Adverse Childhood Experiences Study Research Articles

Legislating to Prevent Adverse Childhood Experiences: Growth and Opportunities for Evidence-Based Policymaking and Prevention.

Since the landmark study of Adverse Childhood Experiences (ACEs; Felitti et al., American Journal of Preventive Medicine, 14(4):245-258, 1998), there has been a significant growth in efforts to address ACEs and their impact on individual health and well-being. Despite this growing awareness, there has been little systematic review of state legislative action regarding variation in focus or scope or of the broader context impacting the introduction and enactment of ACE-related policy efforts. To inform the role of psychologists and related professionals to contribute to these legislative efforts, we conduct a comprehensive mixed-method analysis of all state bills introduced over the past two decades to investigate the use and impact of ACE research in introduced and enacted state legislative language (51 states, NTotal Bills = 1,212,048, NACE Bills = 425). In addition, these analyses examine congressional office communications (N = 14,916,546 public statements) and voting records (N = 1,163,463 votes) to understand the relationship between legislative members' public discussion of ACEs and their voting behavior on these bills. We find that legislators' public discourse is significantly related to ACE-related policymaking above and beyond political affiliation or demographic characteristics. Furthermore, key legislative language related to domestic violence, evidence-based practice, and prevention were significant predictors of whether an ACE-related bill becomes law-above and beyond the political party in power. These analyses highlight the ways in which ACE-related research has informed state policy. Based upon this work, we offer recommendations for researchers and policymakers.

ACE domains and depression: Investigating which specific domains are associated with depression in adulthood

BackgroundThe study of adverse childhood experiences (ACEs) has shown deleterious effects throughout adulthood. Little attention, however, is given to specific ACE domains as they relate to mental health outcomes, as most studies use cumulative ACE score models. ObjectiveThe current study disaggregates ACEs domains to investigate their independent effect (while controlling for each other and other demographic covariates) on receiving a depression diagnosis as an adult. Participants and SettingData were obtained from the Behavioral Risk Factor Surveillance Survey (BRFSS; N = 52,971). MethodsTo control and account for the numerical number of ACEs, separate models were run among each ACE score (e.g., those with an ACE score of exactly two, three, etc.). An aggregate model with all participants is also included. ResultsAcross all ACE scores, those with a history of family mental illness had the highest likelihood of receiving a depression diagnosis. The second strongest association were those with sexual abuse. No other trends were found among the six other domains. Further, those with a combination of family mental illness and sexual abuse had the highest odds of depression. ConclusionsMental health providers should consider the numerical number of ACEs as well as the specific ACE domains (specifically, family mental illness and sexual abuse). Additionally, this provides evidence for a possible weighting schema for the ACEs scale.

A Pilot Study on the Awareness and Knowledge of Adverse Childhood Experiences Science and Trauma-informed Care among Medical School Students.

Childhood trauma is widespread and contributes to clinical, behavioral, and social health consequences. Despite more than 2 decades of research from the Centers for Disease Control and Prevention-Kaiser Adverse Childhood Experiences (ACEs) Study, ACEs science is still not fully integrated into medical school curricula. Therefore, we conducted a pilot study to assess the level of awareness about ACEs and trauma-informed care (TIC) curricula among medical students. A cross-sectional study was conducted at the Medical College of Georgia using a sample of convenience. Enrolled first-, second-, and third-year students were invited to complete a survey during the Spring 2020 semester. A total of 194 students responded to specific questions about training on and knowledge of ACEs and principles of TIC. The majority of students (80%) indicated they heard of the ACEs Study, and 70% reported they received information about ACEs. Regarding TIC, findings indicated less knowledge on cultural context related to stress and trauma. In addition, first-year students were less likely to know about TIC principles than third-year students. This preliminary study is the first of its kind in the state of Georgia, where recent surveillance data indicate that 60% of adults have experienced at least one ACE. Given that ACEs are widespread, effective educational practices to increase knowledge about ACEs science, and skills to carry out TIC practices may benefit future practicing physicians by introducing ACEs in the first-year curriculum.

Childhood exposure to physical and emotional violence over a 57-year period in Sweden.

