Greater Adverse Childhood Experiences Research Articles

The effects of neighborhood disadvantage and adverse childhood experiences on conditioned pain modulation in adults with chronic low back pain

Chronic low back pain (cLBP) remains a major health crisis worldwide. Current conceptualizations of cLBP utilize the biopsychosocial model, yet research on social factors remains limited. Adverse childhood experiences (ACEs) are a risk factor for a variety of chronic health problems, including cLBP. However, the extent to which socioeconomic context might influence associations between ACEs and cLBP remains unclear. Socioeconomic factors such as healthcare access and living conditions, which cluster at the neighborhood level, may affect how ACEs relate to cLBP in adulthood. This study examined (1) the relationship between ACEs and conditioned pain modulation (CPM), and (2) the moderating effect of area-level deprivation index (ADI) in a sample of community-dwelling adults with cLBP. 183 adults with cLBP (53% female, 62.8% non-Hispanic Black) reported on ACEs, ADI, sociodemographics, and completed experimental testing of conditioned pain modulation (CPM). Greater ACEs were associated with a less efficient CPM response for individuals residing in low neighborhood deprivation (p < 0.01). ACEs were not significantly associated with CPM for those residing in average (p = 0.31) or high deprivation (p = 0.15). Our findings suggest that a history of ACEs is associated with diminished ability to inhibit pain, especially among individuals living in less deprived neighborhoods. The association between ACEs and CPM was weakest for the portion of our sample residing in neighborhoods with the most deprivation. People from disadvantaged backgrounds may experience numerous psychosocial stressors that hinder CPM, making it difficult to assess the specific impact of ACEs on CPM. Trial registrationThis study utilized baseline data collected as part of a parent trial titled “Examining Racial and SocioEconomic Disparities in Chronic Low Back Pain” (ERASED - ClinicalTrials.gov ID: NCT03338192). PerspectiveThis study demonstrates that early life adversity is associated with abnormal endogenous pain modulation, particularly for participants who live in neighborhoods characterized by less deprivation.

Childhood adversity is associated with reduced BOLD response in inhibitory control regions amongst preadolescents from the ABCD study

Adolescence is characterized by dynamic neurodevelopment, which poses opportunities for risk and resilience. Adverse childhood experiences (ACEs) confer additional risk to the developing brain, where ACEs have been associated with alterations in functional magnetic resonance imaging (fMRI) BOLD signaling in brain regions underlying inhibitory control. Socioenvironmental factors like the family environment may amplify or buffer against the neurodevelopmental risks associated with ACEs. Using baseline to Year 2 follow-up data from the Adolescent Brain Cognitive Development (ABCD) Study, the current study examined how ACEs relate to fMRI BOLD signaling during successful inhibition on the Stop Signal Task in regions associated with inhibitory control and examined whether family conflict levels moderated that relationship. Results showed that greater ACEs were associated with reduced BOLD response in the right opercular region of the inferior frontal gyrus and bilaterally in the pre-supplementary motor area, which are key regions underlying inhibitory control. Further, greater BOLD response was correlated with less impulsivity behaviorally, suggesting reduced activation may not be behaviorally adaptive at this age. No significant two or three-way interactions with family conflict levels or time were found. Findings highlight the continued utility of examining the relationship between ACEs and neurodevelopmental outcomes and the importance of intervention/prevention of ACES.

Does Childhood Trauma Predict Impulsive Spending in Later Life? An Analysis of the Mediating Roles of Impulsivity and Emotion Regulation

We sought to investigate whether adverse childhood experiences increase impulsive spending in later life, and whether emotion dysregulation and impulsivity mediate this association. Limited research has examined associations between these factors, and examining the mechanisms involved may inform interventions for impulsive spending. This study used a cross-sectional, correlational design including 189 adult participants who completed an online survey assessing childhood trauma, adverse childhood experiences, impulsive spending, impulsivity, and emotion dysregulation. Greater adverse childhood experiences and childhood trauma were positively correlated with impulsive spending, as well as general impulsivity and emotion dysregulation. Mediation analyses indicated that emotion dysregulation and greater impulsivity accounted for the positive relationship between childhood trauma and impulse spending. Adverse childhood experiences and childhood trauma are associated with increased risk of impulse spending in adulthood via elevated general impulsivity and emotion dysregulation.

