Adverse childhood experiences and behavioral problems in middle childhood

Children who have been exposed to maltreatment and other adverse childhood experiences (ACEs) are at increased risk for various negative adult health outcomes, including cancer, liver disease, substance abuse, and depression. However, the proximal associations between ACEs and behavioral outcomes during the middle childhood years have been understudied. In addition, many of the ACE studies contain methodological limitations such as reliance on retrospective reports and limited generalizability to populations of lower socioeconomic advantage. The current study uses data from the Fragile Families and Child Wellbeing Study, a national urban birth cohort, to prospectively assess the adverse experiences and subsequent behavior problems of over 3000 children. Eight ACE categories to which a child was exposed by age 5 were investigated: childhood abuse (emotional and physical), neglect (emotional and physical), and parental domestic violence, anxiety or depression, substance abuse, or incarceration. Results from bivariate analyses indicated that Black children and children with mothers of low education were particularly likely to have been exposed to multiple ACE categories. Regression analyses showed that exposure to ACEs is strongly associated with externalizing and internalizing behaviors and likelihood of ADHD diagnosis in middle childhood. Variation in these associations by racial/ethnic, gender, and maternal education subgroups are examined. This study provides evidence that children as young as 9 begin to show behavioral problems after exposure to early childhood adversities.     

Childhood sexual abuse,risky sexual behaviors and adverse reproductive health outcomes among Chinese college students

BackgroundChildhood sexual abuse (CSA) is a serious public health problem worldwide.ObjectivesWe reported the prevalence of CSA and examined its association with risky sexual behaviors and adverse reproductive health outcomes among college students in China.Participants and settingParticipants were 17,966 college students from 130 colleges in Eastern, Central, and Western China, who completed the online questionnaire in January–August 2015.MethodsData were obtained from a cluster-random Internet-based survey. Multivariate logistic regression analyses were employed: risky sexual behaviors and adverse reproductive health outcomes were outcome variables, and various types of CSA were predictor variables, while adjusting for socio-demographic and lifestyle characteristics.ResultsThe overall prevalence of any type of CSA was 27.5%. Most perpetrators were friends/acquaintances (34.6%) or intimate partners (24.7%) of the victims. Respondents who reported penetrative CSA were strongly associated with regular unprotected sex (odds ratio (OR): 3.0, 95% confidence interval (CI): 2.2–4.0), early sexual debut (OR: 5.5, 95% CI: 3.3–9.1), having genital tract symptoms in the last 12 months (OR: 5.0, 95% CI: 4.1–6.0), unintended pregnancy (OR: 6.2, 95% CI: 4.2–9.0), and induced abortion (OR: 5.5, 95% CI: 3.7–8.2) (for boys, the survey asked about history of unintended pregnancy and induced abortion of their sexual partners). A dose-response relationship was found across non-contact, contact, and penetrative CSA.ConclusionsCSA experience may increase the likelihood of risky sexual behaviors and adverse reproductive health outcomes in victims’ early adulthood.     

Extended follow-up of neurological,cognitive, behavioral and academic outcomes after severe abusive head trauma

Studies about long-term outcome following abusive head trauma (AHT) are scarce. The aims of this study were to report long-term neurological, cognitive, behavioral and academic outcomes, ongoing treatments and/or rehabilitation, several years after AHT diagnosis, and factors associated with outcome. In this retrospective study, all patients admitted to a single rehabilitation unit following AHT between 1996 and 2005, with subsequent follow-up exceeding 3 years, were included. Medical files were reviewed and a medical interview was performed with parents on the phone when possible. The primary outcome measure was the Glasgow Outcome Scale (GOS). Forty-seven children (out of 66) met the inclusion criteria (mean age at injury 5.7 months; SD = 3.2). After a median length of follow-up of 8 years (range 3.7–12), only seven children (15%) had “good outcome” (normal life – GOS I) and 19 children (40%) presented with severe neurological impairment (GOS III and IV). Children sustained epilepsy (38%), motor deficits (45%), visual deficit (45%), sleep disorders (17%), language abnormalities (49%), attention deficits (79%) and behavioral disorders (53%). Most children (83%) had ongoing rehabilitation. Only 30% followed a normal curriculum, whereas 30% required special education services. Children with better overall outcome (GOS I and II) had significantly higher educated mothers than those with worse outcomes (GOS III and IV): graduation from high school 59% and 21% respectively (p = 0.006). This study highlights the high rate of severe sequelae and health care needs several years post-AHT, and emphasizes the need for extended follow-up of medical, cognitive and academic outcomes.     

