Adverse Childhood Experiences Study Research Articles

Adverse Childhood Experiences Among Immigrants to the United States.

A growing number of studies have examined the "immigrant paradox" with respect to health behaviors in the United States. However, little research attention has been afforded to the study of adverse childhood experiences (ACE; neglect, physical and sexual abuse, and witnessing violence) among immigrants in the United States. The present study, using Waves I and II data from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), aims to address these gaps by comparing forms of ACE of first- and second-generation immigrants with native-born American adults in the United States. We also examined the latent structure of ACE among immigrants and conducted analyses to assess the psychiatric correlates of identified latent classes. With the exception of neglect, the prevalence of ACE was markedly higher among native-born Americans and second-generation immigrants compared with first-generation immigrants. Four latent classes were identified-limited adverse experience ( n = 3,497), emotional and physical abuse ( n = 1,262), family violence ( n = 358), and global adversity ( n = 246). The latter three classes evinced greater likelihood of being diagnosed with a mood, anxiety, personality, and substance use disorder, and to report violent and non-violent antisocial behavior. Consistent with prior research examining the associations between the immigrant paradox and health outcomes, results suggest that first-generation immigrants to the United States are less likely to have experienced physical and sexual abuse and witness domestic violence. However, likely due to cultural circumstances, first-generation immigrants were more likely to report experiences that are deemed neglectful by Western standards.

Childhood Maltreatment, Depression, and Suicidal Ideation: Critical Importance of Parental and Peer Emotional Abuse during Developmental Sensitive Periods in Males and Females.

Background: The adverse childhood experience (ACE) study found that risk for depression increased as a function of number of types of childhood maltreatment, and interpret this as a result of cumulative stress. An alternative hypothesis is that risk depends on type and timing of maltreatment. This will also present as a linear increase, since exposure to more types of abuse increases likelihood of experiencing a critical type of abuse at a critical age.Methods: 560 (223M/337F) young adults (18–25 years) were recruited from the community without regard to diagnosis and balanced to have equal exposure to 0–4 plus types of maltreatment. The Maltreatment and Abuse Chronology of Exposure Scale assessed severity of exposure to 10 types of maltreatment across each year of childhood. Major depressive disorder (MDD) and current symptoms were evaluated by SCID, interview, and self-report. Predictive analytics assessed importance of exposure at each age and evaluated whether exposure at one or two ages was a more important predictor than number, severity, or duration of maltreatment across childhood.Results: The most important predictors of lifetime history of MDD were non-verbal emotional abuse in males and peer emotional abuse (EA) in females at 14 years of age, and these were more important predictors across models than number of types of maltreatment (males: t9 = 16.39, p < 10-7; females t9 = 5.78, p < 10-4). Suicidal ideation was predicted, in part, by NVEA and peer EA at age 14, but most importantly by parental verbal abuse at age 5 in males and sexual abuse at age 18 in females.Conclusion: This study provides evidence for sensitive exposure periods when maltreatment maximally impacts risk for depression, and provides an alternative interpretation of the ACE study results. These findings fit with emerging neuroimaging evidence for regional sensitivity periods. The presence of sensitive exposure periods has important implications for prevention, preemption, and treatment of MDD.

Gender-specific profiles of adverse childhood experiences, past year mental and substance use disorders, and their associations among a national sample of adults in the United States.

