Adverse Childhood Experiences Study Research Articles

Feasibility Study of Adverse Childhood Experiences, Treatment-Related Sequelae, and Inflammatory Markers in Breast Cancer Survivors.

To explore the incidence of adverse childhood experiences (ACEs) in breast cancer survivors and potential associations with long-term treatment-related sequelae. English-speaking breast cancer survivors three or more years from diagnosis with complete treatment response (N = 120) were recruited prior to scheduled survivorship clinic visits. Participants in this cross-sectional observational feasibility study rated anxiety, depression, fatigue, sleep disturbance, cognitive issues, resilience, and ACEs (experienced prior to age 18 years). Blood samples were analyzed for inflammatory and epigenetic biomarkers. ACEs assessment was feasible. Higher ACE scores correlated with greater fatigue, anxiety, and depression, and with lower cognitive function (p < 0.05). Resilience was positively associated with cognitive function and negatively associated with fatigue, anxiety, and depression. There is evidence for the impact of ACEs on long-term treatment-related sequelae in women with breast cancer. Oncology nurses should consider incorporating ACEs assessment into the workflow for women receiving survivorship care.

Adverse Childhood Experiences (ACEs) in 252 Board-Certified Plastic Surgeons: Prevalences, ACE Clustering, and Effects on Adult Health and Behaviors, Including Self-Defined Depression, Work Addiction, and Burnout.

The CDC/Kaiser Adverse Childhood Experiences (ACE) study documented that ACEs predict adult health and self-harming behaviors. ACEs have been documented in physicians and are higher in physicians treated for problematic behavior. Plastic surgeons have never been assayed. Might ACE prevalences in plastic surgeons predict their adult health and/or behavior? 252 ABPS-certified plastic surgeons (72% men, 28% women, ) completed the 10-question CDC/Kaiser ACE survey by de-identified email. Data was collected on adult health and behaviors previously associated with ACEs in the literature. 42% of plastic surgeons had 1 or more ACEs; 9.9% had 4 or more. Emotional abuse was 2 times higher than the control CDC/Kaiser population, though other ACEs were lower. Gender differences existed: women suffered more sexual abuse (17% vs. 8%), physical neglect (7% vs. 1%), violence against their mothers (7% vs. 2%), and self-defined burnout (32% vs. 17%). ACEs occurred in clusters. Total ACEs predicted autoimmune disorders, chronic pain/fatigue, self-defined depression, irritable bowel, antidepressant/anxiolytic use, alcohol abuse, >3 marriages, >10 sexual partners, sex and work addiction, eating disorders, and self-defined burnout (all p< 0.020). Emotional abuse predicted alcohol abuse. Sexual abuse predicted sex addiction. Emotional neglect predicted autoimmune disease, antidepressant/anxiolytic use, eating disorder, and work addiction. Physical neglect predicted chronic fatigue/chronic pain, depression, and burnout (all p< 0.001 or less). Adverse childhood experiences occurred in 42% of our 252-member plastic surgeon cohort and predicted 13 adult illnesses and self-harming behaviors that can impair surgeons' lives and performances. Recognition may facilitate their recognition and treatment.

Comparative Study of Adverse Childhood Experiences of Adolescents in Indonesia

Comparative Study of Adverse Childhood Experiences of Adolescents in Indonesia

A Prospective Study of Adverse Childhood Experiences and Illicit Drug Use in Adulthood