Acceptability of positive and punitive discipline methods: comparisons among abusive, potentially abusive, and nonabusive parents

The present study compared abusive, potentially abusive, and control group parents' perceptions of commonly used discipline procedures. The clinical samples were obtained from Parents Anonymous (PA) and consisted of both court-referred (abusive) and self-referred (potentially abusive) members. The subjects were presented with case vignettes that described a child with either mild or severe behavior problems and asked to rate four methods of disciplining the child. The discipline methods involved positive reinforcement, timeout, timeout with spanking, and spanking. The findings indicated that (1) overall, the parents generally evaluated positive reinforcement as significantly more acceptable than timeout, timeout with spanking, and spanking; (2) self-referred PA members viewed timeout, timeout with spanking, and spanking as relatively more acceptable than did their demographically similar comparison group; and (3) court-referred PA parents' ratings did not significantly differ from their comparison group, since both groups rated the reinforcement method as significantly more acceptable than the other three discipline methods.     

Unwanted and illegal sexual experiences in childhood and adolescence

Three hundred forty-two anonymous surveys regarding unwanted sexual experiences (USE) were filled out in three clinic sites: a pediatric sexual abuse clinic, family practice clinic, and family planning clinic. In the latter two clinics, 40% of females and 16% of males had at least one unwanted sexual experience prior to turning 18 years old. Only 91% of the sexual abuse clinic patients indicated their experience was unwanted. In addition, 27% of the subjects had wanted sexual experiences that were illegal and underreported: These experiences involved a partner at least 4 years older or younger. While feelings of victimization were most common, self-blame and naivete about the abuse were also frequently reported, especially in those who had an USE with a peer. Ambivalence, self-blame, and peer pressure were associated with a lower tendency to disclose one's USE. Although unwanted and illegal sexual experiences were less common in Hispanic females, feelings of self-blame and ambivalence regarding their USE were more frequent in comparison with White females. These findings have important investigative and therapeutic implications for professionals who encounter victims of sexual abuse.     

Linking childhood sexual abuse and abusive parenting: the mediating role of maternal anger

OBJECTIVE: This study had two primary objectives: First, to examine the association between childhood sexual abuse (CSA) and later parenting characteristics, particularly physical abuse potential, and second, to explore maternal anger as a mediator of the relationship between CSA and adult physical abuse potential. METHOD: Utilized a community sample of low SES participants that included 138 mothers classified as having experienced CSA, and a comparison group of 152 non-sexually abused mothers. Parenting variables examined included the mothers' physical abuse potential, nurturance toward their children, unrealistic developmental expectations of children, as well as frequencies of spanking and general punishment. Data was collected via interview and other self-report measures. RESULTS: Even after controlling for mothers' childhood experience of Physical abuse, CSA significantly predicted adult risk of physically abusing one's own children. Further, maternal anger was confirmed as a mediator of the relationship between having been sexually abused as a child and the potential for physically abusing one's own children. CONCLUSIONS: CSA may be a risk factor for subsequent physically abusive parenting, while anger appears to play a significant role in mediating this relationship. Findings are discussed in the context of current knowledge concerning the impact of child sexual abuse and the processes contributing to abusive parenting.     

