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ACEs Research Corner — January 2020


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's posting the summaries of the abstracts and links to research articles that address only ACEs science. Thank you, Harise!! -- Jane Stevens]


Arseneault L.
Annual Research Review: The persistent and pervasive impact of being bullied in childhood and adolescence: implications for policy and practice. J Child Psychol Psychiatry. 2018 Apr;59(4):405-421. PMID: 29134659 “Bullying should be considered as another form of childhood abuse alongside physical maltreatment and neglect. Several rigorous studies reviewed provide strong and robust support for an independent contribution of childhood bullying victimisation to the development of poor outcomes throughout the life span, including mental, physical and socioeconomic outcomes.”  Authors make suggestions for anti-bullying policy and interventions.

 McKelvey LM, Edge NC, Mesman GR, et. al.
Adverse experiences in infancy and toddlerhood: Relations to adaptive behavior and academic status in middle childhood. Child Abuse Negl. 2018 Aug;82:168-177. PMID: 29908436 From a sample of 1469 low income families, and after controlling for many factors, ACE score at a young age was associated at age 11 with the child having an individualized educational program since starting school, having been retained a grade, problems with attention, and problems with externalizing (aggression) and internalizing (depression, anxiety) behavior.

Witt A, Sachser C, Plener PL, Brähler E, Fegert JM.
The Prevalence and Consequences of Adverse Childhood Experiences in the German Population. Dtsch Arztebl Int. 2019 Sep 20;116(38):635-642. PMID: 31617486 From a representative German population survey of 2531 adults, 43.7% reported at least one ACE, and 8.9% 4 or more.  The most common were parental separation and divorce (19.5%), alcohol/drug abuse (16.7%), and emotional neglect (13.4%).  Those with 4+ ACEs were 7.8 times more likely to report depression, 7.1 times more anxiety, and 10.5 times more physical aggressiveness.

Krantz TE, Andrews N, Petersen TR, et. al.
Adverse Childhood Experiences Among Gynecology Patients With Chronic Pelvic Pain. Obstet Gynecol. 2019 Nov;134(5):1087-1095. PMID: 31599850 Of 60 women with chronic pelvic pain and matched controls, “Chronic pelvic pain participants had a greater than threefold odds of having a history of childhood abuse and having witnessed domestic violence during childhood compared with the control group. In women with chronic pelvic pain, 53% had four or more ACEs, compared to 27% of the control group.

Blasingame GD.
Traumatic Brain Injury and Sexually Offensive Behaviors. J Child Sex Abus. 2018 Nov-Dec;27(8):972-977. PMID: 30211665 Sexually offensive behavior is known to be one of many consequences of traumatic brain injury (TBI). This article provides a brief review of research to ascertain the effects of TBI in childhood and adulthood as related to cognitive, behavioral, social, and sexual behaviors. Brain impairment is also identified as a result of adverse childhood experiences (ACEs). Individuals with sexual offending histories are found to have experienced high numbers of ACEs. Sexually offensive and sexual offending behaviors post-TBI appears to occur in between 3.5 and 9% of affected adults.”

Forkey H, Conn AM.
Childhood Trauma Management in Primary Care. Adv Pediatr. 2018 Aug;65(1):143-158. PMID: 30053921“Addressing childhood trauma in the pediatric health care setting is similar to treating illness and infection: we must think in terms of prevention, detection, and treatment…what works best for one office may not work best for another. An important next step may be to determine what training and resources are needed to improve comfort and competence in addressing childhood trauma.”

Haltom JP, Card E, Wells N, Lowen DE.
The hands that cradle: A pilot study of parent adverse childhood experience scores. J Am Assoc Nurse Pract. 2019 Jun 5;31(6):330-336. PMID: 30829968 Article describes the process, limitations and considerations for an appropriate context of asking parents of suspected child abuse about ACEs, and copies of materials — informational handout on ACEs, verbal consent form, demographic questionnaire, and “Finding Your ACE Score” questionnaire.

Foy JM, Green CM, Earls MF, et. al
Mental Health Competencies for Pediatric Practice. Pediatrics. 2019 Nov;144(5). pii: e20192757. PMID: 31636143 “In this report, the American Academy of Pediatrics updates its 2009 policy statement, which proposed competencies for providing mental health care to children in primary care settings and recommended steps toward achieving them…expands competencies in response to science and policy that have emerged since: the impact of adverse childhood experiences and social determinants on mental health, trauma-informed practice, and team-based care.”  This policy statement contains an algorithm for patient care, a list of core mental health competencies for clinical skills and practice enhancements, and an extensive list of resources.

