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ACEs Research Corner — March 2021


[Editor's note: Dr. Harise Stein at Stanford University edits a web site — — that focuses on the health effects of abuse, and includes research articles on ACEs. Every month, she posts  the summaries of the abstracts and links to research articles that address only ACEs. Thank you, Harise!! -- Jane Stevens]


Flannigan K, Kapasi A, Pei J, et. al.
Characterizing adverse childhood experiences among children and adolescents with prenatal alcohol exposure and Fetal Alcohol Spectrum Disorder. Child Abuse Negl. 2021 Feb;112:104888. PMID: 33388606
Of 333 children and adolescents with prenatal alcohol exposure (PAE), 66% of whom were diagnosed with fetal alcohol spectrum disorder, mean ACE score was 3.4. Common ACEs included not being raised by both biological parents (97.3%), caregiver disruption (88.5%), and exposure to household substance use (69.7%). Females had significantly higher rates of sexual abuse than males (13.3% vs. 3.7%). “Children and adolescents with PAE experience high rates of early adversity.”

Liming KW, Brook J, Akin B.
Cumulative adverse childhood experiences among children in foster care and the association with reunification. Child Abuse Negl. 2021 Mar;113:104899. PMID: 33454641
For 2998 children in foster care 6-18 years old, increased cumulative ACE exposure significantly impeded likelihood of reunification, and slowed time to reunification. Children with 6-9 ACEs and 10+ ACEs were 28% and 42% less likely to reunify, respectively, when compared to their counterparts with 1-5 ACEs.

Adult Manifestations of Child Abuse

Baldwin JR, Caspi A, Meehan AJ, et. al.
Population vs Individual Prediction of Poor Health from Results of Adverse Childhood Experiences Screening. JAMA Pediatr. 2021 Jan 25:e205602. PMID: 33492366
“On the one hand, high ACE scores can identify groups of individuals at heightened mean risk of poor health later in life, independent of other clinical risk factors and regardless of whether ACEs were measured prospectively in childhood or retrospectively in adulthood…On the other hand, ACE scores alone do not accurately discriminate between individuals with or without health problems in later life. Many individuals with high ACE scores will not develop poor health outcomes, and most poor health outcomes in the population will be observed in those with low ACE scores, as these groups are more prevalent. Therefore, these findings caution against the use of ACE scores in disease prediction and clinical decision-making.”

Koball AM, Rasmussen C, Olson-Dorff D, et. al.
The relationship between adverse childhood experiences, healthcare utilization, cost of care and medical comorbidities. Child Abuse Negl. 2019 Apr;90:120-126. PMID: 30776737
For 2038 adult patients who were screened for ACEs in a Midwestern health care system and followed for a year, those with high ACEs (4+), even after controlling for age, gender, and insurance type, made more but kept fewer appointments. “Those with high ACEs had the greatest impact on potential lost revenue given that they late-cancelled and no-showed more appointments. Those with high ACEs also had more medical comorbidities, medications, and needed more care coordinator than those with moderate or no ACEs.”

Sweeting JA, Garfin DR, Holman EA, Silver RC.
Associations between exposure to childhood bullying and abuse and adulthood outcomes in a representative national U.S. sample. Child Abuse Negl. 2020 Mar;101:104048. PMID: 31945515
From a national adult survey, 26.29% reported childhood bullying, 15.02% physical abuse, 15.56% witnessing parental violence, 11.42% sexual abuse, and 8.64% parental neglect. These childhood experiences were variously associated as adults with greater overall distress, functional impairment, fear of the future, and more mental and physical health ailments.

Godoy LC, Frankfurter C, Cooper M, et. al.
Association of Adverse Childhood Experiences with Cardiovascular Disease Later in Life: A Review.  JAMA Cardiol. 2021 Feb 1;6(2):228-235. PMID: 33263716
ACEs “elicit chronic activation of the stress response system, leading to autonomic, neuroendocrine, and inflammatory dysfunction. The subsequent development of traditional risk factors, such as diabetes, hypertension, smoking, and obesity, results in the onset of CVD and premature mortality. Adults with 4 or more ACEs compared with those with none have a more than 2-fold higher risk of developing CVD and an almost 2-fold higher risk of premature mortality.”