The aim of the present study was to examine the prevalence of childhood experiences of physical violence (CPV) and emotional violence (CEV) at the hands of parents over a 57-year period among adults born between 1937 and 1993. In 2012, a survey among women and men aged 18-74 years in Sweden was undertaken to examine the lifetime prevalence of physical, psychological and sexual violence and associations with current health in adulthood. Questionnaires were based on the Adverse Childhood Experiences study and a previous national survey of violence exposure. Descriptive statistics were used to analyse the frequency of exposure to CPV and CEV, and changes over time were analysed using analysis of variance and logistic regression. A total of 10,337 individuals participated (response rates: 56% for women and 48% for men). CPV decreased significantly over the time period studied, particularly for those born after 1983. This decrease was more evident for male respondents. Throughout the time period studied, the proportion of women reporting CEV was higher than for men. Among both genders there was a steady rise in CEV rates from those born in the late 1930s to those born in the mid-1980s, after which there was a decline that was more marked for men. A significant group of children in Sweden experience violence at the hands of parents. However, our data corroborate previous national studies that children's exposure to violence has decreased. Clear gender differences indicate that these changes have affected girls and boys differently.

A single-item measure of childhood relationship quality and association with adult health and health behaviours.

Adverse childhood experiences are known to relate positively to various health risks and adverse health behaviour in adult life, although the precise mechanisms are still debated. The aim of this study was to investigate whether a single-item measure of the quality of childhood relationships with family and household members might show a similar association. We measured the overall quality of relationships with family and household members during the first 18 years of life. A one-dimensional question scored 0-10 (N=4983) was included in the ongoing SIBS Iceland Patient Association's national 'Life and Health' public health prevention project among adults. Relationship quality was then assessed against measures of health and health behaviour using 21 validated scales. A lower childhood relationships score was associated with a higher risk of all 21 suboptimal health and health behaviour outcomes in adulthood, with adjusted effect sizes measured by standardised betas (magnitude 0.111-0.284), variance explained (1.3-8.5%) and per-point adjusted odds ratios (1.10-1.30). The strongest associations were found with measures of social and mental health, followed by physical health, alcohol and tobacco use, sleeping problems, financial sustenance, physical pain and aerobic fitness. Odds were found to match well with pooled odds ratios presented in a systematic review of 37 adverse childhood experiences studies. This may indicate that a one-dimensional relationships question is a useful substitute in surveys in which a traditional multi-question adverse childhood experiences scale cannot be accommodated. Further investigations are recommended to investigate the applicability of a single adverse childhood experiences question.

Trauma‐informed care, schools, and mental health professionals

The prevalence of exposure to trauma and its link to negative health outcomes has been well‐documented. Beginning with the first adverse childhood experiences (ACEs) study by Felitti et al. (1998), we have learned that childhood trauma is both common and significantly related to behavioral and learning issues in school, as well as a host of other poor behavioral and physical health outcomes, and often ultimately school failure.

Recognizing the cumulative burden of childhood adversities transforms science and practice for trauma and resilience.

The Adverse Childhood Experiences (ACEs) studies transformed our understanding of the true burden of trauma. Notable elements of Felitti and colleagues' findings include the influence of adversity on many physical as well as psychological problems and the persistence of impacts decades after the traumas occurred. In this article, we make the case that the most revolutionary finding was the discovery of a strong dose-response effect, with marked increases in risk observed for individuals who reported four or more adversities. Over the past two decades, our understanding of the cumulative burden of trauma has expanded further, with recognition that experiences outside the family, including peer victimization, community violence, and racism, also contribute to trauma dose. Recent research has provided evidence for the pervasiveness of trauma, which we now realize affects most people, even by the end of adolescence. Extensive scientific evidence has documented that more than 40 biopsychosocial outcomes, including leading causes of adult morbidity and mortality, are associated with adverse childhood experiences, measured by dose. We summarize the state of science and explain how ACEs built a movement for uncovering mechanisms responsible for these relationships. Perhaps unexpectedly, the pervasiveness of trauma also expands our understanding of resilience, which is likewise more common than previously recognized. Emerging research on positive childhood experiences and poly-strengths suggests that individual, family, and community strengths may also contribute to outcomes in a dose-response relationship. We close with an agenda for research, intervention, and policy to reduce the societal burden of adversity and promote resilience. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The importance of adverse childhood experiences during the perinatal period.

