Self-reported adverse childhood experiences and quality of life among children in the two last grades of Dutch elementary education

BackgroundAdverse Childhood Experiences (ACEs) may have a life-long impact on mental health and are related to physical disease, such as diabetes and cardiovascular diseases in adulthood. Research on ACEs suffers from recall bias when performed with adults.ObjectiveTo estimate the prevalence of ACEs and the interrelationships between ACEs as reported by children, and to determine the impact on their self-reported quality of life (QoL). Children’s opinions on the ACE-Questionnaire were also obtained.MethodA cross-sectional study was conducted with a child version of the ACE-Questionnaire. This questionnaire assesses parental separation or divorce, physical and emotional child abuse and neglect, sexual violence, domestic violence, household substance abuse, psychological issues or suicide, and incarceration of a household member. QoL was measured with the Kidscreen-10.Participants and settingThe questionnaire was completed by 644 children at a mean age of 11 years (range 9–13 years), in the two last grades of regular elementary schools, recruited throughout the Netherlands.ResultsData were weighted by ethnicity to obtain a representative sample of children in Dutch elementary education. Of all children, 45.3% had one or more out of ten ACEs. Child maltreatment was experienced by 26.4%. ACEs often co-occurred. A higher number of ACEs correlated with a lower mean level of QoL (p < 0.001). Mean QoL was 8.5 points lower (Cohen’s d = 0.8) in children who experienced child maltreatment. Children’s opinions on the questionnaire were positive in 82.4%.ConclusionPrevention of ACEs, professional training and trauma-focus in schools are urgently needed.     

Examining patterns of adversity in Chinese young adults using the Adverse Childhood Experiences—International Questionnaire (ACE-IQ)

Ample evidence supports significant and enduring associations between adverse childhood experiences (ACEs) and negative outcomes later in life. Subsets of ACEs (e.g. childhood maltreatment and household dysfunction) have been examined in Chinese populations, but no known study has comprehensively examined the full constellation of different types of ACEs or patterns of ACE exposure in Chinese samples. As a direct response to the call to establish a global ACEs surveillance framework, this study provides the first translation and validation of the World Health Organization ACE – International Questionnaire (ACE-IQ). Further, patterns of ACE exposure were identified through latent class analysis. The 29-item ACE-IQ was translated and back-translated from English to traditional Chinese to measure exposure to 13 categories of ACEs. The Chinese ACE-IQ demonstrated good content validity; the ACE-IQ domain subscales also showed satisfactory test-retest reliability and semantic equivalence. In a sample of 433 Chinese young adults, three patterns of ACE exposure were uncovered: Low ACEs (65.82%), Household Violence (24.94%), and Multiple ACEs (9.24%). Concurrent exposure to physical abuse, domestic violence, and emotional abuse (i.e. Household Violence) was a novel pattern found in this study sample, and suggests there may be traditional Chinese norms that potentiate risks for violent household environments in the absence of other household risk factors. Findings underscore the importance of examining ACE exposure within local contexts, as children’s adverse experiences may be idiosyncratic to geographic, social, and cultural norms.     

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.     

Associations between childhood deaths and adverse childhood experiences: An audit of data from a child death overview panel

BackgroundDespite strong associations between adverse childhood experiences (ACEs) and poor health, few studies have examined the cumulative impact of ACEs on causes of childhood mortality.MethodsThis study explored if data routinely collected by child death overview panels (CDOPs) could be used to measure ACE exposure and examined associations between ACEs and child death categories. Data covering four years (2012–2016) of cases from a CDOP in North West England were examined.ResultsOf 489 cases, 20% were identified as having ≥4 ACEs. Deaths of children with ≥4 ACEs were 22.26 (5.72–86.59) times more likely (than those with 0 ACEs) to be classified as ‘avoidable and non-natural’ causes (e.g., injury, abuse, suicide; compared with ‘genetic and medical conditions’). Such children were also 3.44 (1.75–6.73) times more likely to have their deaths classified as ‘chronic and acute conditions’.ConclusionsThis study evidences that a history of ACEs can be compiled from CDOP records. Measurements of ACE prevalence in retrospective studies will miss individuals who died in childhood and may underestimate the impacts of ACEs on lifetime health. Strong associations between ACEs and deaths from ‘chronic and acute conditions’ suggest that ACEs may be important factors in child deaths in addition to those classified as ‘avoidable and non-natural’. Results add to an already compelling case for ACE prevention in the general population and families affected by child health problems. Broader use of routinely collected child death records could play an important role in improving multi-agency awareness of ACEs and their negative health and mortality risks as well in the development of ACE informed responses.     