This study examined profiles of adverse childhood experiences (ACEs) and mental and substance use disorders (MSUDs), and associations between distinct profiles of ACEs and MSUDs. Participants were adults (N = 34, 652) involved in the National Epidemiologic Survey on Alcohol and Related Conditions. Latent class analysis was used to examine both profiles of ten ACEs and ten past year MSUDs. Dual latent class analysis regression was used to examine associations between profiles of ACEs and MSUDs. Given gender differences in ACEs and MSUDs, analyses were conducted separately for females and males. Four profiles of ACEs and three profiles of MSUDs were selected for both genders. The four profiles of ACEs were characterized by the following probabilities: high multiple ACEs, high parental substance abuse, high childhood physical abuse, and low ACEs. The three profiles of MSUDs were characterized by the following probabilities: high multiple MSUDs for females and low MSUDs except alcohol use disorders for males, moderate-to-high major depressive episode, and low MSUDs. When compared to the low ACEs and MSUDs profiles, members in the higher ACEs profiles had 3.71-89.75 times greater odds of also being members in the higher MSUDs profiles. However, more than one-third of members in the high multiple ACEs profiles were also in the low MSUDs profiles. Study findings suggest four profiles of the ACEs widely studied as part of the Adverse Childhood Experiences study and risk and resilience for recent MSUDs among men and women nationally affected by ACEs.

Adverse childhood experiences: assessing the impact on health and school engagement and the mitigating role of resilience.

The ongoing longitudinal Adverse Childhood Experiences Study of adults has found significant associations between chronic conditions; quality of life and life expectancy in adulthood; and the trauma and stress associated with adverse childhood experiences, including physical or emotional abuse or neglect, deprivation, or exposure to violence. Less is known about the population-based epidemiology of adverse childhood experiences among US children. Using the 2011-12 National Survey of Children's Health, we assessed the prevalence of adverse childhood experiences and associations between them and factors affecting children's development and lifelong health. After we adjusted for confounding factors, we found lower rates of school engagement and higher rates of chronic disease among children with adverse childhood experiences. Our findings suggest that building resilience-defined in the survey as "staying calm and in control when faced with a challenge," for children ages 6-17-can ameliorate the negative impact of adverse childhood experiences. We found higher rates of school engagement among children with adverse childhood experiences who demonstrated resilience, as well as higher rates of resilience among children with such experiences who received care in a family-centered medical home. We recommend a coordinated effort to fill knowledge gaps and translate existing knowledge about adverse childhood experiences and resilience into national, state, and local policies, with a focus on addressing childhood trauma in health systems as they evolve during ongoing reform.

Adverse events in children: predictors of adult physical and mental conditions.

A senior member of a 5-person pediatric group recently heard a presentation about the Adverse Childhood Experiences (ACE) study. He decided to present the study to his colleagues with the intention of incorporating a similar screening tool for ACE in their practice.The ACE study assessed adverse child experiences recalled by 17,000 adult patients who were participating in a comprehensive medical evaluation at a large Health Maintenance Organization. The ACE questionnaire assessed emotional, physical, and sexual abuse; emotional and physical neglect; mother treated violently; household substance abuse; household mental abuse; parental separation or divorce; and incarcerated household members (http://www.acestudy.org/yahoo_site_admin/assets/docs/ACE_Calculator-English.127143712.pdf).Thirty-six percent of the participants did not endorse any ACE. One, 2 or 3 ACE's were endorsed by 26%, 16%, and 9.5%, respectively. Four or more ACEs were endorsed by 12% of the cohort. The study found that "the major risk factors for causes of death in adults, smoking, alcohol abuse, obesity, physical inactivity, use of illicit drugs, promiscuity, and suicide attempts, were all increased by ACEs. Compared with persons with an ACE score of 0, those with an ACE score of 4 or more were twice as likely to be smokers, 12 times more likely to have attempted suicide, 7 times more likely to be alcoholic, and 10 times more likely to have injected street drugs" (2).When he researched the ACE study further, the pediatrician discovered that there was a modified form of the ACE study questions available for parents of children and adolescents. The members of the pediatric practice were intrigued by the reported relationship between ACEs and the high prevalence of chronic physical and mental health conditions and economic outcomes. Could this be a method for pediatricians to screen for risks of serious physical and psychiatric diseases in adult life? A brisk discussion followed about what they would do with this information if the ACE screening questions were used in their practice. Is it an effective strategy for primary care pediatric practice?

