Pediatric Adverse Childhood Experiences: Implications for Life Course Health Trajectories

Abstract

lems have their origins early in life. 1 The timing, intensity, and cumulative burden of adversities, especially in the relative absence of protective factors, can affect gene expression, the conditioning of stress responses, and the development of immune system function. Individuals affected by a high burden of adverse experiences may adopt compensatory high-risk behaviors that can further erode their health and mental health. Not all adversity occurs in childhood(eg,military combat),but a highburden of cumulative intrafamilial (child maltreatment, domestic violence, impaired caregiving) and other adversities (income and food insecurity) in childhood can have profound lifelong effects unless mitigated by protective factors within the family or the community, or through specific interventions. Two of the articles in this issue indicate that the impact of intrafamilial adverse childhood experiences (ACEs) on health and mental health begin to manifest in childhood. Kerker et al 2 used the nationally representative longitudinal National Survey of Child and Adolescent Well-Being study toassessthe ACEscoresofchildrenunder theageof6years who remained at home after child protective investigation and found they were similar to those of children who were removed and placed in foster/kinship care. The authors also reported that higher ACE scores in this population were associated with more mental health (Child Behavior Checklist score >64) and chronic medical problems, and, for preschool children, lower social scores. Earlier studies of children informally placed with kinship caregivers after child welfare investigation showed a high prevalence of health problems, although fewer mental health problems, compared to children in nonrelative foster care, indicating that almost all children involved with child welfare are at high risk for poor outcomes that may be rooted in cumulative childhood trauma. 3 In a second article in this issue, Thompson et al 4 used LONGSCAN longitudinal data to