Patterns of adversity and pathways to health among White,Black, and Latinx youth

Research has demonstrated the negative impact of Adverse Childhood Experiences (ACEs) on long-term trajectories of mental and physical health. Yet existing literature on this topic is limited in its understanding of outcomes among youth samples, optimal measurement items and methods, and differences in adverse experiences across race/ethnicity. The current study used a person-centered approach to measure ACEs and their impact on youth health outcomes across three different racial/ethnic groups from a large national database. Patterns of exposure to adverse experiences among Black, Latinx, and White youth (N = 30,668, ages 12–17) were determined empirically using latent class analysis (LCA). Significant differences in class membership by demographic indicators (age, household income, sex) and concurrent health outcomes were identified. Different models emerged for Black (2 classes), Latinx (3 classes), and White youth (3 classes). Older and lower-income youth were more likely to have experienced adversities, but there were no differences in adversity likelihood by sex. Additionally, racial/ethnic minority youth were at greater risk of experiencing higher levels of adversity, poverty, and poor health when compared to their White counterparts. Rather than occuring in meaningful clusters, adverse experiences among youth reflected a cumulative risk model such that classes were defined by the overall intensity of adverse experiences (i.e., low, moderate, high). Findings provide greater knowledge regarding the relationship between ACEs and health and future research directions to inform more targeted and culturally-appropriate screening, prevention, and intervention programs.     

Abuse disclosures of youth with problem sexualized behaviors and trauma symptomology

BackgroundThe majority of youth with problem sexualized behaviors (PSB) have substantiated experiences of abuse or exposures to violence (Silovsky & Niec, 2002). Little is known about specific abuse experiences that may differentiate youth with PSB from those without. Few studies have examined the types of abuse associated with post-traumatic stress symptomology.ObjectiveThe current study explored two research questions: (1) Do children with PSB differ from children without PSB in terms of their abuse disclosures?; and (2) Are the types of abuse disclosed associated with the child’s scores on a post-traumatic stress measure?.Participants & settingData were analyzed for youth (N = 950) ages 3–18 years who completed a clinical assessment at a child advocacy center in the Midwest during the 2015 calendar year.MethodsYouth completed assessments that included a forensic interview and either the Trauma Symptom Checklist for Young Children (TSCYC) for children ages 3–10 years, or the Trauma Symptom Checklist for Children (TSCC) for children ages 11–16 years. Bivariate logistic regression was used to answer the research questions.ResultsFindings indicated that youths who disclosed offender to victim fondling were less likely to disclose PSB (OR = 0.460, p = .026), and children exposed to pornography were more likely to disclose PSB (OR = 3.252, p = .001). Additionally, youth who disclosed physical abuse (OR = 1.678, p = .001) or victim to offender sexual contact (OR = 2.242, p = .003) had higher odds of clinically significant trauma scores.ConclusionsImplications for practitioners and future research directions are discussed.     

Childhood trauma as a predictor of reoffending in a Northern Irish probation sample

BackgroundIt is well-documented that there is a high prevalence rate of childhood trauma experiences among the prison population, and studies have found a link between childhood trauma and later acts of violence.ObjectiveThe aim of the current study was to investigate whether childhood trauma (i.e., physical, sexual, emotional abuse and physical neglect) among offenders who have served a life sentence in Northern Ireland was associated with general and violent reoffending patterns. The study also explored the relationship between childhood trauma resulting from the sectarian conflict “The Troubles” in the region and its impact on reoffending.MethodThe casefiles of 100 offenders were coded for trauma experiences and official reoffending data was extracted. Logistic regression analysis was performed to explore the relationship between trauma and reoffending.ResultsThe most common form of childhood trauma were emotional abuse and/or emotional neglect (n = 43), conflict-related trauma (n = 43) and physical abuse (n = 40). Only age (OR .91) and conflict-related trauma (OR 5.57) emerged as significant predictors (p < .05) of general reoffending at any time post release. Similarly, only age (OR .92) and conflict-related trauma (OR 4.57) emerged as significant predictors (p < .05) of violent reoffending. Although it did not reach significance (p = .09), childhood physical abuse was related to an increase in the odds of violently reoffending, of a large magnitude (OR 4.09).ConclusionsConflict-related trauma significantly predicted general and violent reoffending among offenders with previous violent convictions.     