Functional decline during the COVID-19 pandemic among U.S. military veterans: Results from the National Health and Resilience in Veterans Study.

The coronavirus disease-2019 pandemic has contributed to widespread social and economic stressors, along with substantial health problems, including loss of life. To date, however, relatively few studies have examined the prevalence and correlates of declines in mental and physical functioning in U.S. military veterans, an older and potentially vulnerable segment of the U.S. adult population. Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, a nationally representative, longitudinal study of 3078 veterans. Veterans were surveyed prior to the pandemic (pre-pandemic) and 1year later during the height of the pandemic (peri-pandemic). Multivariable analyses were conducted to identify risk and protective variables associated with pre-to-peri pandemic declines in self-reported physical and mental functioning. The prevalence of veterans who experienced functional decline (≥0.5 standard deviation reductions) pre-to-peri-pandemic was 18.1% (N=541) for physical functioning and 18.3% (N=547) for mental functioning. Older age, greater adverse childhood experiences (ACEs), and pandemic-related posttraumatic stress symptoms were the strongest correlates of physical functional decline, while greater ACEs, loneliness, pandemic-related posttraumatic and social restriction stress symptoms, and lower protective psychosocial characteristics were the strongest correlates of mental functional decline. Although the majority of U.S. Veterans showed functional maintenance or improvement 1year into the pandemic, nearly one-in-five experienced a decline in physical or mental functioning. Results could help inform identification of veterans who may be at risk for functional decline during large-magnitude stressors, such as national or global pandemics.

47 Exposure to Early Life Adversity is Related to Alterations in Neural Correlates of Inhibitory Control in Preadolescents: Findings from the ABCD Study Cohort

Objective:Rapid neurodevelopment occurs during adolescence, which may increase the developing brain’s susceptibility to environmental risk and resilience factors. Adverse childhood experiences (ACEs) may confer additional risk to the developing brain, where ACEs have been linked with alterations in BOLD signaling in brain regions underlying inhibitory control. Potential resiliency factors, like a positive family environment, may attenuate the risk associated with ACEs, but limited research has examined potential buffers to adversity’s impact on the developing brain. The current study aimed to examine how ACEs relate to BOLD response during successful inhibition on the Stop Signal Task (SST) in regions underlying inhibitory control from late childhood to early adolescence and will assess whether aspects of the family environment moderate this relationship.Participants and Methods:Participants (N= 9,080; Mage= 10.7, range= 9-13.8 years old; 48.5% female, 70.1% non-Hispanic White) were drawn from the larger Adolescent Brain Cognitive Development (ABCD) Study cohort. ACE risk scores were created (by EAS) using parent and child reports of youth’s exposure to adverse experiences collected at baseline to 2-year follow-up. For family environment, levels of family conflict were assessed based on youth reports on the Family Environment Scale at baseline and 2-year follow-up. The SST, a task-based fMRI paradigm, was used to measure inhibitory control (contrast: correct stop &gt; correct go); the task was administered at baseline and 2-year follow-up. Participants were excluded if flagged for poor task performance. ROIs included left and right dorsolateral prefrontal cortex, anterior cingulate cortex, anterior insula, inferior frontal gyrus (IFG), and pre-supplementary motor area (pre-SMA). Separate linear mixed-effects models were conducted to assess the relationship between ACEs and BOLD signaling in ROIs while controlling for demographics (age, sex assigned at birth, race, ethnicity, household income, parental education), internalizing scores, and random effects of subject and MRI model.Results:Greater ACEs was associated with reduced BOLD response in the opercular region of the right IFG (b= -0.002, p= .02) and left (b= -0.002, p= .01) and right pre-SMA (b= -0.002, p= .01). Family conflict was related to altered activation patterns in the left pre-SMA, where youth with lower family conflict demonstrated a more robust negative relationship (b=.001, p= .04). ACEs were not a significant predictor in other ROIs, and the relationship between ACEs and BOLD response did not significantly differ across time. Follow-up brain-behavior correlations showed that in youth with lower ACEs, there was a negative correlation between increased activation in the pre-SMA and less impulsive behaviors.Conclusions:Preadolescents with ACE history show blunted activation in regions underlying inhibitory control, which may increase the risk for future poorer inhibitory control with downstream implications for behavioral/health outcomes. Further, results demonstrate preliminary evidence for the family environment’s contributions to brain health. Future work is needed to examine other resiliency factors that may modulate the impact of ACE exposure during childhood and adolescence. Further, clinical scientists should continue to examine the relationship between ACEs and neural and behavioral correlates of inhibitory control across adolescent development, as risk-taking behaviors progress.

