reduced adult resilience. We observed only slightly attenuated associations after controlling for adult socioeconomic factors and social support in adulthood… indicating that adult resilience may be largely determined in childhood.”
Bellis MA, Hughes K, Ford K, et. al.
Associations between adverse childhood experiences, attitudes towards COVID-19 restrictions and vaccine hesitancy: a cross-sectional study. BMJ Open. 2022 Feb 1;12(2):e053915. PMID: 35105582
For 2285 Welsh adults, “Increasing ACE counts were independently related to low trust in NHS [National Health Service] COVID-19 information, feeling unfairly restricted by government, and ending mandatory face coverings. High ACE counts (4+ vs 0 ACEs) were also associated with supporting removal of social distancing. Breaking COVID-19 restrictions increased with ACE count with likelihood doubling from no ACEs to 4+ ACEs. Vaccine hesitancy was threefold higher with 4+ ACEs (vs 0 ACEs) and higher in younger age groups…ACEs are common across populations of many countries. Understanding how they impact trust in health advice and uptake of medical interventions could play a critical role in the continuing response to COVID-19 and controlling future pandemics.”
Kisely S, Strathearn L, Najman JM.
Self-reported and agency-notified child abuse as a contributor to health anxiety in a population-based birth cohort study at 30-year-follow-up. J Acad Consult Liaison Psychiatry. 2022 Feb 14:S2667-2960(22)00016-7. PMID: 35176517
Health anxiety is the worry of having an illness (older term hypochondriasis). For 2458 Australian adults with data on health anxiety, “Self-reported childhood maltreatment of all types showed significant associations with increased health anxiety..Effects were strongest in women.”
Roberts AL, Zafonte R, Chibnik LB, et. al.
Association of Adverse Childhood Experiences With Poor Neuropsychiatric Health and Dementia Among Former Professional US Football Players. JAMA Netw Open. 2022 Mar 1;5(3):e223299. PMID: 35315919
“Of 1755 former professional US football players, ACEs were associated with a positive dementia screening result. Players with at least 4 ACEs were 48% more likely to have a positive finding on a dementia screen and were at greater risk of poor cognition-related quality of life, pain, and depression compared with players with no ACEs.” From a commentary, this article “makes a strong addition to the literature that athletes with a history of psychological trauma or a mental health disorder are at greater risk of psychological manifestations of concussion compared with athletes without such history – ‘athletes injure the brain they have’.” [Consider the implications for women with ACEs and IPV concussion…]
Adolescents
Aytur SA, Carlino S, Bernard F, West K, Dobrzycki V, Malik R.
Social-ecological theory, substance misuse, adverse childhood experiences, and adolescent suicidal ideation: Applications for community-academic partnerships. J Community Psychol. 2022 Jan;50(1):265-284. PMID: 33942321
In a 2015 survey of New Hampshire 9-12 grade students, the prevalence of suicidal ideation was 15.4% (girls 20.15%, boys 10.67%), and higher ACE scores were associated with a 61% increased risk of suicidality. Protective factors included parental support, good grades, physical activity and community service. Authors show a concept of academic and community partnership impacting community services and legal policy regarding risk and protective behavioral factors.
Parks MJ, Roesler J, Menanteau B, Raguet M, Eisenberg ME.
The Intersection of Depressive Symptoms, Adverse Childhood Experiences, and Protective Factors Among Adolescents: Epidemiological Evidence from Minnesota, 2016 and 2019. Advers Resil Sci. 2022 Jan 26:1-16. PMID: 35098150
From surveys of students in 8, 9, and 11th grades in Minnesota, “Depressive symptoms are highest among adolescents with high risk [4+ ACEs] and few protective factors, and recent increases in the prevalence of depressive symptoms appear to have disproportionately occurred among these adolescents.”
Dubowitz H, Roesch S, Lewis T, et. al.
Neglect in Childhood, Problem Behavior in Adulthood. J Interpers Violence. 2022 Feb 13:8862605211067008. PMID: 35156437
For 473 participants in a long-term study now at mean age 23.8 years, “High-risk youth experiencing neglect beginning in mid-adolescence appear especially vulnerable to later criminal behavior, psychological distress, and IPAV [intimate partner aggression and violence]. Those working with such youth can help ensure that their needs are adequately met, to prevent or mitigate problems in adulthood.”
LGBTQ Concerns
Edwards KM, Scheer JR, Littleton H, Mullet N.
Preventing adverse childhood experiences among sexual and gender minority youth: A call to action. J Gay Lesbian Ment Health. 2021;25(4):355-357. PMID: 35173826
“Over half of SGMY [sexual and gender minority youth] report familial emotional neglect and nearly one in four SGMY report physical abuse by a caregiver. Some forms of ACEs are specific to SGMY, such as family rejection of youth’s sexual orientation and/or gender identity, as well as caregiver-initiated sexual orientation change efforts. There is an urgent need to develop evidence-based programs to prevent family-based ACEs in SGMY.”
