Original Adverse Childhood Experiences Research Articles

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.

Adverse Childhood Experiences and Executive Function Difficulties in Children: A Systematic Review

BackgroundThe relationship between adverse childhood experiences (ACEs) and detrimental mental health outcomes has been increasingly explored within scientific literature since the original ACE study was published by Felitti et al. (1998). Given that deficits in executive functions (EF) are prominent in most forms of psychopathology across the lifespan, there is utility in considering how ACEs relate to EF outcomes. ObjectiveTo consolidate the research to date on the relationship between ACEs and EF outcomes among child samples. MethodsA systematic review was conducted that included 16 scientific databases and 17 grey literatures. ResultsAcross 36 studies, many examined EF related to forms of maltreatment (e.g. abuse, neglect, and exposure to intimate partner violence) and found a strong relationship between maltreatment and EF deficits among children. Similarly, family member mental illness (maternal depression in particular) was associated with poor EF outcomes. The relationship between other ACEs and EF outcomes have not been uniquely examined, including intimate partner violence and family member incarceration. ConclusionsThis review acts as a preliminary step towards broader understanding of outcomes related to early childhood experiences through the consideration of EFs. Through documentation of such relationships, it is possible to consider how prevention and treatment approaches may be improved.

Confirmatory factor analysis of adverse childhood experiences (ACEs) among a community-based sample of parents and adolescents

BackgroundDespite increased understanding of Adverse Childhood Experiences (ACEs), very little advancement has been made in how ACEs are defined and conceptualized. The current objectives were to determine: 1) how well a theoretically-derived ACEs model fit the data, and 2) the association of all ACEs and the ACEs factors with poor self-rated mental and physical health.MethodsData were obtained from the Well-Being and Experiences Study, survey data of adolescents aged 14 to 17 years (n = 1002) and their parents (n = 1000) in Manitoba, Canada collected from 2017 to 2018. Statistical methods included confirmatory factor analysis (CFA) and logistic regression models.ResultsThe study findings indicated a two-factor solution for both the adolescent and parent sample as follows: a) child maltreatment and peer victimization and b) household challenges factors, provided the best fit to the data. All original and expanded ACEs loaded on one of these two factors and all individual ACEs were associated with either poor self-rated mental health, physical health or both in unadjusted models and with the majority of findings remaining statistically significant in adjusted models (Adjusted Odds Ratios ranged from 1.16–3.25 among parents and 1.12–8.02 among adolescents). Additionally, both factors were associated with poor mental and physical health.ConclusionsFindings confirm a two-factor structure (i.e., 1) child maltreatment and peer victimization and 2) household challenges) and indicate that the ACEs list should include original ACEs (i.e., physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, exposure to intimate partner violence (IPV), household substance use, household mental health problems, parental separation or divorce, parental problems with police) and expanded ACEs (i.e., spanking, peer victimization, household gambling problems, foster care placement or child protective organization (CPO) contact, poverty, and neighborhood safety).

Exposure to Racism and Other Adverse Childhood Experiences Among Perinatal Women with Moderate to Severe Mental Illness.

We sought to determine the prevalence and correlates of conventional and expanded adverse childhood experiences (ACEs), including exposure to violence and racism, in perinatal women with mental illness. 133 perinatal women with mental illness completed the original ACEs (conventional ACEs) survey and the 6-question adverse environmental experiences (expanded ACEs) survey from the Philadelphia ACEs study. Associations between racial groups and ACE scores, mental health and psychosocial variables were evaluated. Subjects were predominantly white (68%) and married/partnered (66%), and 57% had at least 4 conventional ACEs. Compared to White women, Black women were significantly more likely to report conventional and expanded ACEs including experiencing racism and witnessing violence. Early life adversity was exceedingly common among pregnant and postpartum women with moderate to severe mental illness. Childhood exposure to racism and environmental trauma are important risk categories for perinatal mental illness.