PREVALENCE AND RELATIONSHIP BETWEEN ADVERSE CHILDHOOD EXPERIENCES AND CHILD BEHAVIOR AMONG YOUNG CHILDREN

Exposure to adverse childhood experiences (ACEs) such as child abuse and neglect impact a child's socioemotional development. Drawing from the methods employed in the Adverse Childhood Experiences (ACE; Felitti et al.,) Study, the present study utilized data from the National Survey of Child and Adolescent Well-Being to examine the prevalence of ACEs among children birth to 6 years, and the relationship of ACEs to emotional and behavioral outcomes 59 to 97 months after the close of investigation or assessment. Logistic regression also was used to examine the cumulative impact of ACEs on child behavior outcomes. By the age of 6, approximately 70% of children experienced three or more ACEs, and there were strong relationships between ACEs. Numerous ACEs were associated with long-term behavioral problems, and results supported a dose-response effect. Three or greater ACEs more than quadrupled the risk of experiencing internalizing problems, and almost quadrupled the risk of experiencing either externalizing or total problems at 59 to 97 months' postinvestigation. Based on these findings, it is crucial for both early screening/assessment and increased collaboration between child welfare and early intervention programs.

Relationship between Child Maltreatment and Alcohol Abuse - Findings from Adverse Childhood Experience Study in Republic of Macedonia

OBJECTIVES: The aim of the study is to determine the relationship between of the problem of alcohol abuse and child maltreatment. METHOD: The ACE study was administered by the University Clinic of Psychiatry, Department for Child and Adolescent Psychiatry. The ACE study used a representative sample of students in year four of secondary school (aged 18 and above) and first- and second-year university students. The sample consisted of 664 secondary school students (258 males and 406 females.The university student sample consisted of 613 (343 female and 270 male) students from four universities. The data were obtaining by applying ACE Study Questionnaires.RESULTS: Individuals who experience psychological abuse are more prone to develop alcoholism. One of the most serious risk factors for abuse and neglect of children was alcoholism, as a form of household dysfunction. Overall, 13.4% of students lived with someone who misused alcohol. Overall, 10.7% lived with someone who was alcoholic. The association to each ACE was highest among respondents who grew up with two alcohol-abusing parents compared with persons with no alcohol-abusing parents. The health-risk behaviours of most concern included among the others alcohol use (by 82.2% of students). Alcohol use is widespread among students and its prevalence rate is almost 28% by both sexes, and they start drinking at the age of 14–15.CONCLUSION: Among the most frequent household dysfunctions was alcohol use by a family member and about 82% of respondents had ever used alcohol.

Relationship between Child Maltreatment and Alcohol Abuse - Findings from Adverse Childhood Experience Study in Republic of Macedonia

Relationship between Child Maltreatment and Alcohol Abuse - Findings from Adverse Childhood Experience Study in Republic of Macedonia

Association between Physical Abuse, Physical Neglect and Health Risk Behaviours among Young Adolescents: Results from the National Study

OBJECTIVES: One of the main objectives of this paper is to analyze the associations between physical abuse and neglect and health risk behaviours among young adolescents in the country.METHOD: A representative sample consisted of total 1277 students (58.6% female and 41.6%), aged 18 and above. About 664 of them are in last (fourth) year of secondary school and 613 respondents are first- and second-year university students. The data were obtained using Adverse Childhood Experiences Study Questionnaires (Family Health History Questionnaire) for collecting information on child maltreatment, household dysfunction and other socio-behavioural factors, applying WHO/CDC-recommended methodology. Statistical significance was set up at p&lt;0.05.RESULTS: Physical abuse (21.1%) and physical neglect (20%) were reported with similar prevalence rates. Disciplining children by spanking or corporal punishment was presented with very high rate of 72.4%.CONCLUSION: The results demonstrated a relationship between physical abuse and later manifestation of health risk behaviours such as: smoking and early pregnancy. Physical neglect increased the chances for drug abuse, drink-driving, having early sex, having more sexual partners.