Self-reported reflective functioning and father-child interactions in a sample of fathers who have used intimate partner violence.

Reflective functioning (RF) has been found to be associated with mother-child interactions, but less is known about the association of fathers' self and child-focused RF and father-child relationships. Fathers who have histories of intimate partner violence (IPV) are known to have poor RF, which may impact their father-child interactions. The current study was designed to examine how types of RF are associated with father-child relationships. Pretreatment assessments and recorded, coded father-child play interactions were used to examine associations among fathers' history of adverse childhood experiences (ACES), RF and coded father-child play interactions in a sample of 47 fathers with a history of IPV use in the last 6 months with their coparent. Fathers' ACES and their child's mental states (CM) were associated with father-child dyadic play interactions. Fathers with greater ACES and higher scores on CM had the most dyadic tension and constriction during play interactions. Those with high ACES but low CM had scores similar to those with low ACES and low CM. These results indicate that fathers who have used IPV and have a history of significant adversity may benefit from interventions to increase their child-focused RF and further improve their interactions with their children.

Adverse Childhood Experiences and Offending as a Function of Acquired Brain Injury Among Men in a High Secure Forensic Psychiatric Hospital.

Acquired brain injury (ABI) is a serious problem that disproportionately affects individuals in correctional services, but relatively little is known about ABI risks and correlates in forensic psychiatric services. We conducted a retrospective chart review of all admissions to a high secure forensic hospital in Ontario, Canada from January 2009 to December 2012 (n = 637) and collected data on ABI, psychiatric diagnoses, developmental disadvantage, criminal offending, and in-hospital aggression. A k-means cluster analysis was employed to assess risk factors by which men with ABI could be identified and multivariate general linear models were used to identify ABI-related differences in offending history and in-hospital aggression. One-fifth of the men had a documented ABI indicator. Based on our cluster analysis, ABI was more likely to be identified by greater adverse childhood experiences (ACEs), more health problems from pregnancy to childhood, and lower socioeconomic status, suggesting that ABI within the forensic context is associated with greater developmental disadvantage. Men with ABI had more serious pre-admission offences, but not more serious admission offences or in-hospital aggression. Men with ABI were more likely than those without to have higher scores on the Violence Risk Appraisal Guide or to be diagnosed with mood and personality disorders, and less likely to have a schizophrenia diagnosis, suggesting an association between ABI and general mental health pathologies but not with psychotic illness. The disadvantage of ABI among men in forensic psychiatric hospitals is most likely evinced in antisocial behaviour rather than serious mental illness. Given that ACEs are likely to precede or co-occur with ABI, strategies that mitigate ACEs hold promise for ABI prevention.

Health Care Access and Quality Among Children Exposed to Adversity: Implications for Universal Screening of Adverse Childhood Experiences.