Adverse Childhood Experiences: Research, Effects, and Tools for Change

Adverse Childhood Experiences: Research, Effects, and Tools for Change

124. Adverse Childhood Experiences, Body Mass Index And Body Image In Adolescents: Are They Interrelated?

Adverse childhood experiences (ACEs) are clearly associated with increased rates of obesity later in life. Many adolescents with BMIs >85% exhibit unhealthy weight control behaviors, and body image (BI) disturbances may mediate these behaviors. However, the association between ACEs, BMI, and BI remains unexamined. Therefore, we have conducted a pilot study to examine, among preadolescents at high risk for multiple ACEs: 1) the prevalence of ACEs, BI, and BMI, and 2) the associations between number of ACEs and both BI scores and BMI percentiles. The study was conducted at a middle school in Rochester NY with a large proportion of minority and low-income students. All 7-8th graders were screened in 9/2017. ACEs were assessed using the ACE-Q (Center for Youth Wellness), an adolescent focused version of the original ACE screener. High ACEs were categorized as >3. BI was measured with the SATAQ, using a version that was validated on middle school students. Scores range from 14-70, with higher scores representing higher disturbance (or poor body esteem) in BI. A previous study of BI of white middle-class adolescents showed a mean SATAQ score of about 30 +/- 10. BMI was measured by percentile ranking, as recommended for preadolescents. We used descriptive statistics to analyze means (SD), frequencies and/or percentiles of ACEs, BI, and BMI. Bivariate analysis examined the relationship between high ACEs and BI scores and BMI percentiles. Students who assented to participate (N=151) were 62% Black or Hispanic; genders were balanced. The prevalence of ACEs in these youth was very high: 48% had >3 ACEs. In this sample, 47% had a BMI that was at the >85th percentile (overweight), and 25.5% were at the >95th percentile (obese). The mean BI score was 34.44 +/- 14.28. Thus in our sample, both BMI and BI scores were somewhat higher than previous reports for low SES youth. However, we found no significant relation between high ACEs and BI score (p=.321) or BMI percentile (p= .176). In this relatively new area of investigation, we found no associations between ACEs and BI or ACEs and BMI, unlike three previous studies. If a study with a larger sample confirms our results, our findings suggest that the preadolescent period might be optimal for interventions to prevent obesity, since ACEs and BMI, and also BMI and BI, are known to be associated in post-pubertal adolescents and in adults. The next phase of this study will evaluate the effects of a resilience intervention on pre/post BI scores in preadolescents with high ACE scores. If these results are positive, parallel studies in adolescents after puberty would be warranted.

Expanding the Original Definition of Adverse Childhood Experiences (ACEs).

We report two studies examining psychometric properties of an expanded measure of adverse childhood experiences (ACEs) that combined the original ACEs items with items from the Juvenile Victimization Questionnaire. In Study 1, we examined its factorial structure, internal consistency, and concurrent validity in undergraduates (N = 1479). In Study 2, we also examined replicability of frequencies of ACEs, test-retest reliability, and convergent and predictive validity. Results suggested a model with four inter-related factors: maltreatment, household dysfunction, community dysfunction, and peer dysfunction/property victimization. Internal consistency, test-retest reliability, concurrent and convergent validity were acceptable, and findings were replicated across samples. We suggest that this expanded measure is assessing early experiences of victimization and helplessness in the face of perceived intentional emotional and physical threats or actual harm by others, and that although they may not all be "traumatic," their cumulative impact is associated with poor mental health in young adults.

Adverse Childhood Experiences in Children with Intellectual Disabilities: An Exploratory Case-File Study in Dutch Residential Care

Adverse Childhood Experiences (ACEs) are negative childhood events occurring in a child’s family or social environment, that may cause harm or distress. Children with intellectual disabilities (ID) and their families are underrepresented in international ACEs research, while current insights can also contribute to the improvement of their health and well-being. Deficiencies in intellectual and adaptive functioning and living circumstances can increase their vulnerability to adversities. In the present exploratory study 69 case-files of children referred to a Dutch national center for residential youth care for children with ID were analyzed to assess the prevalence and associations of ACEs. It was found that almost half (49.3%) of the children experienced 2 ACEs from the original ACEs framework or more (M (mean) = 2.1; SD (standard deviation) = 1.8) and that the number of ACEs in children was related to the presence of ACEs in parents. Both child and parental ACEs were also related to attachment- and trauma- and stressor-related disorders. Finally, living circumstances and multiple ACEs from the expanded ACEs framework, especially related to parental characteristics, were found to be related to ACEs in children with ID. This implicates the importance of a transgenerational approach when further investigating the impact of ACEs on mental and physical health in children with ID (intellectual disabilities).

Assessing Health Outcomes and Youth-Related Items for the Adverse Childhood Experiences Questionnaire

Recently, several researchers have suggested additional items be included to the Adverse Childhood Experiences (ACE) questionnaire for a younger population (children ages 10–17). Two sets of items have been proposed by Finkelhor and colleagues. However, it is unclear which set of items is the most useful in an emerging adult population. The current study compared the original ACE questionnaire with two revised sets of items proposed by Finkelhor, Shattuck, Turner, and Hamby in young adults. The best model depended on the outcome used as the original ACE questionnaire was the best fit in predicting depression, but the revised models were the best predictors of anxiety and perceived physical health. Future studies should continue to investigate whether these new items continue to improve the usefulness of the ACE scale or whether these items become less salient across the life span.