Childhood Abuse, Household Dysfunction and the Risk of Attempting Suicide in a National Sample of Secondary School and University Students

OBJECTIVES: One of the main objectives of this paper is to analyze the associations between childhood abuse, household dysfunction and the risk of attempting suicide among young adolescents in the country.METHOD: A representative sample consisted of total 1277 students (58.6% female and 41.6% male), aged 18 and above in year four of 664 secondary school and 613 first- and second-year university students. The data were obtained using Adverse Childhood Experiences Study Questionnaires (Family Health History Questionnaire) for collecting information on child maltreatment, household dysfunction and other socio-behavioural factors, applying WHO/CDC-recommended methodology. Statistical significance was set up at p&lt;0.05.RESULTS: Emotional neglect, physical abuse and physical neglect were the most frequent abusive experiences students had. Overall, suicide attempts were reported by 3.1 % of respondents (4.7% by females and 0.8% by males). Those respondents who had been emotionally abused were almost three times as likely to attempt suicide, physical abuse almost doubles the chances of attempting suicide, substance abuse in the family increased the chances 2.3 times for attempting suicide, violent treatment of the mother almost quadrupled them for attempted suicide, having a family member who had been in prison increased the odds of almost 3.5 times for attempting suicide. Attempted suicide was found to be 1.5 times more likely as the number of ACEs reached 3 and 3.4 times more likely as the number of adverse childhood experiences reached four or more. CONCLUSION: Identifying and treating children, adolescents and young adults who have been affected by adverse childhood experiences may have substantial value in our evolving efforts to prevent suicide.

Primary Care Physician Describes Health Care ‘Hot Spotting’

Primary Care Physician Describes Health Care ‘Hot Spotting’

P.7.b.001 Clinical characteristics of depression among adolescent females: a cross-sectional study

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.

Help Wanted: Studies of Firearms Injuries Affecting Children

* Abbreviations: CDC — : Centers for Diseases Control and Prevention The continued high incidence of firearms deaths in the United States is a national disgrace. Despite declining rates over the past decade, firearm injuries remain the second leading cause of death for young Americans, trailing only motor vehicle crashes.1 The toll of gun violence extends well beyond those killed or injured. Children growing up in communities with high rates of gun violence grow up without a favorite uncle, classmate, close friend, or relative. These effects are real, as described in the Adverse Childhood Experiences Study, which demonstrated the long-term consequences of witnessing violence on physical and mental health.2 The article, by Carter et al in this issue,3 describes patterns of firearm ownership among adolescents and young adults who presented to the emergency department for assault-related injuries. Nearly 1 in 4 of these patients had a firearm; few of them were obtained legally. Many of the patients in the Carter study obtained their guns from friends and family. In … Address correspondence to Robert D. Sege, MD, PhD, Division of Family and Child Advocacy, Boston Medical Center, 850 Harrison Ave, Dowling 3 South, Boston, MA 02118. E-mail: Robert.sege{at}bmc.org

Childhood disruptiveness and anxiousness impact the relationship between childhood adversity and later suicide attempt

Question: What influence do childhood anxiousness and disruptiveness have on the association between childhood adversity and later suicide attempts, and do mental disorders modify these associations? People: Two groups were...

An ounce of prevention or two… providing anticipatory guidance regarding personal space and privacy. A commentary