Previous research indicates that adverse childhood experiences (ACEs) increase the risk for illicit drug use. Yet, much of this research relies on retrospective ACE reports and does not consider the wide array of more proximal life experiences that may impact adults’ substance use. The present research used two waves of data from the longitudinal Toledo Adolescent Relationships Study (TARS) to examine the impact of ACEs reported during adolescence on illicit drug use frequency in adulthood (average age 32) among 930 (403 men and 527 women) respondents. Findings indicated that ACEs had a cumulative effect on adults’ illicit drug use. Each additional ACE increased drug use frequency by 0.087 units (p &lt; 0.05). Biological sex (b = -0.446, p &lt; 0.001), number of biological children (b = -0.155, p &lt; 0.01), anxiety symptoms, (b = 0.071, p &lt; 0.001), adolescent drug use (b = 0.166, p &lt; 0.001), and residing with other substance-using individuals (b = 1.127, p &lt; 0.001) were also significant correlates of illicit drug use in adulthood. Mediation analyses revealed that respondents’ anxiety symptoms and adolescent drug use mediated the total effect of ACEs on adults’ drug use frequency. Based on these results, it is argued that clinicians and others working with those who are at risk for or who are presently using illicit substances should consider how early life adversity influences drug use, both directly and indirectly via proximal risks.

Leveraging multivariate approaches to advance the science of early-life adversity

Since the landmark Adverse Childhood Experiences (ACEs) study, adversity research has expanded to more precisely account for the multifaceted nature of adverse experiences. The complex data structures and interrelated nature of adversity data require robust multivariate statistical methods, and recent methodological and statistical innovations have facilitated advancements in research on childhood adversity. Here, we provide an overview of a subset of multivariate methods that we believe hold particular promise for advancing the field's understanding of early-life adversity, and discuss how these approaches can be practically applied to explore different research questions. This review covers data-driven or unsupervised approaches (including dimensionality reduction and person-centered clustering/subtype identification) as well as supervised/prediction-based approaches (including linear and tree-based models and neural networks). For each, we highlight studies that have effectively applied the method to provide novel insight into early-life adversity. Taken together, we hope this review serves as a resource to adversity researchers looking to expand upon the cumulative approach described in the original ACEs study, thereby advancing the field's understanding of the complexity of adversity and related developmental consequences.

Exploring the interconnection between adverse childhood experiences and psychological well-being of emerging adults in a rural community in Lagos, Nigeria

There has been an increase in the study of Adverse Childhood Experiences (ACEs) and their related outcomes in recent years. The current study explored the interconnections between ACEs and psychological wellbeing among emerging adults in a rural community in Lagos. The specific objectives were to establish the correlations between all the dimensions of ACEs and psychological wellbeing and check the predictive role of all the sub-conventional ACEs on psychological wellbeing. Three hundred seventy-eight high and tertiary school emerging adults were selected through a non-probabilistic sampling method. The ten conventional ACEs and Ryff's Psychological wellbeing scales were used to assess the respondents. Zero-order correlation and multiple regression were used to test the hypothesis. The results revealed that adverse childhood experience was significantly related to psychological wellbeing, which means that the higher the number of ACEs, the lower an individual's psychological wellbeing. Also, all the dimensions of ACEs significantly predict psychological wellbeing except verbal abuse (p =.160) and physical abuse (p =.515). ACEs were prevalent among emerging adults in rural communities and had deleterious effects on their psychological wellbeing. More work is needed in advocacies because several people do not know that physical and verbal abuse can affect the psychological wellbeing of emerging adults. Therefore, there is a need to develop various culturally appropriate assessment practices, interventions, and policy responses to the menace.

The Impact of Adverse Childhood Experiences on Problem Gambling in New Mexico.