Given recent advances toward universal screening for Adverse Childhood Experiences (ACEs), our objective was to investigate whether children with higher ACEs experience poorer quality of provider care and greater challenges accessing needed mental health treatment. This study uses a nationally representative sample of US children aged 0-17years drawn from the National Survey on Children's Health for 2016-2019. Caregivers and parents completed surveys between June 2016 and February 2020 (N = 131,774). Logistic regression models adjusting for identified covariates were used to test associations between a child's number of ACEs, their quality of provider care, and their access to mental health treatment. All analyses used appropriate survey weighting commands. High ACEs (4 or more) were associated with lower quality of provider care, including effective care coordination [OR 0.45, 95% CI (0.38, 0.52)], family-centered care [OR 0.49, 95% CI (0.41, 0.58)], shared decision making [OR 0.50, 95% CI (0.39, 0.85)], and referrals for care [OR 0.58, 95% CI (0.43, 0.80)]; children with high ACEs were also less likely to have a medical home [OR 0.66, 95% CI (0.57, 0.76)]. High ACEs were also significantly associated with greater difficulty accessing mental health treatment [OR 0.55, 95% CI (0.43, 0.70)]. Similar results were found for children in the moderate ACE (2-3) and low ACE (1) groups. Findings indicate that greater ACEs were associated with poorer quality medical care and greater difficulty accessing needed mental health treatment. Because findings indicate that children with high ACEs may be the least likely to receive quality care or necessary mental health treatment to address this adversity, universal screening for ACEs should be considered with caution.

Importance of adverse childhood experiences

As we learn more about the life-course approach to chronic disease development, it has become clear that a range of exposures during fetal life, childhood, and adolescence can have a profound impact on health and disease in adulthood. In this volume of The Journal, Andrade et al report on an assessment of adverse childhood experiences and increased cardiometabolic risk in Hispanic adolescents. The authors included 10 adverse experiences that are commonly evaluated and added bullying as an additional adverse experience. They found that those adolescents who experience 4 or greater adverse childhood experiences were more likely to have obesity and markers of cardiometabolic risk than those with fewer adverse experiences (Figure). Research is needed to better understand the mechanisms by which adverse experiences in childhood result in increased cardiometabolic risk. Such research may lead to interventions that could prevent atherosclerotic cardiovascular disease. In the meantime, efforts should be made to reduce the number and severity of adverse experiences for children. Article page 267 ▸ Adverse Childhood Experiences Are Associated with Cardiometabolic Risk among Hispanic American AdolescentsThe Journal of PediatricsVol. 237PreviewTo assess the relationship between adverse childhood experiences (ACEs) and cardiometabolic risk among Hispanic adolescents. Full-Text PDF

Risk factors for generalized anxiety disorder among young women and men in informal settlements in South Africa: A cross-sectional study

Generalized anxiety disorder (GAD) is common globally, particularly among young people, but limited research has been done on the risk factors for GAD especially in low-income settings. We sought to understand risk factors for GAD among young (ages 18–32) women and men from urban informal settlements in Durban, South Africa, enrolled in an intervention trial. Descriptive statistics and multivariable logistic regressions were used to assess risk factors, separately by sex. Using the GAD7 scale, among 484 women, 18.6 ​% reported moderate or severe symptoms of GAD. In multivariable analysis, moderate or severe GAD symptoms were associated with stealing because of hunger in the past month, stress because of lack of work, experiencing three or more past year experiences of adverse events, and past year experience of intimate partner violence. Among 505 men, 19.6 ​% reported moderate or severe GAD symptoms. In multivariable analysis, moderate or severe GAD symptoms were associated with stealing because of hunger in the past month, greater adverse childhood experiences, and three or more adverse experiences in the past year. Overall higher GAD symptoms were associated with poverty and violence experience and exposure, addressing these two factors is critical for reducing poor mental health.

Childhood adversity, socioemotional functioning and generalized anxiety in young adults from mixed immigration status families

BackgroundThe translation of research on adverse childhood experiences (ACEs) into effective prevention and treatment of psychopathology requires examination of how ACEs impact mental health. Moreover, increased attention to more marginalized populations, such as immigration-affected ethnic-minority young adults, is greatly needed. ObjectiveThe current study tested the hypothesis that greater ACEs would be related to greater generalized anxiety symptoms directly and indirectly, via ACE-related deficits in coping efficacy, self-compassion, and perceived support, above and beyond immigration-related family stress. Participants and settingParticipants included ethnic minority young adults (n = 322) attending a public university who reported having at least one family member living in the United States without legal protection and/or being undocumented themselves. MethodsData was collected online using validated measures of the primary study variables. Participants also completed a pilot measure of immigration-related stress in their family. A multiple mediation model was tested in a structural equation modeling framework. ResultsA substantial percentage of young adults experienced 4 or more ACEs and clinically-significant generalized anxiety symptoms (38.5% and 20.5%, respectively); a greater number of ACEs were directly (β = 0.33, p < .001) and indirectly, via lower self-compassion (standardized indirect effect 95% CI: 0.04, 0.14), associated with significantly greater generalized anxiety symptoms, above and beyond immigration-related family stress and other indicators of socioemotional functioning. ConclusionFindings suggest that ACEs and generalized anxiety are prevalent in ethnic minority young adults from mixed legal status families and their association may be partially accounted for by ACE-related deficits in self-compassion.