Race/Cultural Concerns
Harlow SD, Burnett-Bowie SM, Greendale GA, et. al.
Disparities in Reproductive Aging and Midlife Health between Black and White women: The Study of Women's Health Across the Nation (SWAN). Womens Midlife Health. 2022 Feb 8;8(1):3. PMID: 35130984
“This paper reviews differences in the experience of the menopause transition and midlife health outcomes between Black and White women who participated in the Study of Women’s Health Across the Nation (SWAN), a 25‑year, longitudinal, multi‑racial/ethnic cohort study…and elucidates the contextual factors that are likely influencing these disparities. We review the strengths and weaknesses of SWAN’s design and approach to analysis of racial disparities and…offer recommendations for future cohort studies.”
Valencia CI, Gachupin FC, Molina Y, Batai K.
Interrogating Patterns of Cancer Disparities by Expanding the Social Determinants of Health Framework to Include Biological Pathways of Social Experiences. Int J Environ Res Public Health. 2022 Feb 21;19(4):2455. PMID: 35206642
“Black, Indigenous, and People of Color (BIPOC) populations experience more negative outcomes across the cancer Continuum.” Authors discuss a combined model of social determinants of health with disparities throughout the lifespan that “may contribute to disproportionate tumorigenesis and tumor progression.”
Collins JW Jr, David RJ.
Black Babies Matter. Clin Perinatol. 2022 Mar;49(1):93-101. PMID: 35210011
“Despite dramatic advancements in neonatal intensive care since the 1960s, African-American infants still have more than a two-fold higher first-year mortality rate than non-Latinx White infants.” Authors discuss the impact of racism and social class in the United States on the “African-American women's birth outcome disadvantage”.
Scarlett W.
The Hippocratic Oath Does Not Cover Racism: How Do We React When Ethical and Moral Issues Arise with Our Physician Colleagues? J Am Coll Surg. 2022 Mar 1;234(3):395-397. PMID: 35213504
Author brings up dilemmas occurring when a physician with extensive racist/homophobic media posts applies for hospital credentialling – most hospitals do not check social media, and do not have procedural guidelines covering this scenario.
Providers
Shonkoff JP, Boyce WT, Levitt P, Martinez FD, McEwen B.
Leveraging the Biology of Adversity and Resilience to Transform Pediatric Practice. Pediatrics. 2021 Feb;147(2):e20193845. PMID: 33495367
“Building on growing public awareness of the impact of early experiences on the developing brain, pediatricians are well positioned to drive an expanded understanding of how the interactive influences of genetic predispositions, physical and social environments, and developmental timing affect the foundations of both school readiness and lifelong health.” Recommendations are made at both the practice and population level.
Steen M, Raynor J, Baldwin CD, Jee SH.
Child Adversity and Trauma-Informed Care Teaching Interventions: A Systematic Review. Pediatrics. 2022 Feb 15:e2021051174. PMID: 35165742
This review “described curricula on ACEs, TIC, and child maltreatment taught to health care professionals and trainees. The curricula varied widely in breadth, duration, and quality…pediatric providers need to learn to exercise caution in screening children for ACEs, to avoid creating a self-fulfilling ‘expectancy effect’ that labels a high-risk child as likely to have poor outcomes. Good teaching will give the next generation of health care professionals foundational knowledge to address ACEs proactively and implement effective TIC to improve the lives of children.”
Loveday S, Hall T, Constable L, et. al.
Screening for Adverse Childhood Experiences in Children: A Systematic Review.
Pediatrics. 2022 Feb 1;149(2):e2021051884. PMID: 35104358
From a review of ACEs screening studies, authors conclude that “Screening for ACEs increases identification of adversity and may increase referrals to services. There are limited data about whether this leads to an increase in referral uptake by families. There are no reported data addressing mental health outcomes.”
Wamser-Nanney R, Campbell CL.
Correlates of caregiver's help seeking behavior among young maltreated children. Child Abuse Negl. 2022 Apr;126:105520. PMID: 35091133
For 448 six-year-old maltreated children, the child’s level of behavioral challenges, caregiver’s level of education, and caregiver’s depression significantly contributed to decisions regarding seeking mental health consultation for the child. Cumulative maltreatment and individual types of maltreatment were not tied to help-seeking behavior.
Mudrick NR, Blackwell J, Watts C, et. al.
How do States Inform Nurses of Their Policies for Mandatory Reporting of Child Maltreatment? Policy Polit Nurs Pract. 2022 Feb 16:15271544211072843. PMID: 35171056
From a state-by-state analysis of websites on appropriately identifying and reporting suspected child abuse or neglect, authors found that states provide little guidance or education about their child maltreatment laws, and few have resources targeted for nurses. “States should consider adding mandatory reporting training as a requirement for nursing licensure and for continuing education.”