The study of Adverse Childhood Experiences (ACEs) has consistently demonstrated a strong relationship with poor behavioral health outcomes. Further research is needed to understand if a specific ACE, or subcategorizations of ACEs, matter more for behavioral health outcomes. A study of the association between ACEs and problem gambling involving a racially mixed sample (13,217 participants) in New Mexico is presented to illustrate how certain ACEs may have a larger impact on behavioral health outcomes. The researchers examined: 1.) the impact that each individual ACE have on participant's reported problem gambling; 2) which group (abuse or household challenges) had a greater odds ratio and marginal impact on participant's self-reported gambling; and 3) which BRFSS subcategories (emotional abuse, physical abuse, sexual abuse, IPV, substance abuse, mental illness, parental separation or divorce, and incarcerated household member) had a greater odds ratio and marginal impact on participant's self-reported gambling. The results of this study indicate ACEs had a significant influence on problem gambling, and data suggests that when BRFSS data is examined in groups or subcategories there is a difference in the influence that ACEs have on problem gambling. In particular, we found that odds ratio to be significant when participants reported mental health problems in the home (OR = 1.34, 95% CI [1.02, 1.76], p < 0.04), living with incarcerated household members (OR = 1.75, 95% CI [1.28, 2.41], p < 0.001), how often adults hit each other (OR = 1.29, 95% CI [1.10, 1.52], p < 0.001), and how often anyone at least 5years older than them forced them to have sex (OR = 1.42, 95% CI [1.10, 1.82], p < 0.01) In relation to types of abuse, There was a significant difference in self-reported problem gambling for individuals who reported sexual abuse (OR = 1.64, 95% CI [1.10, 2.46], p < 0.016), as well as participants reporting living with an incarcerated household member (OR = 2.08, 95% CI [1.34, 3.22], p < 0.001); approaching significant results also included individuals who witnessed their parents act violent towards one another (OR = 1.52, 95% CI [.99, 2.33], p < 0.055), and having parents who were separated or divorced (OR = 0.68, 95% CI [0.46, 1.00], p < 0.053). Finally, there was a significant difference in self-reported problem gambling for individuals who reported abuse (OR = 1.36, 95% CI [1.11, 1.66], p < 0.003), while participants reporting household challenges did not quite reach statistical significance (OR = 1.49, 95% CI [0.99, 1.33], p < 0.062. These findings show us that the way we ask questions about the precedence and outcomes of risky behavior matter and warrant further attention.

What's the matter with ACEs? Recommendations for considering early adversity in educational contexts

BackgroundCurrently, some trauma-informed education practices use “ACE scores,” a number that represents the sum of endorsed items from a survey derived from the Adverse Childhood Experiences (ACEs) study in 1998. We caution that the survey provides limited information within education, and such scores have limited utility for designing and delivering individualized intervention to support students who have experienced adversity. ObjectiveWe sought to illustrate why ACEs are not well-suited for use in trauma-informed education, provide definitions for adversity-related terms from which a broader and common understanding of adversity can stem, and provide recommendations for integration of adversity-informed approaches to the educational context. MethodsWe compiled definitions of adversity-related constructs and made recommendations based on review of relevant research from the fields of psychology and education. ResultsRather than tailoring educational practices to specific children based on the “traumatic” events they experience, we recommend educators focus their efforts on building supportive classrooms geared toward supporting students with best practices drawn from the Science of Learning, and with the understanding that early adversity can influence heterogeneous trajectories in student development and behavior. In addition, further research on educational practices, including the use of a shared language for describing and defining adversity-related experiences, are the concrete steps needed to better support a goal of adversity-informed education.

Addressing intergenerational trauma in Black families:Trauma-informedsocioculturally attuned family therapy.

Increased attention to the prevalence and impact of traumatic experiences have been highlighted within the mental health field since Felitti et al.'s study of adverse childhood experiences. Black communities experience traumatic events at a higher rate than other racial groups. The phenomena of historical trauma, race-based trauma, and intergenerational trauma have been speculated to be reasons for this discrepancy. In this article, the authors explore factors that compound the traumatic experiences of Black communities, review socioculturally attuned family therapy and trauma-informed care, and propose an approach to addressing intergenerational trauma in Black families that integrates socioculturally attuned family therapy and trauma-informed care.