Resting state prefrontal cortex oxygenation in adolescent non-suicidal self-injury – A near-infrared spectroscopy study

IntroductionNeural alterations in limbic and prefrontal circuits in association with self-injurious behavior have been studied primarily in adult borderline personality disorder (BPD). In adolescent patients, research is still sparse. Here, we used resting functional near-infrared spectroscopy (NIRS) to examine oxygenation of the prefrontal cortex (PFC) and its association with symptom severity in adolescents engaging in non-suicidal self-injury (NSSI) and matched healthy controls (HC). MethodsAdolescents (12–17 years) with recurrent episodes of NSSI (n = 170) and healthy controls (n = 43) performed a low-demanding resting-state vanilla baseline task. Mean oxygenation of the PFC and functional connectivity within the PFC, were measured using an 8-channel functional NIRS system (Octamon, Artinis, The Netherlands). Various clinical variables derived from diagnostic interviews and self-reports were included in statistical analyses to explore potential associations with PFC oxygenation and connectivity. ResultsAdolescents with NSSI showed significantly decreased PFC oxygenation compared to HC, as indexed by oxygenated hemoglobin. Lower PFC oxygenation was associated with greater adverse childhood experiences and less health-related quality of life (HRQoL). While there was no evidence for alterations in PFC connectivity in adolescents engaging in NSSI compared to HC, increased PFC connectivity in the full sample was associated with greater adverse childhood experience, greater BPD pathology, greater depression severity and psychological burden in general, as well as lower HRQoL. ConclusionThis study is the first to examine PFC oxygenation using NIRS technology in adolescents engaging in NSSI. Overall, results indicate small effects not specific to NSSI. Clinical implications of these findings and recommendations for further research are discussed.

Interaction between adverse childhood experiences and polygenic risk in patients with bipolar disorder

The interaction between genes and environment often occurs when they depend on one another. We hypothesized that adverse childhood experiences (ACEs) would interact with genetic predispositions to bipolar disorder (BD), demonstrating earlier age at onset (AAO) and worse clinical outcomes. We aimed to clarify the effects of the interaction between ACEs and genetic susceptibility using polygenic risk score (PRS) on AAO and clinical outcomes. Single nucleotide polymorphisms and clinical data, including ACEs, were obtained from the Bipolar Genomic Study, which contains a large sample of BD participants. A total of 1615 subjects with BD I were obtained and divided into two groups according to the presence or absence of ACEs and an additional four groups based on the number of ACEs (none versus one versus two versus ≥ three types). ACEs was evaluated using the childhood life events scale (CLES). BD–PRS was obtained from the Psychiatric Genomics Consortium, which compared BD patients and healthy controls. The BD–PRS was higher in the group with ACEs than without ACEs at most p-value thresholds. In multivariate linear regression analyses, both groups with more ACEs and higher BD–PRS were independently and interactively associated with an earlier AAO of BD; however, only greater ACEs were associated with worsened clinical outcome. These findings highlight the clinical importance of evaluating ACEs and polygenic risk in research of the etiology of BD.