Andersson SO, Annerbäck EM, Söndergaard HP, et. al.
Adverse Childhood Experiences are associated with choice of partner, both partners' relationship and psychosocial health as reported one year after birth of a common child. PLoS One. 2021 Jan 20;16(1):e0244696. PMID: 33471844
For 818 Swedish couples surveyed one year after the birth of a common child, 59% of both mothers and partners reported exposure to at least one of ten ACEs. 11% of mothers and 9% of partners reported exposure to 4+ ACEs, and there was a correlation with mothers exposed to ACEs tending to have partners also exposed to ACEs. Parents with 4+ ACEs were 13.82 times more likely to report bad health, anxiety (91.97), depression (17.42), and perceived stress (11.04). “The consequences to the children should be further studied…”

Racine N, Devereaux C, Cooke JE, Eirich R, Zhu J, Madigan S.
Adverse childhood experiences and maternal anxiety and depression: a meta-analysis. BMC Psychiatry. 2021 Jan 11;21(1):28. PMID: 33430822
From a research review, ACEs conferred a small to moderate effect on maternal mental health – increased risk of prenatal and postpartum depressive symptoms, and prenatal anxiety.

LGBTQ Concerns

Bond MA, Stone AL, Salcido R Jr, Schnarrs PW.
How often were you traumatized? Reconceptualizing adverse childhood experiences for sexual and gender minorities. J Affect Disord. 2021 Mar 1;282:407-414. PMID: 33422816
From an online survey of sexual and gender minority adults, half had experienced 3 or more ACEs. Authors changed the ACE screen to show a scale for each item re: frequency of exposure to that ACE. Using this method showed better validation for self-reported anxiety and PTSD symptoms. “These results suggest that a better way to measure ACEs for sexual and gender minorities is to ask them how often they were exposed, rather than asking whether they were exposed.”

Race/Cultural Concerns

Rosado JI, Ramirez A, Montgomery J, Reyes E, Wang Y.
Adverse childhood experiences and its association with emotional and behavioral problems in U.S. children of Latino immigrants. Child Abuse Negl. 2021 Feb;112:104887. PMID: 33401158
Of 100 Latino children aged 8-17 in Florida, “Child ACEs ranged from 1.38 (parent-report) to 1.56 (child self-report) with emotional abuse, incarceration, and loss/separation from a caregiver being the most common. ACEs were correlated with emotional symptoms, hyperactivity/inattention problems, and with total behavioral difficulties.

Hamby S, Schultz K, Elm J.
Understanding the burden of trauma and victimization among American Indian and Alaska native elders: historical trauma as an element of poly-victimization. J Trauma Dissociation. 2020 Mar-Apr;21(2):172-186. PMID: 31752627
“This paper summarizes prior work on adverse childhood experiences and poly-victimization, addresses the limitations of past research on these issues, and expands these constructs to include concepts of historical trauma in order to better understand victimization and trauma among AI/AN elders.”  


Jewkes R, Jordaan E, Myrttinen H, Gibbs A.
Masculinities and violence: using latent class analysis to investigate the origins and correlates of differences between men in the cross-sectional UN Multi-country Study on men and violence in Asia and the Pacific. J Glob Health. 2020 Dec;10(2):020439. PMID: 33437463
From a UN study of men aged 18-49 in random households in six countries, those who were more violent against women were more likely to report poverty, substance use, depression, and gender inequitable attitudes and practices; and to have experienced childhood abuse, neglect and bullying. “We have highlighted the childhood origins of men's violent and anti-social behaviour, as well as the interrelationships with men's mental health, poverty and misogyny, showing that these (intersectional) developmental processes transcend culture and setting.”


Oh JE, López-Santacruz HD.
Adaptation measures in dental care for children with history of Adverse Childhood Experiences: A practical proposal. Spec Care Dentist. 2021 Jan;41(1):3-12. PMID: 33040392
For abused children who may have difficulties with dental care due to their maltreatment history, authors note specific psychological considerations by age group, and make recommendations for care modifications.  


MacIsaac A, Mushquash AR, Mohammed S, et. al.
Adverse Childhood Experiences and Building Resilience With the JoyPop App: Evaluation Study. JMIR Mhealth Uhealth. 2021 Jan 4;9(1):e25087. PMID: 33393908
For 156 college students, “Daily incorporation of an app-based resilience intervention can help youth who have experienced adversity to improve emotion regulation skills and experience reductions in depression.”