The Adverse Childhood Experiences (ACEs) study (Felitti et al., 1998) has led to an understanding of how exposure to abuse, neglect, and family dysfunction in childhood are related to subsequent physical and mental health problems. These issues are important to consider during the perinatal period, with studies indicating that pregnant women who report adverse experiences in childhood may be at risk of experiencing mental health and substance use problems. This study examined the association of pregnant women's ACEs with symptoms of depression, anxiety, posttraumatic stress, and substance use, and examined the potential buffering effect of women's resilience against the deleterious effects of ACES on mental health and substance use. Women reported on ACES, mental health symptoms, substance use, and resilience when they were screened for participation in a perinatal psychosocial support intervention, which was integrated into obstetrical clinics in a Southern academic medical center. Almost a quarter of the 303 women in this sample reported four or more ACEs, indicating significant risk. Those reporting more overall ACEs also reported more symptoms of depression, posttraumatic stress, and increased risk of tobacco use. Unique effects of specific ACEs subtypes were also found. Women exposed to child maltreatment reported more anxiety, depression, and posttraumatic stress symptoms, and were at risk for tobacco, cannabis, or opioid use during pregnancy. Women exposed to household dysfunction reported more posttraumatic stress symptoms and were at increased risk of tobacco and alcohol use during pregnancy. Women's resilience attenuated effects of household dysfunction on posttraumatic stress symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A descriptive study of adverse childhood experiences and depression, anxiety, and stress among undergraduate nursing students.

The 10-point Adverse Childhood Experiences (ACEs) score measures childhood exposure to traumatic events. An ACEs score of 4 or higher has been associated with long-term physical and mental health problems, and increased mortality. It is unclear if the rates of undergraduate nursing students experiencing ACEs is different from the general population, and what impact ACEs has on nursing students' depression, anxiety and stress. The purpose of this study was to assess the rate of ACEs in nursing students and to examine the relationship between ACEs and perceived depression, anxiety, and stress among undergraduate nursing students. This is a descriptive correlational study to determine Adverse Childhood Experiences (ACEs) scores and Modified Depression Anxiety and Stress Scale (DASS-21) scores for undergraduate pre-licensure students at a private mid-western college. Students' ACEs scores were correlated with DASS-21 scores and demographic data. 409 students volunteered to participate in the study. Seventeen percent of students had high ACEs scores (≥4). Those students with high ACEs scores also scored statically significantly higher on the DASS-21 items relating to depression, anxiety, and stress. Results from this study demonstrated that many nursing students have experienced ACEs and nursing students with ACEs scores of 4 or higher had higher rates of depression, anxiety, and stress. These findings should drive faculty in nursing programs to acknowledge the prevalence of ACEs among their nursing students and recognize that impact on the mental health of students.

An eye-tracking study of interpersonal threat sensitivity and adverse childhood experiences in borderline personality disorder

BackgroundPrevious eye-tracking studies provide preliminary evidence for a hypersensitivity to negative, potentially threatening interpersonal cues in borderline personality disorder (BPD). From an etiological point of view, such interpersonal threat hypersensitivity might be explained by a biological vulnerability along with a history of early life adversities. The objective of the current study was to investigate interpersonal threat hypersensitivity and its association with adverse childhood experiences (ACE) in patients with BPD employing eye-tracking technology.MethodsWe examined a sample of 46 unmedicated, adult female patients with BPD and 25 healthy female volunteers, matched on age and intelligence, with a well-established emotion classification paradigm with angry, fearful, happy, and neutral facial expressions. ACE were assessed retrospectively with the Childhood Trauma Questionnaire.ResultsPatients as compared to healthy volunteers reflexively directed their gaze more quickly towards the eyes of emotional and neutral faces and did not adapt their fixation patterns according to the facial expression presented. Misclassifying emotional and neutral faces as angry correlated positively with the patients’ self-reported ACE.ConclusionsBuilding on and extending earlier findings, our results are likely to suggest a visual hypervigilance towards the eyes of emotional and neutral facial expressions and a childhood trauma-related anger bias in patients with BPD. Given the lack of a clinical control group, the question whether these findings are specific for BPD has to remain open. Thus, further research is needed to elucidate the specificity of altered visual attention allocation and the role of ACE in anger recognition in patients with BPD.