A study of adverse childhood experiences and psychopathology of imprisoned sexual offenders at a central prison, Hyderabad, Telangana

Abstract Introduction: Sexual offense has been defined as sexual contact with another person (including touching of the sexual organs of another) or touching of another person with one’s sexual organs without that person’s consent. Adverse childhood experiences could lead to health problems, behavioral problems, and psychosocial problems like crimes. Aims: The aim is to study adverse childhood experiences and psychopathology of imprisoned sexual offenders. Materials and Methods: A sample of 48 sexual offenders from a central prison and after taking informed consent, a semi-structured intake pro forma was used, followed by that adverse childhood experiences–international questionnaire, Mini-international neuropsychiatric interview-7.0.2 were applied. Results: It was found that the majority of the offenders had experienced adversities in their childhood, the most common being community violence and physical abuse, emotional neglect. Half of the participants had antisocial personality disorder. A statistically significant relationship was found between adverse childhood experiences score and number of offenses committed (P = 0.002). Conclusion: It can be concluded that the presence of adverse childhood experiences could affect physical, mental health in adulthood, and increase crimes.

Recommendations for Population-Based Applications of the Adverse Childhood Experiences Study: Position Statement by the American College of Preventive Medicine

Childhood adversity profoundly influences health, well-being, and longevity. Prevention and interventions to mitigate its harmful effects are essential. The American College of Preventive Medicine reviewed the research literature and other professional and governmental statements about adverse childhood experiences to support the development of evidence-based and population-focused recommendations about prevention, screening, and mitigation interventions for childhood adversity. We performed an umbrella review to find, assess and synthesize the evidence from systematic reviews focused on 3 key questions: the prevention or mitigation of the effects of adverse childhood experiences; the association of screening for adverse childhood experiences with various benefits, including health outcomes; and the effectiveness and harms of interventions in individuals with elevated adverse childhood experience scores. Adverse childhood experience‒related recommendations from 6 professional and governmental organizations were also reviewed. On the basis of these reviews, the American College of Preventive Medicine developed a position statement through consensus. A total of 8 systematic reviews, including 260 studies in total, were identified and combined with adverse childhood experiences‒related recommendations from 6 professional organizations to support the American College of Preventive Medicine recommendations. The American College of Preventive Medicine offers 7 adverse childhood experiences‒related recommendations focused on screening, education/training, policy/practice, and research: 2 are evidence-based, and 5 are based on expert opinion. Notably, regarding secondary prevention of adverse childhood experiences, the American College of Preventive Medicine endorses population-level surveillance and research around childhood adversity but not adverse childhood experience screening in individual clinical encounters. Despite limitations in the heterogeneity and quality of the published systematic reviews, the extant literature supports the American College of Preventive Medicine recommendations. Interventions to enhance protective factors and prevent and mitigate the consequences of adverse childhood experiences and other childhood adversity are promising and require further implementation and research.

26.1 The Adverse Childhood Experiences (ACE) Study and Subsequent Studies and the Relationship of ACEs to Long-Term Chronic Disease and Mental Health Issues

The first study to explore the relationship between deleterious childhood exposures that lead to chronic diseases that underlie many of the leading causes of death in adults was led by Vincent Felitti, MD, who will review this research.

382 A Survey of Exposure to Community Violence and Adverse Childhood Experiences in Emergency Department Patients

382 A Survey of Exposure to Community Violence and Adverse Childhood Experiences in Emergency Department Patients

The State of the Science on Adverse Childhood Experiences.

The Adverse Childhood Experiences (ACEs) study was conducted to advance understanding of psychological trauma in early life as a possible determinant of adult health. In the past decade, there has been a movement to use the ACEs research questionnaire in a variety of clinical settings to screen individuals and assess their trauma score. But critics argue that the ACEs questionnaire was never intended to be used for individual-level screening, and even that harm can be done by using the questionnaire for this purpose. In the meantime, researchers have developed a protective factor questionnaire that they call the "Positive Childhood Experiences" (PCEs) survey that captures experiences that predict trauma resilience. The objective of this article is to explain the history of the ACEs questionnaire, the current controversy about its use for screening, the emergence of the concept of PCEs, and implications for occupational therapy practitioners and researchers.