Lopez M, Ruiz MO, Rovnaghi CR, et. al.
The social ecology of childhood and early life adversity. Pediatr Res. 2021 Jan;89(2):353-367. PMID: 33462396
“Research to ensure that ELA [Early Life Adversity] can be assessed in the context of a child’s social ecology, not just their ACEs score, is urgently needed. ELA and ELS [Early Life Stress] increase the child’s vulnerability to short-term effects on behaviors, emotions, lifestyle choices, and relationships, with long-term effects on their physical health, psychiatric, social, and economic outcomes. Positive experiences and protective factors must also be considered. Cumulative knowledge from these studies can then guide practical interventions.

Struck S, Stewart-Tufescu A, Asmundson AJN, et. al.
Adverse childhood experiences (ACEs) research: A bibliometric analysis of publication trends over the first 20 years. Child Abuse Negl. 2021 Feb;112:104895. PMID: 33388607
The number of research articles on ACEs has increased dramatically in recent years. Main outcomes categories were mental health (31.43%) and physical health (27.12%).


Lawson M, Piel MH, Simon M.
Child Maltreatment during the COVID-19 Pandemic: Consequences of Parental Job Loss on Psychological and Physical Abuse Towards Children. Child Abuse Negl. 2020 Dec;110(Pt 2):104709. PMID: 32893003
From an online survey of 342 community parents, “Children of parents who experienced job loss related to the COVID-19 pandemic were nearly five times as likely to be psychologically maltreated during the pandemic compared with children of parents who did not lose their jobs…Children that have been psychologically maltreated exhibit higher rates of aggression, hyperactivity, conduct problems, anxiety, and depression across the lifespan…Thus, parental job loss during the COVID-19 pandemic presents significant risk for children’s concurrent development and long-term adjustment…Parental job loss was additionally associated with an increased probability of physical abuse…in addition, the odds of being psychologically maltreated and physically abused during the pandemic were 112 and 20 times higher, respectively, among children that were maltreated in the year prior to the pandemic.” Entire journal issue “Protecting Children from Maltreatment during Covid-19” Table of Contents and Abstracts

Entringer S, de Punder K, Overfeld J, et. al.
Immediate and longitudinal effects of maltreatment on systemic inflammation in young children. Dev Psychopathol. 2020 Dec;32(5):1725-1731. PMID: 33427162
For 173 maltreated children 3-5 years of age, for girls an increase in C-reactive protein (CRP - a blood marker of inflammation) was found immediately after the abuse was recognized and stayed elevated during the two years of the study follow-up period, but there was no increase in CRP noted for boys.

Suzuki S, Fujisawa TX, Sakakibara N, et. al.
Development of Social Attention and Oxytocin Levels in Maltreated Children. Sci Rep. 2020 May 4;10(1):7407. PMID: 32366913
For a group of maltreated children compared to typical findings, maltreated children had lower salivary oxytocin levels (the “tend and befriend” hormone), lower gaze fixation, and increased social-emotional problems. Authors suggest that lower oxytocin levels are associated with decreased eye contact as a social cue, thus leading to increased risk of social interaction issues.

McIntyre RS, Subramaniapillai M, Lee Y, et. al.
Efficacy of Adjunctive Infliximab vs Placebo in the Treatment of Adults With Bipolar I/II Depression. JAMA Psychiatry. 2019 Aug 1;76(8):783-790. PMID: 31066887For 60 adults with bipolar depression and inflammatory conditions, treatment with an anti-inflammatory agent did not decrease overall depressive symptoms compared with placebo; however, depressive symptoms did significantly decrease in a subpopulation who reported childhood maltreatment.

Haas JJ.
The Role of the School Nurse in Detecting and Preventing Child Abuse During This Age of Online Education. NASN Sch Nurse. 2021 Jan;36(1):16-19. PMID: 32969318
“School nurses can and should champion the cause of child safety in their schools, even during school closures through the implementation of key nursing interventions such as staff education on detecting child abuse in online environments. School nurses can also protect children by supporting parents who are dealing with great stressors due to the current global pandemic. Providing resources for families, encouraging parental self-care, educating families about online safety, and encouraging family discussion about child abuse all help to prevent abuse and maltreatment of children. When child abuse goes unreported because of school closures, school nurses can bridge the gap and advocate for detection and prevention in online education.”

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