Early life trauma - review of clinical and neurobiological studies.

Psychological trauma is a significant risk factor for physical and mental health development distortion. This paper presents the results of longitudinal epidemiological surveys and naturalistic observations. It also reviews the results of the most important neurobiological findings in the field of impact of early life trauma on cognitive and emotional development, and the structure and functions of the brain. Trauma is defined as subjective experiences that overwhelm a person's ability to maintain psychophysical integrity. During the stage of neurodevelopment, various life adversities, such as emotional and sensory deprivation, abandonment and neglect by caregivers as well as physical or emotional violence and sexual abuse overwhelm the physiological and mental capacity of a child and impact their cognitive, emotional and social development, adversely influencing adulthood functioning. Symptoms of abused children can evolve and change with time, from moderate signs of distress to more complex symptoms and organized disorders. The most important longitudinal studies, such as the Lives Across Time Study, Minnesota Study, Adverse Childhood Experiences Study, The Great Smoky Mountains Study, and the English and Romanian Adoptee Study are discussed in the paper. The lifelong influences of early adversities on brain structures like the corpus callosum, hippocampus, the amygdaloid nuclei, ventral striatum and cerebral cortex has been described. The variability of the sensitivity of specific brain regions, based on different rates of maturation, has also been discussed. This review integrates and summarizes the basic knowledge about the impact and neurobiological consequences of early traumatic adversities.

How Much More Data Do We Need? Making the Case for Investing in Our Children.

* Abbreviations: ACE — : adverse childhood experience CPS — : Child Protective Services Child maltreatment is well recognized as one of the most significant contributors to pediatric morbidity and mortality throughout the world.1,2 The effect of child maltreatment on morbidity and mortality in older adults has been documented for >20 years as demonstrated by the Adverse Childhood Experiences (ACEs) study.3 The impact of maltreatment on teenage suicide and other mental health diagnoses is also well known.4,5 To date, however, a direct relationship between maltreatment specifically, rather than the broader risk of ACES, and mortality in teenagers and young adults had not been reported. In this issue of Pediatrics , Segal et al6 evaluated this potential relationship by linking >50 administrative data sets from South Australia that included data from >300 000 children born between 1986 and 2003 who survived to age 16. The authors examined the relationship among multiple demographic factors, Child Protective Services (CPS) involvement, and mortality from 1990 to 2019. For the 20% of children with CPS contact before age 16, the nature of the contact was divided into 7 categories, which included “investigation only,” “substantiation,” and “removal to … Address correspondence to Rachel Berger, MD, MPH, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224. E-mail: rachel.berger{at}chp.edu

Assessing the Toxic Levels in Parenting Behavior and Coping Strategies Implemented During the COVID-19 Pandemic

Assessing the Toxic Levels in Parenting Behavior and Coping Strategies Implemented During the COVID-19 Pandemic

Associations between adverse childhood experiences and weight, weight control behaviors and quality of life in Veterans seeking weight management services

IntroductionA neglected area of trauma research with Veterans is the study of Adverse Childhood Experiences (ACEs). The present study aimed to examine the prevalence of ACEs, and to explore relationships between ACEs and measures of weight, eating behaviors and quality of life in weight loss seeking Veterans. MethodsParticipants were 191 Veterans [mean age 58.9 (SD = 12.8), mean Body Mass Index (BMI) 35.4 (SD = 6.1), 86.9% male, 33.7% racial/ethnic minority] receiving care at VA Connecticut Healthcare System (VA CT) who attended an orientation session of VA's behavioral weight management program. Participants completed a measure of ACEs and measures related to weight, eating and health. ResultsAmong completers, 68.6% endorsed at least one ACE. The average number of reported ACEs was 2.2 (SD = 2.5), with 48.7% of Veterans reporting more than one type of ACE. Women were more likely to report any ACE (88.0% vs. 65.6%, p = .025) and reported significantly more ACEs compared to males (4.2 vs. 1.9, p < .001). ACEs were associated with lower physical activity (p = .05), lower quality of life (p's < 0.05), and lower weight-related quality of life (p < .01), but not weight, weight control strategies, binge eating, or alcohol use. ConclusionACEs are common among weight loss seeking Veterans, particularly among female Veterans. Findings suggest that there is a high rate of ACEs in Veterans, which are associated with exercise and quality of life outcomes, but not diet and weight outcomes.

