Elevated Adverse Childhood Experiences Score Research Articles

Childhood Adversity and Adolescent Smartphone Use Across Sexual Orientation and Gender Expression

Nonheterosexual and gender-nonconforming (GNC) individuals tend to report adverse childhood experiences (ACEs) more frequently compared with heterosexual and gender-conforming individuals, and individuals who have experienced ACEs, identify as nonheterosexual, or exhibit moderate to high levels of GNC are more prone to engaging in problematic smartphone use (PSU). However, there is limited school-based data among adolescents regarding this matter. To explore the associations between ACEs and PSU among adolescents across different sexual orientation and gender expression groups. Using data from the 2021 School-Based Chinese Adolescents Health Survey, this cross-sectional study includes participants from 288 public high schools across 8 provinces in China. Statistical analysis was performed from October 2023 to February 2024. Data on ACEs, sexual orientations, and gender expressions (high, moderate, and low GNC) were collected. PSU was assessed using the 10-item Smartphone Addiction Scale-Short Version (SAS-SV). Weighted linear, logistic, or Poisson regression models were used. Among the 85 064 adolescents included (mean [SD] age, 14.92 [1.77] years), 42 632 (50.1%) were female, 70 157 (83.2%) identified as Han Chinese, and 14 208 (16.8) identified as other ethnicities (Miao, Hui, Yi, Dai, and other ethnic groups). The prevalence of PSU among participants was 35.4%. Weighted Poisson regression models indicated that the interaction between GNC and ACE was significant (adjusted prevalence ratio [APR], 0.98; 95% CI, 0.97-0.99). Further stratified analysis demonstrated homosexual adolescents who experienced 4 or more ACEs showed a significantly increased prevalence of PSU (APR, 1.79; 95% CI, 1.64-1.96). Similarly, a markedly higher prevalence of PSU was observed among bisexual individuals with 4 or more ACEs (APR, 1.60; 95% CI, 1.41-1.80). Regarding gender expression categories, a significantly higher prevalence of PSU was noted among high GNC adolescents with 4 or more ACEs (APR, 1.78; 95% CI, 1.60-1.98) compared with low GNC adolescents without ACEs. Furthermore, experiencing any 3 ACE categories (abuse, neglect, and household dysfunction) was associated with an increased prevalence of PSU across different sexual orientation and gender expression subgroups. In this cross-sectional study, the amalgamation of elevated ACE scores with nonheterosexual orientations or GNC identities was significantly associated with increased PSU prevalence. These findings underscore that preventing ACEs may be beneficial in mitigating PSU among adolescents, particularly for nonheterosexual adolescents and those with high levels of GNC.

Parents’ adverse childhood experiences matter too: The impact of multigenerational trauma on participation in early childhood education for Latinx children

Childhood trauma impacts most children in the United States, with exposure to adverse childhood experiences (ACEs) like abuse, neglect, or witnessing violence linked to negative outcomes across the lifespan. Early childhood education (ECE) programs, such as therapeutic preschools, that utilize two-generation approaches to services have demonstrated proven benefits for children with trauma exposure; however, less is known about the impact of ACEs on early childhood program engagement and retention. The current study, set in a two-generation therapeutic preschool program, examined 173 pairs of primarily Latinx parents and children to understand in what ways parent and child ACEs, coupled with family contextual risks like homelessness and child welfare involvement, impact program engagement for children with trauma histories. Results indicate that children whose parents had an elevated ACE score (four or more trauma experiences) were more likely to terminate ECE participation early compared to children whose parents had less cumulative trauma. Families with parents and children who both had high ACEs were over six times more likely to terminate program participation early. However, once accounting for early termination, ACEs had minimal impact on ECE engagement. These findings highlight the need for ECE programs to consider the whole family at entry and target early retention efforts towards families with greater cumulative trauma histories.

Adverse Childhood Experiences in Patients With Neurologic Disease.

