Original Adverse Childhood Experiences Research Articles

Adverse Childhood Experiences and Sleep Disturbances Among Puerto Rican Young Adults

Sleep quality is a known marker of overall health. Studies suggest that adverse childhood experiences (ACEs) are associated with sleep disturbances among children and adults. To examine the association of retrospective and prospective ACEs with sleep quality among a cohort of Puerto Rican young adults from 2 sociocultural contexts. This prospective cohort study used data from the Boricua Youth Study (BYS), a population-based study representing Puerto Rican children from the South Bronx, New York, and Puerto Rico conducted from August 2000 to August 2003. Participants who were 5 to 9 years of age at enrollment in the BYS and who participated in wave 4 of the BYS took part in the Health Assessment (HA) when they were 18 to 29 years of age, from April 2013 to August 2017. Of the eligible 982 participants, 813 (82.8%) participated in the HA. Statistical analysis was conducted from January 2023 to January 2024. Prospective ACEs measured from parent and youth responses and retrospective ACEs measured among young adults using questions from the validated ACE questionnaire from the original ACEs study conducted by Kaiser Permanente and the Centers for Disease Control and Prevention and published in 1998. Analysis included 8 overlapping items from both questionnaires. Sleep quality was assessed in the HA with the Pittsburgh Sleep Quality Index. The summary score included 7 components of the Pittsburgh Sleep Quality Index. The hypothesis was formulated after data collection. Sleep quality information was gathered at the same time as retrospective ACEs in the HA. Of the 813 participants, 438 (53.9%) lived in Puerto Rico as children, 411 (50.6%) identified as female, and the mean (SE) age of participants was 22.9 (0.07) years. After adjusting for sociodemographic factors, retrospective ACEs had a significant association with worse sleep outcomes (β [SE] = 0.29 [0.07]; 95% CI, 0.15-0.44; P < .001). Prospective ACEs did not have a significant association with sleep quality, after adjusting for sociodemographic factors (β [SE] = 0.05 [0.10]; 95% CI, -0.14 to 0.24; P = .59). This study suggests that there is a significant association between retrospective ACEs and sleep quality among Puerto Rican young adults, after adjusting for sociodemographic factors. Prospective ACEs were not significantly associated with sleep disturbances, after adjusting for sociodemographic factors. Addressing ACEs reported in young adulthood may help reduce sleep disorders.

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

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

Can ICD-10 Z codes be used as proxy measures for ACE categories? – a proof of concept

ABSTRACT Objective The landmark study by Felitti showed adverse childhood experiences (ACEs) influence future health outcomes. This paper looks at the routine data collected in a Child and Youth Mental Health Service (CYMHS) related to contextual factors in the International Classification of Diseases (ICD-10 Z codes) and seeks to identify proxies for the ten original ACEs categories. In the absence of routinely collected ACE categories, these ICD-10 Z codes which could potentially act as ACE proxies would be helpful for clinical understanding and service delivery. Method ICD-10 Z codes collected routinely from 2108 individuals were analysed to identify Z codes which might serve as proxies for the ACE categories. To understand whether these Z codes were used appropriately during service delivery to indicate ACE categories, randomly selected files of patients having at least one of the above Z codes in their list of diagnoses were reviewed. Subsequently, the associations between several Z codes (serving as ACE proxies), demographic factors, and clinical outcome measures were explored. Results Significant differences were observed in terms of the mean ACE score of patients when sex, Indigenous status and certain diagnostic groups were considered. Similarly, when patient groups having exposure to different numbers of ACEs were compared, significant differences were observed in outcome scores (HoNOSCA and CGAS). Conclusion There is evidence that certain Z codes, can act as ACE proxies. This suggests a possible utility of this method in studying other associations and possibly helping to tailor future therapeutic interventions.

Expanded Adverse Childhood Experiences (ACEs) and Adult Cannabis Use: A Latent Class Analysis.