Adverse Childhood Experiences Affect Health Risk Behaviors and Chronic Health of Iowans

Adverse childhood experiences (ACEs), include childhood abuse and household dysfunction, and are associated with a variety of behavioral risk factors and chronic illnesses in adulthood. This study replicates the original ACEs study (Felitti et al. American Journal of Preventive Medicine, 14(4), 245–258. doi:10.1016/s0749-3797(98)00017-8, 1998) with a representative sample of adults in Iowa. Data come from the Behavioral Risk Factor Surveillance System (BRFSS) survey of 2012 when ACE assessments were first introduced in Iowa by the Centers for Disease Control and Prevention (2012). The majority of adults in Iowa (58%) have experienced at least one ACE, and depending on the type of ACE, co-occurrence of ACEs ranged from 76% to 97%. Health risk behaviors in adulthood, such as drinking, smoking, and obesity were significantly related to the number of ACEs experienced. ACEs were also associated with depression. Chronic health outcomes including heart disease, stroke, and COPD were also significantly predicted by the number of ACEs. This replication study demonstrates that the need for intervention and prevention programs in Iowa are similar to the needs found in other states in the U.S. for addressing the consequences of ACEs.

Family Adversity and Resilience Measures in Pediatric Acute Care Settings.

Adverse childhood experiences (ACEs) impact health across the life course. The purpose of this study was to identify caregiver ACEs, current adversity, and resilience in families seeking care in pediatric acute care settings. Study aims included identifying demographic characteristics, current adversities, and resilience measures associated with caregiver ACEs ≥4. A cross-sectional survey study design was used and a convenience sample (n=470) recruited at emergency and urgent care settings of a large Midwest pediatric hospital system. Measures were self-reported. The original 10-item ACEs questionnaire measured caregiver past adversity. Current adversity was measured using the 10-item IHELP. The six-item Brief Resiliency Scale measured resilience, and WHO-5 Well-Being Index was used to measure depressive affect. Compared to participants with ACEs score of 0-3 participants with ACEs ≥4 were more likely to have multiple current adversities, increased risk of depression, and lower resilience. Caregivers using pediatric acute care settings carry a high burden of ACEs and current adversities. Caregiver ACEs are associated with current child experiences of adversity. Caregivers socioeconomic status and education level may not be an accurate indicator of a family's risks or needs. Pediatric acute care settings offer opportunities to access, intervene, and prevent childhood adversity.

Do Pediatricians Ask About Adverse Childhood Experiences in Pediatric Primary Care?

ObjectiveThe stress associated with adverse childhood experiences (ACEs) has immediate and long-lasting effects. The objectives of this study were to examine 1) how often pediatricians ask patients' families about ACEs, 2) how familiar pediatricians are with the original ACE study, and 3) physician/practice characteristics, physicians' mental health training, and physicians' attitudes/beliefs that are associated with asking about ACEs. MethodsData were collected from 302 nontrainee pediatricians exclusively practicing general pediatrics who completed the 2013 American Academy of Pediatrics Periodic Survey. Pediatricians indicated whether they usually, sometimes, or never inquired about or screened for 7 ACEs. Sample weights were used to reduce nonresponse bias. Weighted descriptive and logistic regression analyses were conducted. ResultsOnly 4% of pediatricians usually asked about all 7 ACEs; 32% did not usually ask about any. Less than 11% of pediatricians reported being very or somewhat familiar with the ACE study. Pediatricians who screened/inquired about ACEs usually asked about maternal depression (46%) and parental separation/divorce (42%). Multivariable analyses showed that pediatricians had more than twice the odds of usually asking about ACEs if they disagreed that they have little effect on influencing positive parenting skills, disagreed that screening for social emotional risk factors within the family is beyond the scope of pediatricians, or were very interested in receiving further education on managing/treating mental health problems in children and adolescents. ConclusionsFew pediatricians ask about all ACEs. Pediatric training that emphasizes the importance of social/emotional risk factors may increase the identification of ACEs in pediatric primary care.

A revised inventory of Adverse Childhood Experiences

This study examines whether the items from the original Adverse Childhood Experiences (ACE) scale can be improved in their prediction of health outcomes by adding some additional widely recognized childhood adversities. The analyses come from the National Survey of Children's Exposure to Violence 2014, a telephone survey conducted from August 2013 through April 2014 with a nationally representative sample of 1,949 children and adolescents aged 10–17 and their caregivers who were asked about adversities, physical health conditions and mental health symptoms. The addition of measures of peer victimization, peer isolation/rejection, and community violence exposure added significantly to the prediction of mental health symptoms, and the addition of a measure of low socioeconomic status (SES) added significantly to the prediction of physical health problems. A revised version of the ACES scale is proposed.

