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PACEs in Pediatrics

ACEs Research Corner — September 2018

 

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

Schickedanz A, Halfon N, Sastry N, Chung PJ.
Parents' Adverse Childhood Experiences and Their Children's Behavioral Health Problems. Pediatrics. 2018 Aug;142(2). pii: e20180023. PMID: 29987168
Using data from two linked national studies, children of parents with a history of 4 or more ACEs had more behavioral problems, 2.1 times higher odds of hyperactivity, and 4.2 times higher odds of an emotional disturbance diagnosis than children of parents with no ACEs. Maternal ACEs showed a stronger association with child behavior problems than paternal ACEs.

Amnie AG.
Emerging themes in coping with lifetime stress and implication for stress management education. SAGE Open Med. 2018 Jun 20;6:2050312118782545. PMID: 29977550
Of 233 adults who filled out an online survey, 21% did not have any ACEs, 79.0% had 1 or more, and 37.6% 4 or more. The most common ACEs were emotional abuse and emotional neglect. Of the 188 who filled out a qualitative portion on how they handled stress, 37.2% used avoidant coping with abuse of drugs and/or alcohol and disengagement from relationships. 17.6% used problem focused coping such as seeking counseling or other treatments, and 45.2% used emotion focused coping with meditation, yoga, humor, spirituality, exercise, or seeking social support.

Jakubowski KP, Cundiff JM, Matthews KA.
Cumulative childhood adversity and adult cardiometabolic disease: A meta-analysis. Health Psychol. 2018 Aug;37(8):701-715. PMID: 30024227
Review of research studies showing a significant effect of cumulative childhood maltreatment and increasing adult cardiometabolic disease.

Baldwin JR, Arseneault L, Caspi A, et. al.
Childhood victimization and inflammation in young adulthood: A genetically sensitive cohort study. Brain Behav Immun. 2018 Jan;67:211-217. PMID: 28867281
From a long term twin study of 2232 children, and despite controlling for other risk factors, greater exposure to childhood victimization was associated with higher levels of inflammation for females, but not for males, at age 18.

Nowakowski-Sims E, Rowe A.
The relationship between childhood adversity, attachment, and internalizing behaviors in a diversion program for child-to-mother violence. Child Abuse Negl. 2017 Oct;72:266-275. PMID: 28865397
In a survey of 80 youth arrested for domestic battery against a mother, the mean score of childhood adversity for these youth was 10 (out of 17) possible experiences. 

Flanagan T, Alabaster A, McCaw B, et. al.
Feasibility and Acceptability of Screening for Adverse Childhood Experiences in Prenatal Care. J Womens Health (Larchmt). 2018 Jul;27(7):903-911. PMID: 29350573
In this pilot study from the Northern California Kaiser system, prenatal patients were screened at 14-23 weeks for ACEs score as well as resilience. 78% of patients were screened. 54% reported 0 ACEs, 28% 1-2, and 18% 3+. Over 90% were somewhat or very comfortable discussing ACEs, and strongly or very strongly agreeing that clinicians should ask about ACEs. “Clinicians' willingness to screen for ACEs was contingent on adequate training, streamlined workflows, inclusion of resilience screening, and availability of mental health, parenting, and social work resources.” 

Sege RD, Harper Browne C.
Responding to ACEs With HOPE: Health Outcomes From Positive Experiences. Acad Pediatr. 2017 Sep - Oct;17(7S):S79-S85. PMID: 28865664
“The HOPE framework emphasizes…elevating the importance of maximizing positive experiences for children, in addition to minimizing risks and the effects of negative experiences”.  Guiding principles include that all domains of individual, relational, community, and societal factors must be addressed; that child and parental health and well-being are inextricably linked; and that child health incorporates physical, cognitive, social, and emotional outcomes.

Sterling S, Chi F, Weisner C, et. al.
Association of behavioral health factors and social determinants of health with high and persistently high healthcare costs. Prev Med Rep. 2018 Jun 27;11:154-159. PMID: 30003015
Taken from the 4.1 million members of the Northern California Kaiser system, a random sample of high-cost vs. non-high-cost adult members matched by age, gender, race/ethnicity, and medical severity were interviewed by phone.  Factors associated with being in the higher medical utilization and cost group were psychiatric diagnosis, financial stressors, and ACEs. ACEs alone predicted persistent high-cost status in the subsequent year. 

 

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