In addition to traditionally assessed abuse, neglect, and household dysfunction, adverse childhood experiences (ACEs) include adversities like racial discrimination, community violence, and bullying. Prior research established associations between the original ACEs and substance use, but few used Latent Class Analysis (LCA) to examine patterns of ACEs. Examining patterns of ACEs may yield additional insights beyond cumulative risk studies focusing only on the number of different ACEs experiences. Therefore, we identified associations between latent classes of ACEs and cannabis use. Studies on ACES rarely examine cannabis use outcomes, which is important as cannabis remains one of the most commonly used substances and is associated with negative effects on health. Yet it is still unclear how ACEs influence cannabis use. Participants were adults in Illinois (n = 712) recruited through Qualtrics' online quota-sampling method. They completed measures of 14 ACEs, past 30-day and lifetime cannabis use, medical cannabis use (DFACQ) and probable cannabis use disorders (CUDIT-R-SF). Latent class analyses were performed using ACEs. We identified four classes, labeled: Low Adversity, Interpersonal Harm, Interpersonal Abuse and Harm, and High Adversity. The largest effect sizes (p<.05) were observed for those in the High Adversity class, who had elevated risks for lifetime (OR =6.2), 30-day (OR = 5.05), and medicinal cannabis use (OR = 17.9) relative to those in the Low Adversity class. Those in the Interpersonal Abuse and Harm and Interpersonal Harm classes also had increased odds (p<.05) for lifetime (OR =2.44/OR=2.82), 30-day (OR = 4.88/OR= 2.53), and medicinal cannabis use (OR = 2.59/OR =1.67(ns)) relative to those in the Low Adversity class. However, no class with elevated ACEs had higher odds for CUD relative to the Low Adversity class. Additional research could further disentangle these findings using extensive measures of CUD. Additionally, as participants in the High Adversity class had higher odds of medicinal cannabis use, future research could carefully study their consumption patterns.

Biological Burden of Adverse Childhood Experiences in Children.

This study aimed to examine relationships between adverse childhood experiences (ACEs) and related life events and allostatic load (AL)-"wear and tear" from chronic stress-in a pediatric population. Children were screened with the PEdiatric ACEs and Related Life Event Screener (PEARLS) tool, a 17-item questionnaire capturing experiences of abuse, neglect, household challenges, and related life events. Biological data were available for 207 participants, and AL was operationalized using clinical or empirical cutoff points across 4 physiological systems (i.e., cardiac, metabolic, inflammatory, neurologic). Covariate-adjusted multivariable regression models were used to examine associations between AL with adversity and health. Children (mean age = 6.5 years, range = 1-11 years) had an average AL score of 1.9 (standard deviation = 1.7), and a U-shaped relationship was observed with child's age. Continuous PEARLS and original ACE scores were not associated with AL. However, children with a reported PEARLS score of 1 to 2 or original ACEs score of 1 to 3 had 1.5 (incidence rate ratio [IRR] = 1.50, 95% confidence interval [CI] = 1.09-2.08) and 1.4 (IRR = 1.41, 95% CI = 1.08-1.84) times greater AL, respectively, compared with participants with none reported. In secondary analyses, caregiver mental illness was associated with higher child AL (adjusted IRR = 1.27, 95% CI = 1.01-1.58). AL was also associated with poorer perceived child general health (adjusted β = -0.87, 95% CI = -1.58 to -0.15) and greater odds of child obesity (adjusted odds ratio = 1.51, 95% CI = 1.23-1.89). Measuring AL in a pediatric population requires careful consideration of age. Higher AL was associated with a greater number of reported adversities and worse child health.

Prevalence of Adverse Childhood Experiences in the First Decade of Life: A Study in the Portuguese Cohort, Generation XXI.