C. Henry Kempe’s, 1977, C. Anderson Aldrich seminal lecture “Another hidden pediatric problem: the sexual abuse of hildren” was the clarion call awakening pediatricians to the issue of the sexual victimization of children. Almost 40 years ater pediatricians and society at large continue to grapple with how best to reduce the risk of sexual victimization. Although o one denies the reality of sexual abuse of children the topic remains a challenge. While there is no group more vested in the ealth and welfare of children than pediatricians—whose raison de’tre is to assure a child’s healthy development—there has een limited success in addressing the issue of child sexual abuse (CSA) within the context of routine health care. There is a ignificant body of literature, the Adverse Childhood Experiences Studies (ACE’s) that elucidates the potential for long term erious adverse medical and mental health consequences to childhood trauma. This body of literature reinforces the need to mbark on universal prevention by developing new and creative public health strategies to further reduce the vulnerability f children to sexual abuse (Fellitti et al., 1998). National prevention strategies in the United States have focused primarily on offender management and school-based ducation which has garnered a lot of public attention and approval yet child sexual abuse remains a prevalent problem. chool based programs promote disclosure, reduce self blame but remain insufficient to fully address this pervasive public ealth problem. The development of a comprehensive health and safety promotion curriculum for medical professionals ould be complementary to existing school based strategies (Finkelhor, 2009). At present, pediatricians do not hesitate to provide anticipatory guidance regarding back to sleep safety, car and bicycle afety, water and environmental safety, and a myriad of others to their patients; yet, the topic of a child’s right to personal pace and privacy is sub-optimally addressed. While this may be due to the difficult nature of the topic, avoiding discussing he issue of personal space and privacy with children and their caretakers may only further perpetuate the problem of CSA. e must respond to the issue, and embark on an initiative to introduce anticipatory guidance about personal space and rivacy throughout a child’s life in developmentally appropriate ways. I propose that we do so under the euphemism of a hild’s right to “Personal Space and Privacy” (PSP) rather than CSA prevention. The first step is to educate parents and children about the right to PSP, and provide caretakers with age appropriate anguage so they can comfortably talk about the importance of PSP with children throughout childhood. Too many parents till believe that talking to children about stranger danger, registered sex offenders, and the risk of abuse in organized ports, educational institutions, and religious organizations is sufficient for protecting them from sexual victimization. This isconception contributes to the unfortunate reality that children are uneducated about how to recognize and respond to ituations in which their personal space and privacy is invaded by someone who they know and should trust. The heightened vulnerability of young children, due to reasons such as their need for genital/perianal care and bathing ssistance, provides even more reason to educate children early and in a consistent manner about their PSP. In fact, caretakers ay use these opportunities to send context-appropriate anticipatory guidance messages to their children about PSP. If aretakers teach their children about the difference between “okay” and “not okay” touching when providing genital/perianal are and bathing assistance, then children will possess the knowledge to recognize when someone is invading their PSP and

Adverse Childhood Experiences and Adult Criminality: How Long Must We Live before We Possess Our Own Lives?

Empirical research associated with the Kaiser Permanente and Centers for Disease Control and Prevention Adverse Childhood Experiences (ACE) Study has demonstrated that ACE are associated with a range of negative outcomes in adulthood, including physical and mental health disorders and aggressive behavior. Subjects from 4 different offender groups (N = 151) who were referred for treatment at an outpatient clinic in San Diego, CA, subsequent to conviction in criminal court, completed the ACE Questionnaire. Groups (nonsexual child abusers, domestic violence offenders, sexual offenders, and stalkers) were compared on the incidence of ACE, and comparisons were made between the group offenders and a normative sample. Results indicated that the offender group reported nearly four times as many adverse events in childhood than an adult male normative sample. Eight of ten events were found at significantly higher levels among the criminal population. In addition, convicted sexual offenders and child abusers were more likely to report experiencing sexual abuse in childhood than other offender types. On the basis of a review of the literature and current findings, criminal behavior can be added to the host of negative outcomes associated with scores on the ACE Questionnaire. Childhood adversity is associated with adult criminality. We suggest that to decrease criminal recidivism, treatment interventions must focus on the effects of early life experiences.