Pathways to delinquent and sex offending behavior: The role of childhood adversity and environmental context in a treatment sample of male adolescents

BackgroundExposure to greater Adverse Childhood Experiences (ACEs) has been associated with increased likelihood of general and sex offending behaviors. However, few studies consider both the impact of varied ACE exposures and other early experiences on pathways to offending behaviors in adolescents who have engaged in sexually abusive behaviors.ObjectiveThe purpose of this study was to examine the impact of ACEs and sexual boundary problems within the home on the development of delinquent and sexually abusive behavior.Participants & settingData were collected from archival records of male adolescents (N = 285) who had received treatment for sexually abusive behavior at a youth facility.MethodsThis study investigated the effects of individual adverse experiences on delinquent nonsexual and sexually abusive behaviors through structural equation modeling.ResultsStructural equation modeling revealed a three-factor model for ACEs. Direction and significance of paths between ACEs and the onset, persistence, and nature of maladaptive behaviors differed. Household dysfunction was related to an earlier onset (β = 1.19, p = 0.013) and more persistent nonsexual delinquent offending (β = 1.05, p = 0.048) and contact sexual offending (β = 1.19, p = 0.010). Conversely, sexual abuse and exposure to sexual boundary problems were associated with an earlier onset of sexually abusive behavior (β = −1.08, p = 0.038) as well as indicators of adolescent-onset (β = −1.30, p = 0.002), less persistent (β = −1.53, p = 0.001), and nonviolent (β = −1.89, p = 0.001) delinquency.ConclusionsFindings suggest variations in ACE exposures differentially influence the onset, severity, and persistence of delinquent and sexually abusive behaviors among these youths.     

Association of adverse childhood experiences with shaking and smothering behaviors among Japanese caregivers

Shaking and smothering in response to infant crying are life-threatening child abuse. Parental childhood abuse history is known to be one of the most robust risk factors for abusing their offspring. In addition to childhood abuse history, other adverse childhood exposures (ACEs) need to be considered due to co-occurrence. However, few studies have investigated the impact of ACEs on caregivers shaking and smothering their infant. This study aims to investigate the association of ACEs with shaking and smothering among caregivers of infants in Japan. A questionnaire was administered to caregivers participating in a four-month health checkup between September 2013 and August 2014 in Chiba City, Japan, to assess their ACEs (parental death, parental divorce, mentally ill parents, witness of intimate partner violence, physical abuse, neglect, psychological abuse and economic hardship), and shaking and smothering toward their infants (N = 4297). Logistic regression analysis was used to examine the cumulative and individual impacts of ACEs on shaking and smothering. Analyses were conducted in 2015. A total of 28.3% reported having experienced at least one ACE during their childhood. We found that only witness of IPV had a significant association with shaking of infant (OR = 1.93, 95% CI: 1.03–3.61). The total number of ACEs was not associated with either shaking or smothering. Our findings suggest that shaking and smothering in response to crying can occur regardless of ACEs. Population-based strategies that target all caregivers to prevent shaking and smothering of infants are needed.     

Parents’ PTSD symptoms and child abuse potential during the perinatal period: Direct associations and mediation via relationship conflict

BackgroundPosttraumatic stress disorder (PTSD) symptoms are associated with parental aggression towards children, but little is known about the relation between parents’ PTSD symptoms and their risk for perpetrating child physical abuse during the early parenting years, when the potential for prevention of abuse may be highest.ObjectiveTo examine direct associations between mothers’ and fathers’ PTSD symptoms and child abuse potential, as well as indirect effects through couple relationship adjustment (i.e., conflict and love) in a high-risk sample of parents during the perinatal period, most of whom were first-time parents.Participants and settingFrom March 2013 to August 2016, data were collected from 150 expecting or new parental dyads in which the mother was participating in a home visiting program.MethodsData were analyzed using the Actor-Partner Interdependence Mediation Model.ResultsFor mothers and fathers, there were direct associations between PTSD symptom severity and child abuse potential (βs = .51, ps <.001), and this association for fathers was stronger at higher levels of mothers’ PTSD symptoms (β = .15, p = .03). In addition, parents’ own and their partners’ PTSD symptoms were each indirectly associated with parents’ own child abuse potential through parents’ report of interparental conflict (standardized indirect effects = .052–.069, ps = .004) but not love.ConclusionsAddressing parents’ PTSD symptoms and relationship conflict during the perinatal period using both systemic and developmental perspectives may uniquely serve to decrease the risk of child physical abuse and its myriad adverse consequences.     