Adverse childhood experiences (ACEs) are a modifiable risk factor for diseases throughout life. This study estimates the prevalence of ACEs in children, addressing associated sociodemographic characteristics and examining the relationship of ACEs with the child’s health and behaviors. We used information on 5295 participants at 10 years old, of the birth cohort Generation XXI, established in Porto, Portugal. Children answered a self-administered questionnaire on ACEs, based on the original ACEs study. Principal component analysis was used to group correlated ACEs, and a score was computed to assess their cumulative effect. Overall, 96.2% of children reported having been exposed to at least one ACE. The most prevalent ACE was a household member shouting, yelling, or screaming at the child (57.7%). Boys were more likely than girls to report “abuse”, “school problems”, and “death/severe disease”. Low parental education, income, and unemployment were associated with an increased risk of “school problems”, “death/severe disease”, and “household dysfunction”. We observed that the dimensions of ACEs could be identified at 10 years of age. A disadvantaged socioeconomic environment was associated with dimensions of ACEs. These data illustrate the natural history of dimensions of ACEs and their potential social patterning.

Centers for Disease Control and Prevention Investments in Adverse Childhood Experience Prevention Efforts

Centers for Disease Control and Prevention Investments in Adverse Childhood Experience Prevention Efforts

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

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

Adverse childhood experiences: A scoping review of measures and methods

Adverse childhood experiences (ACEs) lead to excess morbidity and mortality. However, this evidence has not resulted in large-scale efforts to prevent ACEs. We conducted a scoping review of ACEs research to determine its direction and identify advancement toward solutions to prevent ACEs. The review was conducted using PRISMA guidelines. Articles were considered eligible for inclusion if they were empirical studies based on original quantitative data from humans published between 1999 and 2019 and used the term “adverse” or adversity” to refer to a construct under study or a specific measure in the methodology. After a comprehensive search across nine databases, screening of the abstracts of 3,944 articles and the full texts of 2,341 articles, 1,361 empirical articles met inclusion criteria. We coded year of publication; journal name; stated study purpose (e.g., descriptive, intervention); types of adversities used to define ACEs; funding sources and declared conflicts of interest; country of the sample; and affiliation with other studies. To characterize the extent to which ACEs research focuses on ACE prevention, we then coded “narratives” reflected in research goals, with a particular focus on whether this research focuses exclusively on ACEs as the primary predictor variables, or if it integrates “upstream” social determinants of health and health inequities that may lead to ACE exposure. Thus, we coded how the elements of the stated research goals related to ACEs (e.g., predictor, mediator, moderator, and outcome variables) using the World Health Organization’s framework on social determinants of health (Solar & Irwin, 2010). Finally, we coded whether protective factors were included in research designs and the level of these factors (e.g., individual vs. community), and researchers’ recommendations for translating their findings to action. All variables were coded by at least two coders; inter-rater reliabilities ranged from 79 to 100%. We found that 60.6% of articles were based on samples recruited from the U.S.; funding sources have shifted to U.S. institutions with biomedical or clinical concerns; that only 47.2% of articles included in their definition of ACEs all seven items from the original ACE study; and that the dominant narrative about ACEs started with ACEs as the “villains” who begin a story of decline and ended with “victims” who have behavioral and/or emotional problems. Studies overwhelmingly examined the downstream effects of ACEs rather than upstream causes or preventive interventions. That is, only 6.6% of articles proposed protective factors that went beyond the individual or family level; and researchers’ recommendations favored amelioration of ACEs after they occur, with only 20% of articles mentioning primordial or primary prevention. This disproportionate focus on downstream determinants after ACEs have already occurred limits the impact of this research in terms of potential cost-benefit, social justice, and mitigation of health inequities. We recommend that future ACEs research be incorporated into broader, strengths-based and action-oriented frameworks focused on social determinants of health and health inequities; link ACEs to their putative causes as a bridge to primordial/primary prevention; address obstacles to this shift toward upstream causes of ACEs; and communicate findings and recommendations more effectively.

Maximizing the Benefit of Screening for Adverse Childhood Experiences.