Self-Rated Health and Association with ACEs

Background: Prior studies have demonstrated an association between experiencing trauma in childhood and poorer self-rated health in adulthood. Much less is known about this association among low-income minority patients in primary care settings. Methods: We replicated the Adverse Childhood Experiences (ACE) Study, a collaborative venture between the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente, with a low-income minority sample of primary care patients (N = 801) at a community-based healthcare center. We conducted a cross-sectional retrospective quantitative survey study. Data were analyzed using binary logistic regression to evaluate the hypothesis that low-income minority patients who reported more childhood trauma (abuse, neglect, household dysfunction, cumulative adverse childhood experiences [ACEs]) would more likely have reported poorer health in adulthood. Results: The number of ACEs in our sample was considerably higher than the original CDC ACE Study, as almost 50% of patients surveyed at our clinic reported 4 or more ACEs, confirming that trauma is central among individuals served in many urban primary care settings. The results of the ACE abuse, neglect, and cumulative ACEs score were in the expected direction and statistically significant suggesting that participants who reported more childhood abuse and neglect and who reported more childhood trauma (cumulative/total ACEs) were more likely to report poorer health in adulthood. Conclusion: These findings have implications for providers, researchers, and policy makers to develop more collaborative approaches to primary care that better target the negative sequelae of ACEs.

Improving the Adverse Childhood Experiences Study Scale

To test and improve upon the list of adverse childhood experiences from the Adverse Childhood Experiences (ACE) Study scale by examining the ability of a broader range to correlate with mental health symptoms. Nationally representative sample of children and adolescents. Telephone interviews with a nationally representative sample of 2030 youth aged 10 to 17 years who were asked about lifetime adversities and current distress symptoms. Lifetime adversities and current distress symptoms. The adversities from the original ACE scale items were associated with mental health symptoms among the participants, but the association was significantly improved (from R2 = 0.21 to R2 = 0.34) by removing some of the original ACE scale items and adding others in the domains of peer rejection, peer victimization, community violence exposure, school performance, and socioeconomic status. Our understanding of the most harmful childhood adversities is still incomplete because of complex interrelationships among them, but we know enough to proceed to interventional studies to determine whether prevention and remediation can improve long-term outcomes.

A prospective study to assess the relation between different traumatic events and the risk of six physical health conditions in a population-based sample

Methods: We assessed PTSD (PCL N=50), combat intensity (34 summed, weighted items in tertiles), depression (PHQ), and alcohol misuse (TICS) in a sample of 2422 Soldiers. Family history of depression and alcohol misuse were assessed using 2 items from the Adverse Childhood Experiences Study. Results: In logistic regression models, combat intensity increases risk for PTSD (for intermediate intensity, odds ratio [OR]=2.5, 95% confidence interval [CI]=1.8–3.5; for high intensity, OR=5.2, CI=3.8,7.2; prNχ for trend=0.000). Family history of depression (OR=1.4, CI=1.0–2.0), and alcohol misuse (OR=1.4, CI=1.1–1.9), and subject depression (OR=20.6, CI=15.0–28.4) and alcohol misuse (OR=1.5, CI=1.1–2.0), all increase risk for PTSD but do not confound the association of combat experiences and PTSD. No effect modification was detected. Conclusion: Family histories of depression and alcohol misuse modestly predict PTSD, but neither confound nor modify the effect of subjects' combat experience, depression, and alcohol misuse on PTSD. Intensity of exposure to warfare itself principally drives PTSD symptomatology and concomitant depression and alcohol misuse.

Mobilizing Resilience and Recovery in Response to Adverse Childhood Experiences (ACE): A Restorative Integral Support (RIS) Case Study

The Restorative Integral Support (RIS) model is a comprehensive, whole person approach to addressing adversity and trauma. The Adverse Childhood Experiences (ACE) Study conducted by the Centers for Disease Control (CDC) and Kaiser Permanente reveals a relationship between childhood trauma and adult health and social problems. The current empirical case study presents the Committee on the Shelterless (COTS), in Petaluma, CA, as an example of one social service agency employing RIS to break cycles of homelessness. By applying RIS, research-based programming is offered within a culture of recovery that mobilizes resilience through social affiliations. The authors recommend RIS model implementation and research in programs serving populations with ACE backgrounds.