Adverse Childhood Experiences and Child Development Outcomes in Ceará, Brazil: A Population-based Study

More than 200 million children fail to reach their full developmental potential in low- and middle-income countries. Adverse childhood experiences, maternal mental health, and intimate partner violence are negatively associated with child development outcomes. The relationship of these risk factors with child communication, gross motor, fine motor, problem-solving, and personal-social development scores in Brazil are assessed. A population-based, cross-sectional study of preschool children living in the state of Ceará, Brazil, in 2017 was conducted. Child development was assessed with the Ages and Stages Questionnaire. Adverse childhood experiences for children were self-reported by the participants' mothers using the Centers for Disease Control and Prevention Adverse Childhood Experiences Study‒adapted metric. Maternal mental health and intimate partner violence were evaluated using validated questionnaires. Sample-adjusted multivariable generalized linear models with interaction terms were used to determine the association of intimate partner violence, maternal mental health, and adverse childhood experiences with developmental outcomes and identify possible moderators. Data were analyzed between 2019 and 2020. Children exposed to ≥3 adverse childhood experiences had -0.12 (95% CI= -0.24, 0) lower communication, -0.25 (95% CI= -0.46, -0.03) lower gross motor, -0.27 (95% CI= -0.47, -0.07) lower fine motor, and -0.17 (95% CI= -0.3, -0.03) lower personal-social domain scores than children with no adverse childhood experiences. Furthermore, the greater number of adverse childhood experiences was linearly associated with lower developmental scores. Maternal mental health and intimate partner violence were also associated with lower development scores. Adverse childhood experiences were independently associated with developmental outcomes in Brazilian children. Community-based interventions to reduce the impact of adverse childhood experiences, intimate partner violence, and maternal mental health may benefits child development outcomes.

Explainable Artificial Intelligence Recommendation System by Leveraging the Semantics of Adverse Childhood Experiences: Proof-of-Concept Prototype Development.

BackgroundThe study of adverse childhood experiences and their consequences has emerged over the past 20 years. Although the conclusions from these studies are available, the same is not true of the data. Accordingly, it is a complex problem to build a training set and develop machine-learning models from these studies. Classic machine learning and artificial intelligence techniques cannot provide a full scientific understanding of the inner workings of the underlying models. This raises credibility issues due to the lack of transparency and generalizability. Explainable artificial intelligence is an emerging approach for promoting credibility, accountability, and trust in mission-critical areas such as medicine by combining machine-learning approaches with explanatory techniques that explicitly show what the decision criteria are and why (or how) they have been established. Hence, thinking about how machine learning could benefit from knowledge graphs that combine “common sense” knowledge as well as semantic reasoning and causality models is a potential solution to this problem.ObjectiveIn this study, we aimed to leverage explainable artificial intelligence, and propose a proof-of-concept prototype for a knowledge-driven evidence-based recommendation system to improve mental health surveillance.MethodsWe used concepts from an ontology that we have developed to build and train a question-answering agent using the Google DialogFlow engine. In addition to the question-answering agent, the initial prototype includes knowledge graph generation and recommendation components that leverage third-party graph technology.ResultsTo showcase the framework functionalities, we here present a prototype design and demonstrate the main features through four use case scenarios motivated by an initiative currently implemented at a children’s hospital in Memphis, Tennessee. Ongoing development of the prototype requires implementing an optimization algorithm of the recommendations, incorporating a privacy layer through a personal health library, and conducting a clinical trial to assess both usability and usefulness of the implementation.ConclusionsThis semantic-driven explainable artificial intelligence prototype can enhance health care practitioners’ ability to provide explanations for the decisions they make.