Adverse childhood experiences (ACEs), first described by Felitti et al1 in 1998, affect over two-thirds of US adults2 and have been linked to numerous deleterious longitudinal health, mental health, and social outcomes, including cancer,3 pulmonary disease,3 liver disease,4 autoimmune dysfunction, depression, anxiety, psychopathology, and suidicality.5 A growing awareness of ACEs’ impact on child health has given way to initiatives to screen for ACEs in clinical settings and, especially, in primary care, with the assumption that such screening can ameliorate health outcomes.In this issue of Pediatrics, Loveday et al6 present results from a systematic review of screening for ACEs in children. The goals of this study were to review the rationale for screening for ACEs and examine impacts of screening on access to referrals and services for identified needs. This is an important clinical question because new efforts to mandate ACEs screening are being adopted in states such as California.7 Cautions about such implementation have been raised, even by one of the original ACE study authors.8 Critics have warned that population level ACE questionnaires being used are not validated screening instruments and that they do not have predictive value at the individual level9 and can induce an expectancy effect, in which identified problems may lead to unnecessarily proactive identification of future toxic stress and resultant problems.10In their systematic review, Loveday et al6 identified a dearth of studies relevant to child ACEs screening and point out that none of the studies reported on child or parent mental health outcomes. We know from our previous work that there is an intergenerational effect of ACEs11 and also a possible hesitancy to answer questions that are sensitive and potentially retraumatizing.12 Having only 4 studies of this systematic review that meet moderate criteria speaks to the limited evidence for the value of ACEs screening and a lack of evidence that screening improves access or receipt of necessary services. Indeed, although combined in this study, there may be a qualitative difference between screening for a need for resources (broader social determinant of health screening) and for exposure to adversity within the caregiving relationship (eg, abuse, neglect, exposure to intimate partner violence). For the latter, without linking exposure questions with mental health symptom screening, the opportunity to refer appropriately those who could benefit most from evidence-based trauma therapy or other appropriate mental health services may be lost.As primary care providers for children and families who suffer from the burden of ACEs, we recognize that having a framework for understanding ACEs and identifying symptoms within a safe and responsive relationship with patients and families is critical to providing trauma-informed care in the pediatric medical home.13 We understand that there are many barriers to ensuring that those with identified adversities are linked to community resources, such as limited time, staff resources to reach beyond the clinical space, and competing clinical demands,14 especially with the current pandemic in which acute COVID-19 concerns are taking precedence over preventive care.15Consensus has highlighted the need to focus on safe, stable, and nurturing relationships and change the paradigm from simply identifying ACEs to promoting resilience.16 Resilience-informed relational care15 allows pediatricians to provide support for all children from the pediatric setting. Providers should create a safe and empowering environment to raise and respond to a family’ specific social determinants of health (SDOHs) or ACE concerns. When needs exceed capacity to address these within the medical setting, pediatricians can partner with community organizations to link children to resources and trauma-informed services. This work includes preparing the next generation of providers to respond sensitively and appropriately to toxic stress symptoms and the SDOHs17 and understanding the intersectionality of ACEs with SDOHs to promote equity.18 Screening without appropriate office-based guidance and supported linkages to community resources appears to have limited evidence of benefit, as noted in the Loveday et al6 review and may be potentially harmful; yet, pediatricians can use a resilience-informed team-based and community approach to assist families in navigating their most pressing health and social needs.

Adverse childhood experiences in children and adolescents with sickle cell disease: A retrospective cohort study.