To describe the prevalence of high adverse childhood experiences (ACEs) among neurology outpatients and determine their association with health care utilization rates and comorbid medical and psychiatric disease. This was a cross-sectional study of adults seen for outpatient neurology follow-up at the University of Pennsylvania. Participants completed the ACE questionnaire and depression/anxiety screenings. Health care utilization metrics (emergency department [ED] visits, hospitalizations, and outpatient calls) were obtained for all participants. High ACE scores were defined as a score of ≥4. The prevalence of high ACE scores in our cohort was compared with US historical controls. Statistical associations were adjusted for age, sex, and race/ethnicity. One hundred ninety-eight patients were enrolled in the study. Neurology patients were more likely to have elevated ACE scores compared with US population estimates (23.7% vs 12.6%, p < 0.01). High ACE scores were associated with increased ED utilization (odds ratio [OR] = 21, 95% CI [5.8-76.0], p < 0.01), hospitalizations (OR = 5.2, 95% CI [1.7-15.0], p < 0.01), and telephone encounters (OR 3, 95% CI [1.1-8.2], p < 0.05). High ACEs were also associated with medical and psychiatric comorbidities (OR 5.8, 95% CI [2.0-17.0], p < 0.01 and OR 4.5, 95% CI [2.1-9.6], p < 0.01) and high depression and anxiety scores (OR = 6.9, 95% CI [2.8-17.0], p < 0.01, and OR = 4.3, [95% CI 1.7-11.0], p < 0.01). Patients with neurologic conditions are more likely to have high ACEs than the US population, which was associated with higher rates of health care utilization, increased number of medical and psychiatric comorbidities, and higher anxiety and depression scores. Addressing ACEs may be a way to improve the health outcomes of patients with neurologic conditions.

599 Associations between adverse childhood experiences and obstetrical outcomes in an urban underserved population

Adverse childhood experiences (ACEs) such as abuse, neglect, and household dysfunction are strongly associated with poor adult health outcomes in a dose-dependent manner. Less is known about the impact of ACEs on pregnancy, especially in vulnerable populations. The objective of this study was to examine the relationship between ACEs and obstetric outcomes. This is a single-center retrospective cohort study of pregnant women referred to a mental health care coordinator due to elevated psychosocial risks and/or behavioral concerns. Women younger than age 18 and those who did not speak English were excluded. Patients completed validated mental and behavioral health screening tools including the ACE questionnaire. Medical charts were reviewed for obstetric outcomes. The associations between ACE score and adverse obstetric outcomes including preterm birth (<37 weeks), low birth weight (<2500 g), and hypertensive disorders of pregnancy (gestational hypertension and preeclampsia), were analyzed using bivariate analysis and multivariate logistic regression, adjusting for confounding factors (significant at p< 0.1 in bivariate analysis). Our cohort included 92 women of whom 49% had elevated cumulative ACE score ≥ 4 and 26% had a cumulative ACE score ≥ 6. Women with elevated ACE score were significantly more likely to have chronic hypertension; otherwise there were no differences on demographic characteristics or potential obstetric confounds between groups (Table 1). In univariate analysis, ACE score ≥ 4 was not associated with adverse obstetric outcomes, however a score ≥ 6 was associated with an increased risk of preterm birth (OR 3.7, 95% CI 1.2-11.4) and low birth weight (OR 4.9, 95% CI 1.4-17.2). This association did not remain statistically significant after controlling for chronic hypertension. A high level of childhood adversity was associated with chronic hypertension and both prematurity and low birth weight. Future studies should examine whether chronic illnesses help account for poor obstetric outcomes in pregnant women with high childhood adversity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Adverse Childhood Experiences and Justice System Contact: A Systematic Review.

Given the wide-ranging health impacts of justice system involvement, we examined evidence for the association between adverse childhood experiences (ACEs) and justice system contact in the United States. To synthesize epidemiological evidence for the association between ACEs and justice system contact. We searched 5 databases for studies conducted through January 2020. The search term used for each database was as follows: ("aces" OR "childhood adversities") AND ("delinquency" OR "crime" OR "juvenile" OR criminal* OR offend*). We included all observational studies assessing the association between ACEs and justice system contact conducted in the United States. Data extracted from each eligible study included information about the study design, study population, sample size, exposure and outcome measures, and key findings. Study quality was assessed by using the Newcastle-Ottawa Scale for nonrandomized trials. In total, 10 of 11 studies reviewed were conducted in juvenile population groups. Elevated ACE scores were associated with increased risk of juvenile justice system contact. Estimates of the adjusted odds ratio of justice system contact per 1-point increase in ACE score ranged from 0.91 to 1.68. Results were consistent across multiple types of justice system contact and across geographic regions. Most studies reviewed were conducted in juvenile justice-involved populations with follow-up limited to adolescence or early adulthood. ACEs are positively associated with juvenile justice system contact in a dose-response fashion. ACE prevention programs may help reduce juvenile justice system contacts and improve child and adolescent health.