Opening the Time Capsule of ACEs: Reflections on How we Conceptualise Children’s Experiences of Adversity and the Issue of Temporality

Abstract In this article, we engage with some of the fundamental concepts underpinning the original adverse childhood experiences (ACEs) study and subsequent work, whilst recognising that the terminology of ACEs has in some ways become reductionist and problematic. Although an imperfect concept covering a range of childhood adversities at a personal, intrapersonal and community level, ACEs have utility in bridging scientific and lay communities. The evidence clearly identifies that ‘numbers matter’ and that whereas children may be able to cope with a little adversity over a short period of time when they have good support networks, too much adversity over too long a time period, even with good support, will be problematic for the child and their family. Alongside exploring the cumulative impact of adversity, social workers and other professionals need to engage with the temporal component of when adversity is experienced, and for how long, together with the consequences for helping services in deciding when to intervene and for what period of time. This opens the discussion of who is best placed to support children and families experiencing certain types of adversity and how we think about structural issues such as poverty and community violence within the ACEs discourse.

Childhood Loss Experiences, Religiousness/Spirituality, and Hope as Predictors of Adult Life Satisfaction

Purpose The purpose of this study was to explore how adaptive patterns of religiousness/spirituality and hope predict adult life satisfaction in adults, even if they had childhood loss experiences. Design and Methods Using a cross-sectional survey design with132 adult participants (mean age 33.8 ± 15.2, 82% female, 78% Caucasian) we estimated two hierarchical regression models to examine how dimensions of religiousness/spirituality (Brief Multidimensional Measure of Religiousness/Spirituality) and hope (Herth Hope Index) predicted adult life satisfaction (Satisfaction with Life Scale) after controlling for effects of adverse childhood experiences (Adverse Childhood Experiences Study Questionnaire) or chronic sorrow from childhood loss (Kendall Chronic Sorrow Instrument). Results When effects of adverse childhood experiences (ACE) were controlled, higher levels of hope (β = .416, p < .001) and forgiveness (β = .273, p = .023) and lower levels of religious/spiritual values/beliefs (β = −.298, p = .014) predicted higher levels of adult life satisfaction. ACE remained a significant predictor of adult life satisfaction in the final model. When controlling for effects of chronic sorrow, higher life satisfaction was predicted only by forgiveness (β = .379, p = .003), values/beliefs (β = −.354, p = .007), and hope (β = .357, p < .001), with chronic sorrow not a significant predictor of adult life satisfaction in the final model. Conclusion: Greater life satisfaction for adult survivors of childhood loss experiences could be promoted by interventions to enhance hope and foster forgiveness. These adult survivors may also need support as they engage with religious/spiritual struggle to reconcile their values and beliefs with childhood loss.

Thematic section on child and youth complex trauma: Promoting social courage to shift practices, policies and research

Thematic section on child and youth complex trauma: Promoting social courage to shift practices, policies and research

Adverse Childhood Experiences, Resilience, and Emotional Problems in Latinx Immigrant Youth

Although research suggests that Adverse Childhood Experiences (ACEs) are associated with emotional problems, individuals with higher resilience experience less emotional problems. This relation has yet to be examined in the growing Latinx immigrant youth population in the United States. To study the relation between ACEs, emotional problems, and resilience, recently immigrated Latinx youth (N=85) were interviewed using the Adverse Childhood Experiences Study questionnaire, the Strengths and Difficulties Questionnaire, and the Resilience Scale. Moderation analyses revealed ACEs were directly associated with emotional problems, as was resilience. While the interaction effect was not significant, conditional effects indicated a buffering effect such that the relation between ACEs and emotional problems was non-significant at high levels of resilience. In addition to the relatively small sample size, available measures for assessing ACEs and emotional problems are limited in capturing difficulties experienced by Latinx immigrants. Results indicate that individuals with higher resilience do not experience higher emotional problems in the context of childhood adversity. This study contributes to the growing literature on protective factors in Latinx immigrant youth, indicating that assessment of resilience may be beneficial in treating individuals exposed to adversity to mitigate the development of emotional problems.