Adverse childhood experiences (ACEs) are linked to poor health outcomes; however, the relationship between ACEs and health outcomes among children and adolescents with sickle cell disease (SCD) has limited documentation in the published literature. This retrospective cohort study involved 45 children and 30 adolescents. Participants were screened using the Center for Youth Wellness ACE Questionnaire. Parents completed the questionnaire for children. Adolescents provided self-report. ACEs were treated as continuous and categorical scales: 0-1 verus ≥2 original ACEs (individual and/or familial level); 0-1 versus ≥2 additional ACEs (community level); and 0-3 versus ≥4 expanded ACEs (original + additional). Pain and acute chest syndrome events were compared using Wilcoxon rank-sum tests, and correlated with cumulative ACE scores using Spearman's correlation. Multivariable models were fitted to examine the association between ACEs and pain/acute chest syndrome. The cumulative number of original ACEs positively correlated with acute chest syndrome events (rho=.53, p=.003) and pain (rho=.40, p=.028) among adolescents. Adolescents with ≥2 versus 0-1 original ACEs had a higher number of acute chest syndrome events (4.9 ± 2.6 vs. 1.6 ± 2.2, p=.002); however, this association was confounded by asthma. Acute chest syndrome events and hospitalizations for pain did not differ among child ACE groups. Emergency department (ED) pain visits were higher among children with ≥4 versus 0-3 expanded ACEs (1.6 ± 2.8 vs. 3.3 ± 3.2, p=.042), even after controlling for SCD genotype, asthma, disease-modifying treatment, and follow-up years (p=.027). ACEs are linked to increased morbidity among children and adolescents with SCD. Prospective studies are needed to further understand this relationship and test ACE-protective remedies.

The Case for Expanding Adverse Childhood Experiences to Include Police Violence.

The Case for Expanding Adverse Childhood Experiences to Include Police Violence.

Adverse Childhood Experiences (ACEs) in Newly-Diagnosed Childhood and Adolescent/Young Adult (AYA) Cancer Patients with Hematologic Malignancies

Background and Aims: Childhood and adolescent/young adult (AYA) cancer survivors are at increased risk for emotional distress, chronic health conditions, and premature mortality compared to peers with no cancer history. Some, but not all, of this increased risk is explained by cancer- and treatment-related exposures. Because cancer treatment remains necessary to achieve cure, it is critical to identify and target other factors to reduce sub-optimal outcomes. Adverse Childhood Experiences (ACEs) are traumatic events occurring during childhood, such as experiencing violence and/or neglect, which are associated with poor mental health, chronic health conditions, and premature mortality in the adult general population. Little is known on how ACEs impact health in children and AYAs with cancer. Research indicates that otherwise healthy individuals exposed to ACEs experience fewer adverse health outcomes if they possess resilience, which can be learned. This provides a potential target for intervention. This pilot study aimed to identify demographic characteristics associated with ACEs and resilience as well as associations between ACEs, resilience, and the presence of chronic medical conditions, mental health issues, and substance abuse in children and AYAs with cancer.Methods: Childhood and AYA leukemia and lymphoma patients undergoing cancer treatment at the University of Chicago were included for analysis (N=38, 55.26% female, 50% non-Hispanic white, mean age at assessment 14.74±6.97 years). Participants ≤17 years old completed the study with one parent/caregiver. ACEs were measured using age-specific instruments adapted from the original ACEs study by Kaiser Permanente and the Centers for Disease Control and Prevention. Resilience was analyzed using age-specific instruments provided by the Resilience Research Centre, and resilience scores were categorized as low (≤62), moderate (63-70), high (71-76), and exceptional (≥77). For participants 0-11 years old, a parent/guardian completed the study on their behalf. 12-17 year old participants and their parent/guardian both completed the study, and participants over 18 completed the study alone. Descriptive statistics characterized demographic, biologic, treatment, and health behavior variables. The association between total scores for ACEs and resilience were measured using Pearson's correlation. Regression analysis assessed ACEs (logistic model) and resilience scores (linear model) adjusting for age, sex, race/ethnicity, household income, and insurance type. Participants were then stratified, and two sample t-tests compared potential outcomes based on ACE exposures.Results: 23 participants (60.53%) reported prior ACEs (mean total number of ACEs 1.45±1.77; range 1-7), and the mean resilience score for participants was 73.76±9.61 (range 49-85) indicating high resilience overall. Regression analyses showed the odds of reporting ACEs increased with age (OR: 1.18; 95% CI: 1.02-1.37), while resilience scores decreased with age (β=0.76; t(32)=-2.74, p=0.01) holding other variables constant. Sex, race/ethnicity, household income, and insurance type were not associated with ACEs or resilience scores. There was a strong negative correlation between the total number of ACEs and resilience, r(36)=-0.57, p<0.01; the total number of ACEs explained 32% of the variation in resilience scores. Compared to participants who did not report prior ACEs, those with ACEs were more likely to report chronic medical conditions, t(31.41)=-2.47, p=0.02, prior psychiatric diagnoses or mental health issues, t(34.16)=-2.13, p=0.04, as well as substance abuse t(31.41)=-2.47, p=0.02.Conclusions: ACEs were associated with endorsement of chronic medical conditions, mental health issues, and substance abuse in our sample of childhood and AYA patients currently receiving cancer treatment. As the total number of ACEs increased, resilience scores decreased for participants. The results of this study provide the groundwork for further investigations of ACEs and resilience in large cohorts of childhood and AYA cancer patients and survivors. This future work could provide valuable information for creating and implementing interventions designed for childhood and AYA cancer patients and survivors who have experienced ACEs, thus potentially reducing additional morbidity and premature mortality for these high-risk patients. DisclosuresNo relevant conflicts of interest to declare.