Purewal Boparai SK, Au V, Koita K, et. al.
Ameliorating the biological impacts of childhood adversity: A review of intervention programs. Child Abuse Negl. 2018 Jul;81:82-105. PMID: 29727766 “Across institutional, foster care, and community settings, intervention programs demonstrated success overall for improving or normalizing morning and diurnal cortisol levels, and ameliorating the impacts of adversity on brain development, epigenetic regulation, and additional outcomes in children…Clinicians should integrate lessons from the intervention sciences for preventing and treating the health effects of adversity in children and adolescents.

Crandall A, Miller JR, Cheung A, et. al.
ACEs and counter-ACEs: How positive and negative childhood experiences influence adult health. Child Abuse Negl. 2019 Oct;96:104089. PMID: 31362100 “As important as decreasing ACEs may be to improve community health it may be even more important to increase counter-ACEs, particularly in vulnerable populations…Key positive experiences include developing skills in four areas: supportive relationships, safe and stable environments, social and emotional skills, and positive social interactions and connections…even children with high ACEs still experienced positive outcomes when they reported that they felt that their family stood by them in hard times and that they had someone to talk with about difficult feelings.”

Wu Q, Chi P, Lin X, Du H.
Child maltreatment and adult depressive symptoms: Roles of self-compassion and gratitude. Child Abuse Negl. 2018 Jun;80:62-69. PMID: 29571033 From a survey of 358 Chinese college students, self-compassion and gratitude served as protective factors between certain types of childhood maltreatment and subsequent adult depression.

Mersky JP, Lee CP.
Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample. BMC Pregnancy Childbirth. 2019 Oct 28;19(1):387. PMID: 31660899 “Exposure to a greater number of ACEs increased the risk of pregnancy loss, preterm birth, and low birthweight. The relationship between ACEs and pregnancy loss largely followed a dose-response pattern, while the associations between ACEs and both preterm birth and low birthweight appeared to be at least partly non-linear. The latter findings signify potential threshold effects, meaning that some poor birth outcomes may emerge only when an individual is exposed to a critical level of adversity.

Laditka SB, Laditka JN.
An Enduring Health Risk of Childhood Adversity: Earlier, More Severe, and Longer Lasting Work Disability in Adult Life. J Gerontol B Psychol Sci Soc Sci. 2019 Jan 1;74(1):136-147. PMID: 29432605 Graph shows national work disability data for adults with 4+ACEs (compared to 0 ACEs), and the impact of specific adversities. The greatest impact on adult work disability was childhood bullying.

Morrow AS, Villodas MT.
Direct and Indirect Pathways From Adverse Childhood Experiences to High School Dropout Among High-Risk Adolescents. J Res Adolesc. 2018 Jun;28(2):327-341. PMID: 28736884 Of 728 adolescents with a history of abuse and neglect, ACEs were directly and independently associated with school dropout, and also indirectly associated with dropout through poor reading achievement and externalizing (anger) problems.

Roberts BW.
Caring for Patients With Adverse Childhood Experiences. Radiol Technol. 2019 Nov;91(2):141-157. PMID: 31685590 Excellent and thorough article on ACEs for radiology technologists (or anyone!) – background, health effects, theoretical frameworks for stress, neuroplasticity, epigenetics, recent research areas, promoting resilience and protective community, and using trauma-informed care with pediatric patients who have experienced abuse, to minimize patient stress and avoid need for repeat imaging/ increased radiation dosage due to motion artifacts.

Dube SR.
Continuing conversations about adverse childhood experiences (ACEs) screening: A public health perspective. Child Abuse Negl. 2018 Nov;85:180-184. PMID: 29555095 Further discussion on ACEs screening, citing “the concerns about overly diagnosing patients without knowing what to do”. Author feels “Presently, we have a public health crisis…we are at a critical juncture to pragmatically address and prevent ACEs…this is best accomplished by ensuring that the collection and use of data is non-diagnostic, multi-generational, trauma-informed, and includes assessment of patient resiliency. Ethically speaking, we really cannot afford to wait another twenty years to take the needed action for addressing and preventing ACEs.”





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