O11 Development and Pilot Implementation of an Online Trauma-Informed Care (TIC) Educational Module for Graduate-Level Nutrition Students

<h3>Objective</h3> To improve students' attitudes and empathy for creating therapeutic relationships by introducing a trauma-informed approach to nutrition care. <h3>Use of Theory or Research</h3> We adapted a published educational approach tested with pediatric residents. The teaching strategy included principles of Sociocultural Learning Theory. <h3>Target Audience</h3> Participants included 25 students pursuing a master's degree in nutrition. <h3>Curriculum Description</h3> We implemented the TIC educational module within an online nutrition counseling course strategically placed after two modules focused on patient-centered care, cultural humility, and health equity. Students took a pre-test, and we provided them with pre-class reading about TIC, the origins of the Adverse Childhood Experiences (ACE) study, and the National Institute of Minority Health and Health Disparities research framework. The live and synchronous online classroom time for the TIC module included a didactic presentation on the rationale for practicing universal TIC, the link between trauma and chronic disease, examples of TIC practices in nutrition care, and an interactive neonatal abstinence syndrome case-based scenario. In addition to a post-test, we required students to post a learning diary reflection within three days of the TIC module. <h3>Evaluation Methods</h3> We assessed attitudes with an 8 item pre and post-test (5-point Likert scale) in Qualtrics and through online learning diary entries within the Canvas learning management system. <h3>Results</h3> We conducted a paired-samples t-test to evaluate the impact of the TIC education module on students' attitudes with the pre to post-test. There were statistically significant (<i>P</i> < 0.05) changes in attitudes in 5 out of 8 questions with moderate (.37) to large (.95) effect sizes. In the learning diaries, all students reported that the TIC education module was impactful, and most students wrote about how the module challenged their biases and assumptions. <h3>Conclusions</h3> Participation in an online trauma-informed care education module led to significant differences in attitudes that may enhance students' abilities to create therapeutic relationships in future nutrition practice. <h3>Funding</h3> None.

A descriptive study of adverse childhood experiences (ACEs) among female patients with sexual dysfunctions in Armenia

BackgroundAdverse childhood experiences (ACEs) are associated with increased risk for a wide range of negative health outcomes, in-cluding sexual dysfunctions. There is a growing interest to advance the science of ACEs to improve the lives of children and families worldwide.Participants and procedureThe purpose of the present study was to explore the extent to which ACEs occur in patients with sexual dysfunctions in Armenia. To this end, the ACE questionnaire was used to assess the presence of adverse experiences from 85 female patients with sexual dysfunctions and 155 sex- and age-adjusted controls.ResultsMore than two-thirds of the patients (74.1%) had been exposed to one or more ACEs and 27.2% had been exposed to four or more ACEs. In the control group, these numbers were 56.1% and 18.1% respectively. Patients had significantly higher ACE scores (M = 2.06, SD = 1.95) than the control group (M = 1.65, SD = 2.50). Parental divorce and witnessing mother being abused (treated violently) were the most prevalent adversities in the patients.ConclusionsThe presence of multiple adverse childhood experiences in the patient group suggests that psychogenic factors are likely involved in sexual dysfunctions. ACEs Aware initiatives in Armenia aimed at screening for childhood adversities can improve the treatment of sexual dysfunctions and ultimately improve health and wellbeing.

SIDEBAR: Preventing Suicide by Implementing Trauma-Informed, Resilience-Focused Strategies.

A growing body of research points to the benefits of taking a trauma-informed approach when building systems and delivering services at a state and community level. The original adverse childhood experiences (ACEs) study demonstrated the significant links between trauma and a full range of negative

Case-control study of adverse childhood experiences and multiple sclerosis risk and clinical outcomes.