Evidence for Revising the Adverse Childhood Experiences Screening Tool: a Scoping Review.

The relationship between adverse childhood experiences (ACEs) and risky behavior, chronic illness, and premature mortality is well documented. Despite this evidence, screening for ACEs in primary care settings remains limited. Objections to widespread screening include concerns that the original ACE screening tool limited childhood adversities to family and household dysfunction. The purpose of this scoping review is to describe current knowledge for expanding ACEs categories and revising the formatting and scoring of the screening tool. With the assistance of a medical librarian, we used a two-step process to conduct a systematic search in three databases (CINAHL, OVID Medline, PsycINFO). Our aim was to focus on articles that expanded ACE categories and/or revised the scoring or formatting of the ACE tool. Eighteen articles (reporting 19 studies) met criteria. A minimum of two authors extracted the relevant characteristics of the studies independently and conferred to reach agreement. The majority of studies broadened ACEs to include community and systemic categories; three studies revised the formatting or scoring of the ACE tool. Exposure to community violence (ECV) was the most frequently added category (15), followed by economic hardship in childhood (EHC) (13); bullying (10); absence/death of parent or significant others (9); and discrimination (7). This evidence supports the expansion of ACE screening tools for assessment of childhood trauma and timely treatment.

86808 Adverse Childhood Experiences are associated with a higher prevalence of asthma among adolescents with sickle cell disease

ABSTRACT IMPACT: This research highlights Adverse Childhood Experiences as a potential risk factor and intervention target contributing to the disproportionate number of individuals with sickle cell disease affected by asthma, a well-established catalyst to the increased morbidity and mortality impacting this high-risk population. OBJECTIVES/GOALS: Adverse Childhood Experiences (ACEs) are strongly associated with asthma. A disproportionate number of individuals with sickle cell disease (SCD) also have asthma. Asthma is strongly associated with increased SCD morbidity and mortality. This study compared the prevalence of asthma among children and adolescents with SCD with and without ACEs. METHODS/STUDY POPULATION: This retrospective cohort study involved 45 children and 30 adolescents with SCD. ACEs were captured using the Center for Youth Wellness Adverse Childhood Experiences Child and Teen Questionnaires, which encompass the original 10 ACEs as well as 7 (child) and 9 (teen) expert-recommended ('expanded') ACEs. ACE exposures were categorized as: Original 0-1 vs. ≥2; Original + Expanded 0-1 vs. ≥2. Asthma prevalence was compared among ≥2 and 0-1 ACE groups using the chi-square (or Fisher’s exact) test. A binary logistic regression was performed to predict the likelihood of asthma while adjusting for characteristics (age, household income and gender) that were statistically different among ACE comparison groups at baseline. RESULTS/ANTICIPATED RESULTS: Among the 45 child participants, 64% had a history of asthma; whereas 50% of teens had a history of asthma. Asthma prevalence was higher among teens with ≥2 vs. 0-1 Original ACEs (89% v. 33%, p=0.014). A history of ≥2 ACEs remained significant (p=0.024) among teens after adjusting for age, household income and gender. There was no significance in asthma prevalence among child ACE comparison groups. DISCUSSION/SIGNIFICANCE OF FINDINGS: Adolescents with ≥2 ACEs had a higher prevalence of asthma compared to subjects with 0-1 ACE. This study, coupled with the cumulative nature of ACEs and the graded-dose response relationship between ACEs and poor health outcomes, highlight the need for larger, longitudinal studies examining the relationship between ACEs, asthma and SCD outcomes.