Child sexual abuse and persistence of risky sexual behaviors and negative sexual outcomes over adulthood: Findings from a birth cohort

ObjectivesTo determine the impact of child sexual abuse (CSA) on adult sexual behaviors and outcomes over three age periods.MethodsA longitudinal study of a birth cohort born in Dunedin, New Zealand in 1972/1973 was used. Information on CSA was sought at age 26, and on sexual behaviors and outcomes at ages 21, 26, and 32. Comparisons were over the whole period from age 18 to 32, then for the three age periods from age 18 to 21, 21 to 26, and 26 to 32, adjusting for measures of family environment.ResultsOverall, 465 women and 471 men (91.9% of the surviving cohort) answered questions about CSA. Contact CSA was reported by 30.3% of women and 9.1% of men. For abused women, significantly increased rates were observed for number of sexual partners, unhappy pregnancies, abortion, and sexually transmitted infections from age 18 to 21; with rates approaching those of nonabused over time. Conversely, for abused men rates were not significantly elevated in the youngest age period, but were for number of partners from age 26 to 32 and acquisition of herpes simplex virus type 2 from age 21 to 32.ConclusionsGender and age are critical when considering the effect of CSA. While the profound early impact of CSA demonstrated for women appears to lessen with age, abused men appear to carry increased risks into adulthood.Practice implicationsCSA is common and should be considered when young women present with unwanted conceptions or seek multiple terminations, and when men continue to have high risk sexual behavior into adulthood. Furthermore, if CSA is disclosed, sexual risks in adulthood need to be considered.     

Adverse childhood experiences,chronic diseases,and risky health behaviors in Saudi Arabian adults: A pilot study

Adverse childhood experiences (ACEs) have been linked with risky health behaviors and the development of chronic diseases in adulthood. This study examined associations between ACEs, chronic diseases, and risky behaviors in adults living in Riyadh, Saudi Arabia in 2012 using the ACE International Questionnaire (ACE-IQ). A cross-sectional design was used, and adults who were at least 18 years of age were eligible to participate. ACEs event scores were measured for neglect, household dysfunction, abuse (physical, sexual, and emotional), and peer and community violence. The ACE-IQ was supplemented with questions on risky health behaviors, chronic diseases, and mood. A total of 931 subjects completed the questionnaire (a completion rate of 88%); 57% of the sample was female, 90% was younger than 45 years, 86% had at least a college education, 80% were Saudi nationals, and 58% were married. One-third of the participants (32%) had been exposed to 4 or more ACEs, and 10%, 17%, and 23% had been exposed to 3, 2, or 1 ACEs respectively. Only 18% did not have an ACE. The prevalence of risky health behaviors ranged between 4% and 22%. The prevalence of self-reported chronic diseases ranged between 6% and 17%. Being exposed to 4 or more ACEs increased the risk of having chronic diseases by 2–11 fold, and increased risky health behaviors by 8–21 fold. The findings of this study will contribute to the planning and development of programs to prevent child maltreatment and to alleviate the burden of chronic diseases in adults.     

Gender differences in the association between childhood sexual abuse and risky sexual behaviours: A systematic review and meta-analysis

This meta-analytic review examines the association between childhood sexual abuse and risky sexual behaviours with sub-group analyses by gender. Systematic searches of electronic databases including MEDLINE, PubMed, EMBASE, and PsycINFO were performed using key terms. We used a priori criteria to include high quality studies and control for heterogeneities across eligible studies. The review was registered with PROSPERO and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The final meta-analysis applied fixed-effects model to generate pooled odds ratio (OR). Subgroup analyses were conducted to identify potential methodological moderators. The meta-analysis included 8 eligible studies (N = 38,989, females = 53.1%). The overall syndemic of risky sexual behaviors at adulthood was 1.59 times more common in childhood sexual abuse victims. There was a similar association between childhood sexual abuse in general and subsequent risky sexual behaviors in both females and males. However, in cases of substantiated childhood sexual abuse, there was a greater odds of risky sexual behaviors in females (OR = 2.72) than males (OR = 1.69). The magnitude of association of childhood sexual abuse and risky sexual behaviors was similar for males and females regardless of study time, study quality score and method of childhood sexual abuse measurement. There were nonsignificant overall and subgroup differences between males and females. Childhood sexual abuse is a significant risk factor for a syndemic of risky sexual behaviors and the magnitude is similar both in females and males. More research is needed to explore possible mechanisms of association.     