BackgroundAdverse childhood experiences (ACEs) are linked to numerous health conditions but understudied in multiple sclerosis (MS). This study’s objective was to test for the association between ACEs and MS risk and several clinical outcomes.MethodsWe used a sample of adult, non-Hispanic MS cases (n = 1422) and controls (n = 1185) from Northern California. Eighteen ACEs were assessed including parent divorce, parent death, and abuse. Outcomes included MS risk, age of MS onset, Multiple Sclerosis Severity Scale score, and use of a walking aid. Logistic and linear regression estimated odds ratios (ORs) (and beta coefficients) and 95% confidence intervals (CIs) for ACEs operationalized as any/none, counts, individual events, and latent factors/patterns.ResultsOverall, more MS cases experienced ≥1 ACE compared to controls (54.5% and 53.8%, respectively). After adjusting for sex, birthyear, and race, this small difference was attenuated (OR = 1.01, 95% CI: 0.87, 1.18). There were no trends of increasing or decreasing odds of MS across ACE count categories. Consistent associations between individual ACEs between ages 0–10 and 11–20 years and MS risk were not detected. Factor analysis identified five latent ACE factors, but their associations with MS risk were approximately null. Age of MS onset and other clinical outcomes were not associated with ACEs after multiple testing correction.ConclusionDespite rich data and multiple approaches to operationalizing ACEs, no consistent and statistically significant effects were observed between ACEs with MS. This highlights the challenges of studying sensitive, retrospective events among adults that occurred decades before data collection.

Terapia zorientowana na traumę w placówkach ochrony zdrowia

Odkrycie powszechności przeżyć traumatycznych w życiu ludzi było początkiem rozwoju badań nad wpływem różnego rodzaju urazów na stan zdrowia społeczeństwa. Pierwsze badania korelacji między występowaniem doświadczeń traumatycznych w dzieciństwie (ACE) a miarą dolegliwości zdrowia fizycznego i psychicznego w późniejszym wieku wskazało na znaczenie urazów w rozwoju człowieka. Z powodu istotnego wpływu traumy na zdrowie stwierdzono, że żadna pomoc osobom, które doświadczyły urazów, nie może prowadzić do retraumatyzacji. W tym celu określono podstawowe zasady działania dowolnej placówki ochrony zdrowia zorientowanej na traumę (TIC). W pracy przedstawiono sześć podstawowych zasad TIC oraz metody ich zastosowania w celu stworzenia bezpiecznego miejsca pomocy ofiarom traumy. Oprócz specjalnych warunków, jakim powinien podlegać ośrodek TIC, w pracy przedstawiono również wyniki badań dotyczących różnych obrazów zapisu traumy w świadomości człowieka. Uznano, że odmienność zapisu powinna mieć znaczenie w wyborze odpowiednich podejść terapeutycznych.

Poor Individual Risk Classification From Adverse Childhood Experiences Screening

Adverse childhood experiences confer an increased risk for physical and mental health problems across the population, prompting calls for routine clinical screening based on reported adverse childhood experience exposure. However, recent longitudinal research has questioned whether adverse childhood experiences can accurately identify ill health at an individual level. Revisiting data collected for the Adverse Childhood Experience Study between 1995 and 1997, this study derived approximate area under the curve estimates to test the ability of the retrospectively reported adverse childhood experience score to discriminate between adults with and without a range of common health risk factors and disease conditions. Furthermore, the classification accuracy of a recommended clinical definition for high-risk exposure (≥4 versus 0-3 adverse childhood experiences) was evaluated on the basis of sensitivity, specificity, positive and negative predictive values, and positive likelihood ratios. Across all health outcomes, the levels of discrimination for the continuous adverse childhood experience score ranged from very poor to fair (area under the curve=0.50-0.76). The binary classification of ≥4 versus 0-3 adverse childhood experiences yielded high specificity (true-negative detection) and negative predictive values (absence of ill health among low-risk adverse childhood experience groups). However, sensitivity (true-positive detection) and positive predictive values (presence of ill health among high-risk adverse childhood experience groups) were low, whereas positive likelihood ratios suggested only minimal-to-moderate increases in health risks among individuals reporting ≥4 adverse childhood experiences versus that among those reporting 0-3. These findings suggest that screening based on the adverse childhood experience score does not accurately identify those individuals at high risk of health problems. This can lead to both allocation of unnecessary interventions and lack of provision of necessary support.