175 The association between adverse childhood experiences and postpartum depression

Adverse childhood experiences (ACEs) are linked to worsening overall health outcomes and psychological diagnoses. Routine screening in patients with postpartum depression (PPD) could identify patients who would benefit from interventions to prevent the perpetuation of ACEs and establish a system of preventative care to mitigate the risks of adverse health outcomes associated with high ACE scores. The purpose of this study is to explore the link between ACEs and PPD and propose the use of the ACE questionnaire as a routine screening tool in all patients diagnosed with PPD. We hypothesize that patients with PPD will be more likely to have higher ACE scores than the general population. An IRB approved, retrospective cohort study identified all patients diagnosed with PPD at an academic medical center between January 2015 and December 2019. We included patients diagnosed with PPD by ICD-10 codes as documented in their electronic medical record. Subjects were then recruited via telephone and asked to complete an ACE questionnaire. Questionnaires were sent via the REDCap (v.9.5.33) application. ACE scores were calculated, dichotomized based on cut-points of >1, >2, >3 and >4, and compared to the prevalence in the original Kaiser-CDC ACE study using two-sided binomial tests. A p-value of <0.05 was considered significant. There were 132/225 surveys completed (58% response rate). Respondents had a mean age of 32 years (range 21-48 years) and were primarily Caucasian (92.1%). In our PPD population, 80.3% had >1 ACE, 62.1% had >2 ACEs, 48.5% had >3 ACEs, and 31.8% had >4 ACEs. These percentages were significantly higher than the null hypothesis values obtained from the Kaiser-CDC ACE Study percentages of 64%, 38%, 22%, and 12.5%, respectively (all p<0.001). Women with PPD are more likely to have higher ACE scores than the general population. This finding has important implications in regards to counseling, interventions to prevent perpetual ACEs, and establishing important provider-patient relationships for life-long preventative care.

Teaching Trauma-Informed Care: A Symposium for Medical Students.

A large body of evidence links exposure to childhood trauma with negative health outcomes. Training future physicians to recognize and respond to trauma is paramount, and engaging medical students in the preclinical years affords the opportunity to foster the development of a trauma-informed lens that can then be solidified during clinical clerkships. We developed and implemented a 4-hour trauma-informed care (TIC) symposium for 179 second-year medical students at the George Washington University School of Medicine and Health Sciences during the Patients, Populations, and Systems course. The symposium included three interactive didactic sessions focusing on the connection between trauma and health and TIC principles. A facilitated small-group discussion allowed students to apply TIC principles to a patient case, followed by reflection and evaluation. The overall rating of the TIC symposium was 4 out of 5. Strengths included integration of a small-group case with discussion on application of TIC in practice, experience of the lecturers and small-group facilitators, and review of research relating adversity to specific health outcomes. Suggestions for improvement included incorporating role-play and standardized patients. Content analysis of student reflections mapped to the domains of physician competency. A 4-hour symposium can affect student knowledge and understanding of TIC. Teaching TIC presents an opportunity to prepare medical students for a career in medicine through cultivation of required physician competencies. Next steps include enhanced opportunities to practice TIC and follow-up analysis of participants to determine behavior change during clinical years.