Investigating the Relationship between Adverse Childhood Experiences (ACEs) and Resilience: A Study of Undergraduate Students in Turkey

ABSTRACT As the university environment can present unique challenges, it is important to look at the ways in which childhood trauma can impact student resilience, especially in non-Western contexts. The present study examines the relationship between adverse childhood experiences (ACEs) and measures of resilience among college students in Turkey. Students reported low levels of childhood trauma, both overall as well as within the various ACE sub-categories. Correlational analysis revealed statistically significant associations between some ACEs and measures of resilience. In terms of gender differences, females reported greater emotional abuse at a statistically significant level compared to males. Trends in the data also showed gender differences in general resilience as well as in experiences of physical abuse, physical fights, and indirect community violence. Gender moderated the relationship between ACEs and two resilience measures, with female students experiencing greater ACEs in terms of self-efficacy and self-regulation. Findings shed light on some of the ways that childhood trauma may be manifested across gender groups in Turkey. Implications for Turkey’s higher education systems are discussed.

Adverse childhood experiences and childhood obesity: a path analysis approach

ABSTRACTThis study evaluated physical activity/mental health mediators and psychosocial moderators between adverse childhood experiences (ACEs) with childhood obesity. Path analysis was used to analyze a sample of 42,193 children aged 10–17 years from the 2011–2012 National Survey of Children’s Health. Childhood obesity was associated with greater ACEs, but such association was not mediated by physical activity and mental health, or moderated by psychosocial factors. However, our data suggested that positive neighborhood environments are associated with greater physical activity and fewer mental health problems. This study illuminates some complicated associations among childhood obesity and children with ACEs.

The etiology of antisocial personality disorder: The differential roles of adverse childhood experiences and childhood psychopathology

Antisocial Personality Disorder (ASPD) is a severe personality disorder with robust associations with crime and violence, but its precise etiology is unknown. Drawing on near-population of federal correctional clients in the Midwestern United States, the current study examined antecedent background factors spanning adverse childhood experiences and childhood psychopathology. Greater adverse childhood experiences were associated with ASPD diagnosis with physical abuse showing associations with ASPD symptoms and sexual abuse with lifetime diagnosis for ASPD. Conduct Disorder was strongly linked to ASPD; however, Oppositional Defiant Disorder and ADHD had null associations. Given the role of environmental factors in the development of ASPD, greater criminological attention should be devoted to understanding how assorted forms of abuse and neglect coupled with childhood psychopathology contribute to ASPD especially given its linkages to severe criminal offending.

The Comorbidity of Physical, Mental, and Developmental Conditions Associated with Childhood Adversity: A Population Based Study.

Adverse childhood experiences (ACEs) are associated with myriad health conditions and risk behaviors in both adolescents and adults. In this study we examine the association between ACEs and specific physical, mental, and developmental conditions, as well as their comorbidity, in a nationally representative sample of children 0-17 years. Data from the 2011-2012 National Survey for Child Health (NSCH) were used. A total of 95,677 random-digit-dial interviews with parents of children 0-17 years were conducted across all 50 states and the District of Columbia. Outcomes included singular condition domains (physical, mental, and developmental) as well as combinations of condition domains (e.g., physical plus mental, mental plus developmental, etc.). Twenty-three percent of parents reported that their child experienced 1 ACE; 9.2 % experienced 2 ACEs, and 10.3 % experienced three or more. Across all three condition domains and combinations of domains, children who experienced at least one ACE were more likely than children who experienced 0 ACEs to have at least one condition. Additionally, greater ACEs was associated with increased likelihood of at least one condition in each domain and in multiple domains. for practice These findings support the extension of existing family environment screening tools in pediatric practices as well as the establishment of a system for monitoring ACEs in families with multiple or complex conditions.

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.

C.05.03 Optimising short and long term schizophrenia treatment

Antisocial Personality Disorder (ASPD) is a severe personality disorder with robust associations with crime and violence, but its precise etiology is unknown. Drawing on near-population of federal correctional clients in the Midwestern United States, the current study examined antecedent background factors spanning adverse childhood experiences and childhood psychopathology. Greater adverse childhood experiences were associated with ASPD diagnosis with physical abuse showing associations with ASPD symptoms and sexual abuse with lifetime diagnosis for ASPD. Conduct Disorder was strongly linked to ASPD; however, Oppositional Defiant Disorder and ADHD had null associations. Given the role of environmental factors in the development of ASPD, greater criminological attention should be devoted to understanding how assorted forms of abuse and neglect coupled with childhood psychopathology contribute to ASPD especially given its linkages to severe criminal offending.