Child peer sexual abuse: preliminary data on outcomes and disclosure experiences

OBJECTIVE: This study compared experiences of children sexually abused by peers to those of children abused by adolescents/adults. Variables examined included perceived negativity of the abuse, self-reported outcomes, overall psychological functioning, and disclosure. METHOD: An archival data set containing retrospective reports of childhood sexual experiences was culled for instances of sexual abuse by child peers and adolescents/adults. An equivalent nonabused comparison group was identified. The Self-Report Outcome Checklist (SROC; Gilbert, 1994b), the MMPI-Hugo Short Form (Hugo, 1971) and a disclosure survey were also retrieved from these data. RESULTS: Compared to abuse by peers, abuse perpetrated by adolescents/adults was more intrusive and intrafamilial. Both groups rated their experiences as equally negative, and reported equally pervasive outcomes. Those abused by adolescents/adults reported significantly higher scores on the Psychopathic Deviate, Psychasthenia, and Schizophrenia scales compared to nonabused controls; similar findings did not emerge for those abused by child peers. Less than a fourth in either abuse group reported disclosing their experience to a parent. Among those who did not disclose, participants abused by child peers anticipated less support from both parents and more anger from their mothers. CONCLUSIONS: The findings suggest that child peer sexual abuse may be associated with adverse outcomes.     

Exposure to childhood sexual and physical abuse and subsequent educational achievement outcomes

OBJECTIVE: This paper examined the relationship between exposure to sexual and physical abuse (CSA and CPA) in childhood and later educational achievement outcomes in late adolescence and early adulthood in a birth cohort of over 1,000 children studied to age 25. METHOD: Retrospective data on CSA and CPA were gathered at ages 18 and 21 and used to form a best estimate of exposure to CSA and CPA. The relationship between CSA, CPA, and self-reported educational outcomes to 25 years was examined using logistic regression models that took into account social background, parental factors, and individual factors. RESULTS: Increasing exposure to CSA and CPA was significantly associated with failing to achieve secondary school qualifications (CSA: B=.53, SE=.13, p<.0001; CPA: B=.62, SE=.12, p<.0001), gaining a Higher School Certificate (CSA: B=-.48, SE=.13, p<.001; CPA: B=-.78, SE=.14, p<.001), attending university (CSA: B=-.29, SE=.13, p<.05; CPA: B=-.45, SE=.13, p<.001), and gaining a university degree (CSA: B=-.54, SE=.18, p<.005; CPA: B=-.64, SE=.17, p<.001). Adjustment for confounding social, parental, and individual factors explained most of these associations. After control for confounding factors, omnibus tests of the associations between CSA and outcomes and CPA and outcomes failed to reach statistical significance (CSA: Wald chi(2) (4)=7.72, p=.10; CPA: Wald chi(2) (4)=8.26, p=.08). CONCLUSIONS: The effects of exposure to CSA and CPA on later educational achievement outcomes are largely explained by the social, family, and individual context within which exposure to abuse takes place.     

Men's and women's childhood sexual abuse and victimization in adult partner relationships: A study of risk factors

Objectives(1) Document the prevalence of childhood sexual abuse (CSA), childhood physical assault, psychological, physical and sexual intimate partner violence (IPV) in a nationally representative sample. (2) Assess the predictive value of CSA and other characteristics of the respondents and their current partners as potential risk factors for IPV. (3) Assess factors predicting IPV in adulthood in a subsample of women reporting CSA.MethodsThe role of CSA as a risk factor for adult IPV was examined using data from the 1999 Canadian General Social Survey. A national stratified sample of 9170 women and 7823 men with current or previous partners were interviewed by telephone by Statistics Canada. Multiple logistic regressions were used.ResultsCSA consistently predicted IPV for women and men, although this relationship was weaker for men. Age, current marital status and limitations due to physical or mental condition or chronic illness were also predictors of IPV for men and women. For women reporting CSA, age (being younger) or being in a more recent relationship and being limited due to either physical, mental conditions or chronic illness were predictive of adult victimization.ConclusionsThese findings indicate that CSA is associated with a greater risk of IPV beyond sociodemographic risk factors.Practice implicationsTo prevent IPV in women already at risk because of CSA, education about protective strategies seems important, particularly for women with physical or mental limitations, in the beginning stages of intimate relationships or for women with partners who drink excessively.     

Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis

BackgroundThe Center for Disease Control (CDC) and Kaiser Permanente developed the Adverse Childhood Experiences (ACE) scale to identify negative experiences in childhood. The goal of this study is to systematically review outcomes associated with the ACEs in the CDC-Kaiser ACE scale to understand the diversity of outcomes associated with this scale.MethodsThe authors conducted a search of English language articles published through September 30, 2016 using OVID Medline®; Ovid Medline® Daily; Epub Ahead of Print, In-Process & Other Non-indexed citations; ERIC®; HAPI®; and SCOPUS®. Articles were selected by trained reviewers based on a priori inclusion criteria including: research, healthy sample, used the CDC-Kaiser ACE scale, and assessed some health outcome. Two reviewers used an abstraction form to independently collect data from each study. Unadjusted and adjusted odds ratio associated with ACE scale scores were aggregated and compared.ResultsFrom 3167 unique titles, we identified 96 articles that assessed health outcomes associated with the ACEs in the CDC-Kaiser ACE scale. There were more studies focusing on psychosocial/behavioral outcomes than medical outcomes. The majority of the included studies were retrospective, observational, and relied on the same data set. Psychosocial/behavioral outcomes had higher odds ratio than medical outcomes with increasing ACE scale scores.ConclusionsExposure to multiple ACEs is associated with a wide variety of outcomes. This data suggests a benefit of screening for ACEs using this scale and highlights the need to find interventions to ameliorate their effects.     

Men with childhood sexual abuse histories: Disclosure experiences and links with mental health

BackgroundThere is limited research on the disclosure experiences of men who have experienced childhood sexual abuse and on how such experiences might impact mental health outcomes.ObjectiveThe current study described men’s disclosure experiences and examined the role of disclosure characteristics on mental well-being (internalizing and externalizing behaviors, substance use, resilience).Participants and settingMen (N = 253) from across Canada and the U.S. were recruited through websites for males with sexual abuse histories. Men aged 18–59 years anonymously completed an online study on their sexual abuse, disclosure experiences, and mental health outcomes.ResultsFindings indicated that 77.9% of men disclosed their sexual abuse, although they waited an average of 15.4 years before sharing their experience. Once disclosed, 64.4% of the men reported a positive response (e.g., support), while 35.6% reported a negative response (e.g., blame). Regression analyses indicated that a greater delay in disclosure predicted greater externalizing behaviors (B = .49, p < .05), although this was a small effect (Cohen’s f ² = 0.02). Additional disclosure variables were associated with components of externalizing (aggressive and rule-breaking behaviors) and internalizing (somatic complaints) behaviors.ConclusionsThese results require replication in future studies. However, they do suggest that efforts need to be undertaken to address the barriers that hinder men from disclosing their sexual abuse and to ensure that men are supported once they disclose.     

The association of childhood sexual abuse with depressive symptoms during pregnancy, and selected pregnancy outcomes.

OBJECTIVES: The objectives were: (1) to investigate the association during pregnancy of sexual abuse before the age of 18 on depressive symptomatology in pregnancy, controlling for the presence of negative life events and challenges; and (2) to investigate the association of selected pregnancy outcomes (maternal labor and delivery factors, infant birth weight and gestational age) with sexual abuse before age 18. METHODS: Three hundred fifty-seven primiparous women aged 18 years and older were interviewed between 28-32 weeks gestation with reference to current functioning and past history (Objective 1). Medical record information was abstracted after delivery for pregnancy, labor and delivery factors, and pregnancy outcomes (Objective 2). RESULTS: Thirty-seven percent of the women reported past sexual abuse. Prevalence was not associated with ethnic background, educational level, or hospital payment source. Previously sexually-abused pregnant women reported significantly higher levels of depressive symptomatology, negative life events, and physical and verbal abuse before and during pregnancy. There were no significant associations found between past sexual abuse and labor or delivery variables or newborn outcomes. CONCLUSIONS: Previously sexually-abused pregnant women reported a wider constellation of past and current functioning problems than nonabused women although past sexual abuse was not associated with pregnancy outcome. Prenatal care provides a unique opportunity to evaluate the impact of life history and current life events during pregnancy, and to develop a coordinated intervention plan.     

Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: The Urban Men's Health Study

OBJECTIVE: The prevalence and characteristics of childhood sexual abuse (CSA) among men who have sex with men (MSM), and links with sexual risk are explored. A model linking CSA and sexual risk among MSM is proposed. METHOD: A telephone probability sample of urban MSM (n = 2881) was recruited and interviewed between November 1996 and February 1998. The interview covered numerous health issues, including history of sexual victimization. RESULTS: One-fifth reported CSA, primarily by non-family perpetrators. Initial CSA experiences are characterized by high levels of force (43% involved physical force/weapons), and penetrative sex (78%; 46% reported attempted or actual anal intercourse). Such men are more likely than nevercoerced men to engage in high risk sex (unprotected anal intercourse with a non-primary partner or with a serodiscordant male). In multivariate analyses, the effect of childhood sexual coercion on sexual risk is mediated by substance use, patterns of sexual contacts, and partner violence, but not by adult sexual revictimization or by depression. CONCLUSIONS: Findings are interpreted within the context of social learning theory and prior research on sexual risk-taking. The high risk for CSA among MSM, which can predispose such men to patterns of HIV sexual risk, warrants new approaches in HIV prevention.     

Physical punishment, childhood abuse and psychiatric disorders

OBJECTIVES: Physical punishment, as a means of disciplining children, may be considered a mild form of childhood adversity. Although many outcomes of physical punishment have been investigated, little attention has been given to the impact of physical punishment on later adult psychopathology. Also, it has been stated that physical punishment by a loving parent is not associated with negative outcomes; however, this theory has not been empirically tested with regard to psychiatric disorders. The main objective of the present study was to investigate three categories of increasing severity of childhood adversity (no physical punishment or abuse, physical punishment only, and child abuse) to examine whether the childhood experience of physical punishment alone was associated with adult psychopathology, after adjusting for sociodemographic variables and parental bonding dimensions. METHODS: Data were drawn from the nationally representative National Comorbidity Survey (NCS, n=5,877; age 15-54 years; response rate 82.4%). Binary logistic and multinomial logistic regression models were used to determine the odds of experiencing psychiatric disorders. RESULTS: Physical punishment was associated with increased odds of major depression (AOR=1.22; 95% CI=1.01-1.48), alcohol abuse/dependence (AOR=1.32; 95% CI=1.08-1.61), and externalizing problems (AOR=1.30; 95% CI=1.05-1.60) in adulthood after adjusting for sociodemographic variables and parental bonding dimensions. Individuals experiencing physical punishment only were at increased odds of adult psychopathology compared to those experiencing no physical punishment/abuse and at decreased odds when compared to those who were abused. CONCLUSIONS: Physical punishment is a mild form of childhood adversity that shows an association with adult psychopathology.     

Adverse childhood experiences: Prevalence and related factors in adolescents of a Brazilian birth cohort

Adverse childhood experiences (ACEs) can affect people's health and wellbeing not only at the time the ACE is experienced, but also later in life. The majority of studies on ACEs are carried out in high-income countries and little is known about its prevalence in low and middle-income countries. Thus, the aim of this study was to assess the prevalence of ACEs, associations between ACEs and sociodemographic factors, and the interrelationship between types of ACEs in adolescents of a Brazilian birth cohort. Data from 3,951 adolescents (78.4% of the original cohort) from the 1993 Pelotas Cohort were analyzed. Seven types of ACEs were assessed in those up to 18 years old: physical abuse, sexual abuse, physical neglect, emotional neglect, domestic violence, parental separation and parental death. The most common ACE was parental separation (42%), followed by emotional neglect (19.7%) and domestic violence (10.3%). Approximately 85% of the adolescents experienced at least one ACE, and females reported a higher number of adversities. Several socioeconomic, demographic and family-related characteristics were associated with the occurrence of ACEs, e.g. non-white skin color, low family income, low maternal schooling, absence of mother's partner, maternal smoking, and poor maternal mental health. A strong interrelationship was observed among the ACEs, indicating clustering of risk. These aspects should be considered by health and social care professionals in the prevention and identification of childhood adversities.