ACEs policy and adults: The missing role of sexual abuse

Traumatised adults have been rather neglected in policy on adverse childhood experiences (ACEs) in comparison with children. Yet the key message from the original ACE studies was the need to change the way adults with ill health are heard, understood, diagnosed and treated. Within ACEs policy, childhood sexual abuse (CSA) has also had marginal attention. This paper traces how adult survivors of CSA provided the spark for the first and subsequent ACE studies, describing the serious mental and physical health issues this trauma can bring throughout the lifecourse. It raises the possibility that some of the original ten ACEs may be more impactful to health and wellbeing over the lifecourse than others and should receive greater priority in terms of prevention and recovery. A series of questions is asked about how physical and mental health services are responding, and how they may need to be monitored in order to fully integrate the needs of CSA survivors into current Scottish ACEs policy.

Strengthening the predictive power of screening for adverse childhood experiences (ACEs) in younger and older children

BackgroundThere is increasing interest in routine screening for Adverse Childhood Experiences (ACEs) to help identify high-risk children who would benefit from interventions. However, there has not yet been sufficient research concerning which particular set of ACEs would be most predictive as a potential screening tool. ObjectiveThis study compared 40 Adverse Childhood Experiences (ACEs), covering 11 different conceptual domains, in their ability to predict trauma symptoms in childhood. Participants and settingThe current study uses pooled data from three National Surveys of Children’s Exposure to Violence (NatSCEV) conducted in 2008, 2011, and 2014. Each survey collected information on children aged one month to 17 years. MethodsSamples were obtained from a mix of random digit dialing and address based sampling methods. Telephone interviews were conducted with children 10 years and older and with caregivers, if the randomly selected child was under age 10. Results and conclusionA different set of 15 items best predicted trauma symptoms for younger (2−9-year-old) compared to older (10−17-year-old) youth. Some conventional ACEs, like physical and emotional abuse, proved important for both age groups. However, family-related factors were more predictive for younger children, while community and peer violence exposures were more predictive for older children. Our new proposed measures explained substantially more variance in subsequent trauma symptoms than did the original ACE measure (R2 = .31 vs .18 for 2-9 year olds; R2 = .43 vs .26 for 10-17 year olds; p < .001 for all) and identified a larger percentage of children with high levels of trauma.

Adverse Childhood Experiences and Health Indicators in a Young Adult, College Student Sample: Differences by Gender.

The original Adverse Childhood Experiences (ACE) study demonstrated strong, graded relationships between child maltreatment and household dysfunction and adult health status. The present study re-examined these relationships in a sample of young adult, college students to better characterize the developmental timing of health problems related to ACE exposure and differences by biological sex. A cross-sectional general health questionnaire that included items on ACE was administered to young adults (ages 18-29) at universities in California (n = 3880), Minnesota (n = 7708), and Texas (n = 451) between 2017 and 2018. Seven ACE were assessed: psychological, physical, or sexual abuse; violence between parents; or living with household members who were substance misusers, mentally ill, or ever imprisoned. Binary health indicators were regressed on number of ACE as 0 (referent), 1, 2, 3, and 4 or more using logistic regression controlling for age, biological sex, race/ethnicity, and site. Approximately 51.7% of the sample reported at least one ACE with a significantly higher rate among Texas participants (p < 0.001). We observed graded relationships between levels of ACE exposure and physical, mental, and behavioral health indicators including cigarette use, e-cigarette use, drinking and driving, obesity, lifetime depression, suicide ideation and attempt, non-suicidal self-injury, and lack of restful sleep. ACE-exposed females reported worse mental health status than ACE-exposed males while males reported more substance use than females. Most outcomes did not vary significantly by sex. The strong, graded relationships observed between ACE exposure and health status among young adults reinforce the need for trauma-informed intervention programs on college campuses.