Prebirth Household Challenges To Predict Adverse Childhood Experiences Score by Age 3

With this study, we seek to understand the relationship between prebirth household challenges and the child's adverse childhood experiences (ACEs) score by age 3 in a statewide-representative birth cohort to inform primary prevention strategies. We used a longitudinally linked data set from the Alaska 2009-2011 Pregnancy Risk Assessment Monitoring System, its 3-year follow-up survey, and multiple administrative data sources. Using this linked data set, we predicted an expanded ACEs score by age 3 using maternal reported prebirth household challenges. The number of household challenges reported during the 12 months before or during pregnancy predicted ACEs score in a graded, dose-response manner. On average, reporting 4+ prebirth household challenges was associated with an ACEs score 4.1 times that of those reporting 0 challenges. Homelessness was associated with the greatest increase in ACEs score (relative rate ratio = 3.0). Prebirth household challenges that were independently associated with an elevated ACEs score in our final model included problems paying bills, someone close to the mother having a drinking and/or drug problem, homelessness, mother or husband or partner being in jail, husband or partner losing job, separation or divorce, and being checked or treated for anxiety or depression. The accumulation and certain prebirth household challenges are strongly associated with the accumulation of childhood ACEs. Addressing and reducing household challenges during the prebirth period may serve as a primary point of ACEs prevention. Many evidence-based, multidisciplinary intervention strategies can and should be implemented in the prebirth period to strengthen the household unit before the introduction of a new child.

Translating ACE Research into Multi-tiered Systems of Supports for At-risk High-school Students

The Adverse Childhood Experiences (ACE) Questionnaire has provided the basis for a substantial body of research literature that illuminates the enduring social, emotional, academic, health, and life outcome effects of childhood trauma. Additional studies with children and adolescents suggest a strong neurodevelopmental dose-respondent association with high ACE scores and school academic and behavioral problems. As the national effort to include social-emotional learning (SEL) into Multi-Tiered Systems of Supports (MTSS) moves forward in the public schools, the need for psychometrically sound instruments for data-based decision-making becomes critical. The current study investigated a potential relationship between the ACE Questionnaire to more psychometrically sound screening and broadband instruments (Behavior Assessment System for Children (BASC)-3 Self-Report of Personality Form-Adolescent and BASC-3 Behavioral and Emotional Screening System (BESS) Student Form-Adolescent) that are standardized, norm-referenced, multi-gating in design, and commonly used in educational settings. Results indicate that 62% of the students with elevated ACE scores had at-risk scores on the BESS screener. In addition, elevated at-risk scores on the BESS for the students with self-reported elevated ACE scores correlated with multiple at-risk and clinically significant index and composite scores on the broadband BASC-3. The significant index and composite scores created a unique psychological profile of students with high ACE scores who were experiencing significant current distress along with little perceived social support. The results support the use of SEL screening measures that seamlessly and psychometrically link secondary- and tertiary-level diagnostic tools in a multi-gating format in MTSS.

3.64 Intergenerational Transmission of Adversity: A Focus on Perinatal Stress, the Hypothalamic-Pituitary-Adrenal (HPA) Axis, and Infant Neurodevelopment

Accumulating evidence suggests that child neurodevelopment and life course mental health begins in utero, with the offspring of mothers who experienced adverse childhood experiences (ACEs) at increased risk for adversity. Although many mechanisms of transmission have been considered, this study focuses on the hypothalamic-pituitary-adrenal axis. Increasing maternal cortisol is necessary for fetal development over the course of pregnancy. Maternal hair cortisol (HC) levels in the second trimester have previously been associated with perinatal stressors and are negatively correlated with gestational age (GA) at delivery and birth weight (BW). We hypothesized that expectant mothers with elevated ACE scores would have elevated HC and perceived stress and that the elevated HC and stress would be negatively associated with GA, BW, and infant behavior.

Association of Adverse Childhood Experiences and Food Addiction to Bariatric Surgery Completion and Weight Loss Outcome.

Adverse childhood experiences (ACEs) are known risk factors for obesity and poor outcomes following weight loss interventions. ACEs are also associated with addictive behaviors and, potentially, food addiction (FA). This study examined the relationship between ACEs and FA, and their association to undergoing bariatric surgery and post-surgical weight loss outcomes. Between June 2013 and January 2016, 1586 bariatric-surgery-seeking patients completed a psychological evaluation. During their evaluation, the patients were administered measures including the ACE questionnaire and the Yale Food Addiction Scale. 19.2% of those seeking bariatric surgery reported being the victim of childhood sexual abuse, and 22.1% reported being the victim of childhood physical abuse. An elevated ACE score corresponded to increased likelihood of screening positive for FA and more severe FA. When the type of ACE was analyzed separately, ACE was not associated with bariatric surgery completion or percent total weight loss (%TWL). Screening positive for FA corresponded to less %TWL 1year post-surgery as the total number of ACEs increased, yet there was no association with %TWL 2years post-surgery. The participants were classified into two groups, those positive for an ACE or FA versus those negative for both. Those who screened positive were significantly less likely to undergo bariatric surgery. Screening positive for experiencing ACEs was related to severity of FA, and screening positive for being the victim of either childhood abuse or FA reduced the likelihood of completing bariatric surgery. More research is needed to determine how these psychosocial factors might influence bariatric surgery outcomes.