Adverse Childhood Experiences in Alberta, Canada: a population based study

Objective: Adverse childhood experiences (ACEs) are associated with poor health outcomes in adulthood. We developed a four category ACE risk profile variable using a domain-specific approach and examined ACEs as risk factors for diagnosed physical and mental health conditions.Method: A computer-assisted telephone survey was conducted with a random sample of adults in Alberta, Canada. Eight questions were asked on adversity during childhood, based on the original ACE survey and modified to reflect the Canadian context and research methodology. Descriptive and multivariable analyses were conducted.Results: Among the 1207 respondents, the majority were married or living common-law (65.8%), had completed post-secondary education (78.2%), and were Caucasian (86.2%) with a mean age of 52.4 years (SD=16.3). Approximately one-third (27.3%) experienced at least one type of abuse, and almost half (49.5%) experienced at least one form of household dysfunction. ACEs were highly interrelated. Sixty-three percent fell into the low risk profile category, with the remaining 37% divided among the three higher risk profile categories. Overall, the ACE risk profile variable was significantly associated with diagnosed mental health condition/addiction and chronic pain, controlling for sociodemographic characteristics.Conclusion: The ACE risk profile category of adversity in both the abuse domain and the household dysfunction domain conferred the greatest risk for poor health outcomes in adulthood. Given the interrelated nature of ACEs, a more comprehensive approach to conceptualization of ACEs is warranted. Results have implications for prevention of ACEs and recovery from ACEs to decrease disease burden. Strategies may include effective programs to prevent exposure to toxic stress and support nurturing and stable relationships for children and families.

PO-0385a Adverse Childhood Experiences In Alberta, Canada: A Population Based Study

Objective Adverse childhood experiences (ACEs) are associated with poor health outcomes in adulthood. We developed ACE risk profiles using a domain-specific approach and examined ACEs as risk factors for diagnosed physical and mental health conditions. Method A computer-assisted telephone survey was conducted with a random sample of adults in Alberta, Canada. Eight questions were asked on adversity during childhood, based on the original ACE survey and modified to reflect the Canadian context and research methodology. Descriptive and multivariable analyses were conducted. Results Among the 1207 respondents, the majority were married or living common-law (65.8%), had completed post-secondary education (78.2%), and were Caucasian (86.2%) with a mean age of 52.4 years (SD=16.3). Approximately one-third (27.3%) experienced at least one type of abuse, and almost half (49.5%) experienced at least one form of household dysfunction. ACEs were highly interrelated. Sixty-three percent fell into the low risk profile, with the remaining 37% divided among the three higher risk profiles. Overall, ACE risk profile was significantly associated with diagnosed mental health condition/addiction and chronic pain, controlling for sociodemographic characteristics. Conclusion The ACE risk profile of ACEs in both the abuse domain and the household dysfunction domain conferred the greatest risk for poor health outcomes in adulthood. Given the interrelated of ACEs, a more comprehensive approach to conceptualization of ACEs is warranted. Results have implications for prevention of ACEs and recovery from ACEs to decrease disease burden. Strategies may include effective programs to prevent exposure to toxic stress and support nurturing and stable relationships for children and families.

Adverse Childhood Experiences and Diabetes in Adulthood: Support for a Collaborative Approach to Primary Care

Prior studies have demonstrated an association between retrospective reports of experiencing trauma in childhood and the current incidence of type 2 diabetes in adulthood. Much less is known about this association among low-income minority patients in primary care settings. We replicated the adverse childhood experiences (ACEs) Centers for disease control and prevention (CDC) study 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 to examine the association between participants’ reports of past childhood trauma and their current health care outcomes. 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 be diagnosed with type 2 diabetes. Results suggest that the number of ACEs in our sample were considerably higher than the original CDC ACEs study, as almost 50 % of patients surveyed at our clinic reported 4 or more ACEs, confirming that trauma is central in our urban primary care setting. The results of the cumulative ACEs score was in the expected direction and was significant, suggesting that participants who cumulatively reported experiencing more childhood trauma were more likely to be diagnosed with type 2 diabetes in adulthood. These findings have implications for family therapists, primary care providers, researchers, and policy makers to develop more collaborative approaches to primary care that better target the negative sequelae of ACEs.

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.

Psychosocial factors in the short-term prognosis of physical disease: I. peptic ulcer

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.