Prevention
Marks C, Pearson JL, Zúñiga ML, Martin N, Werb D, Smith LR.
Articulating the Trauma-Informed Theory of Individual Health Behavior. Stress Health. 2022 Feb;38(1):154-162. PMID: 34009751
“The Trauma-Informed Theory of Individual Health Behavior (TTB) posits that individual capacity to undertake intentional health-promoting behaviour change is dependent on three factors: (1) the forms and severity of trauma they have been and are exposed to, (2) how this trauma physiologically manifests (i.e., the trauma response) and (3) resilience to undertake behaviour change despite this trauma response. We define each of these factors and their relationships to one another…TTB holds the potential to help researchers and policymakers better understand and intervene on the harms of trauma, and to ultimately support the development of interventions to reduce health behaviour disparities.”
Boyce WT, Levitt P, Martinez FD, McEwen BS, Shonkoff JP.
Genes, Environments, and Time: The Biology of Adversity and Resilience. Pediatrics. 2021 Feb;147(2):e20201651. PMID: 33495368
“We identify 4 core concepts that provide a powerful catalyst for fresh thinking about primary health care for young children: (1) all biological systems are inextricably integrated, continuously ‘reading’ and adapting to the environment and ‘talking back’ to the brain and each other through highly regulated channels of cross-system communication; (2) adverse environmental exposures induce alterations in developmental trajectories that can lead to persistent disruptions of organ function and structure; (3) children vary in their sensitivity to context, and this variation is influenced by interactions among genetic factors, family and community environments, and developmental timing; and (4) critical or sensitive periods provide unmatched windows of opportunity for both positive and negative influences on multiple biological systems. These rapidly moving frontiers of investigation provide a powerful framework for new, science-informed thinking about health promotion and disease prevention in the early childhood period.”
Qu G, Ma S, Liu H, et. al.
Positive childhood experiences can moderate the impact of adverse childhood experiences on adolescent depression and anxiety: Results from a cross-sectional survey. Child Abuse Negl. 2022 Mar;125:105511. PMID: 35078091
For 6363 Chinese elementary and middle school children, “there was a significant positive dose-response relationship between cumulative ACEs exposure and risk of depression and anxiety. There was an inverse dose-response relationship between cumulative PCEs (positive childhood experiences) exposure and risk of depression. Adolescents with low ACEs (<4 counts) and high PCEs (6-7 counts) exposure showed significant lower risk of depression.”
Researchers
Lombard PK, Cronholm PF, Forke CM.
Practical Guidance for Using Behavioral Risk Factor Surveillance System Data: Merging States and Scoring Adverse Childhood Experiences. Am J Prev Med. 2022 Feb 1:S0749-3797(22)00002-2. PMID: 35120769
“The Behavioral Risk Factor Surveillance System is a national health-related survey with an optional adverse childhood experience (ACE) module. States use varying methodologies, question formats, and sampling frames, and little guidance exists for conducting multistate explorations of adverse childhood experiences. In this study, 6 adverse childhood experience scoring approaches are compared, and practical recommendations are offered for when and how each approach can be utilized most effectively.”
Zurca AD, Suttle ML, October TW.
An Antiracism Approach to Conducting, Reporting, and Evaluating Pediatric Critical Care Research. Pediatr Crit Care Med. 2022 Feb 1;23(2):129-132. PMID: 35119430
“In this Special Article for Pediatric Critical Care Medicine, we introduce an antiracism approach to conducting, reporting, and evaluating pediatric critical care research. We propose four recommendations: 1) race and ethnicity are social constructs that should be evaluated as such, with researchers considering the context and relevance of related social determinants of health; 2) race and ethnicity data should be collected with sufficient detail to allow detection of meaningful results and minimize the risk of overgeneralizing findings; 3) as health equity research evolves, the pediatric critical care research field must adapt and proactively strive for inclusivity; and 4) the research community, including investigators, authors, research ethics committees, funding organizations, professional organizations, and journal editorial boards, are all accountable for rigorously conducting and reporting race/ethnicity in research.”
Rozier MD, Patel KK, Cross DA.
Electronic Health Records as Biased Tools or Tools Against Bias: A Conceptual Model. Milbank Q. 2022 Mar;100(1):134-150. PMID: 34812541b
“Electronic health records (EHRs) are subject to the implicit bias of their designers, which risks perpetuating and amplifying that bias over time and across users. If left unchecked, the bias in the design of EHRs and the subsequent bias in EHR information will lead to disparities in clinical, organizational, and policy outcomes.” Authors explain “how elements of the EHR design (structure), use (process), and the ends for which it is used (outcome) can first be used to evaluate where bias may become embedded in the system itself, but then also identify opportunities to resist and actively challenge bias.”
Comments (0)