The effects of adult depression on the recollection of adverse childhood experiences

Adverse childhood experiences (ACEs) have been linked to numerous negative physical and mental health outcomes across the lifespan. As such, self-report questionnaires that assess for ACEs are increasingly used in healthcare settings. However, previous research has generated some concern over the reliability of retrospective reports of childhood adversity, and it has been proposed that symptoms of depression may increase recall of negative memories. To investigate the stability of ACE scores over time and whether they are influenced by symptoms of depression, we recruited 284 participants (M age = 40.96, SD = 16.05) from primary care clinics. Participants completed self-report measures of depression and ACEs twice, three months apart. The test-retest reliability of ACEs was very high (r = .91, p < .001). A cross-lagged panel analysis indicated that PHQ-9 scores at Time 1 were not predictive of changes in ACE scores at Time 2 (β = 0.00, p = .96). Results of this study indicate that changes in symptoms of depression do not correspond with changes in ACE scores among adults. This study provides support for the stability and reliability of ACE scores over time, regardless of depression status, and suggests that ACE measures are appropriate for use in healthcare settings.     

Adverse childhood experiences and preschool suspension expulsion: A population study

BackgroundPreschool suspension and expulsion rates are typically based on teacher reports, and don’t simultaneously account for adverse childhood experiences (ACEs).ObjectiveTo examine estimates in the United States of parent-reported preschool suspension and expulsion rates, in the context of ACEs.Participants and settingParents of children aged 3–5 years old (N = 6,100) in the 2016 National Survey of Children’s Health dataset.MethodWe reported the prevalence estimates of preschool suspension and expulsion, and estimated the unique variance of ACEs as risk factors using weighted sequential logistic regression.ResultsAn estimated 174,309 preschoolers (2.0%) were suspended, and 17,248 (0.2%) children were expelled annually. If divided by 36 school weeks, the instances of weekly suspension and expulsion were at least 4,842 and 479 respectively. Controlling for previous risk factors (i.e., age, gender, race, ethnicity), the odds ratio increased by 80% for every unit of ACEs increment. Children were more likely to be suspended or expelled if they had domestic violence (OR = 10.6, p < .001), living with mental illness (OR = 9.8, p < .001), adult substance abuse (OR = 4.8, p < .001), and victim of violence (OR = 4.5, p = .004), living in high poverty (OR = 3.9, p = .001), divorced parents (OR = 3.3, p = .001), and parent incarceration (OR = 3.0, p = .009).ConclusionThe alarming suspension and expulsion rates call for more comprehensive outreach prevention and response efforts in preschool settings. Cross system collaboration and family support are essential to this work.     

Maternal adverse childhood experiences,attachment style,and mental health: Pathways of transmission to child behavior problems

BackgroundInvestigations have found mothers’ adverse childhood experiences (ACEs) confer an intergenerational risk to their children's outcomes. However, mechanisms underlying this transmission have only been partially explained by maternal mental health. Adult attachment insecurity has been shown to mediate the association of ACEs and mental health outcomes, yet an extension of this research to children's behavioral problems has not been examined.ObjectiveTo examine the cascade from maternal ACEs to risk for child behavioral problems at five years of age, via mothers’ attachment insecurity and mental health.Participants and settingParticipants in the current study were 1994 mother-child dyads from a prospective longitudinal cohort collected from January 2011 to October 2014.MethodsMothers retrospectively reported their ACEs when children were 36 months of age. When children were 60 months of age, mothers completed measures of their attachment style, depression and anxiety symptoms, and their children's behavior problems.ResultsPath analysis demonstrated maternal ACEs were associated with children's internalizing problems indirectly via maternal attachment avoidance, attachment anxiety, and depression symptoms, but not directly (β = .05, 95% CI [−.001, .10]). Maternal ACEs indirectly predicted children's externalizing problems via maternal attachment avoidance, attachment anxiety, and depression. A direct effect was also observed from maternal ACEs to child externalizing problems (β = .06, 95% CI [.01, .11]).ConclusionsMaternal ACEs influenced children's risk for poor behavioral outcomes via direct and indirect intermediary pathways. Addressing maternal insecure attachment style and depression symptoms as intervention targets for mothers with histories of ACEs may help to mitigate the intergenerational transmission of risk.     

Emotional abuse in a sample of multiply maltreated,urban young adolescents: Issues of definition and identification

ObjectiveThe main purpose of this paper is to use the Brassard and Donovan [Brassard, M. R. & Donovan, K. L. (2006). Defining psychological maltreatment. In M. M. Freerick, J. F. Knutson, P. K. Trickett, & S. M. Flanzer (Eds.), Child abuse and neglect: Definitions, classifications, and a framework for research (pp. 151–197). Baltimore, MD: Paul H. Brookers Publishing Co., Inc.] framework to examine and describe the nature of emotional abuse experienced by a sample of urban, ethnically diverse male and female youth (N = 303) identified as maltreated by a very large public child welfare agency.MethodsCase record abstraction was conducted on the DCFS records of these maltreated youth using the Maltreatment Case Record Abstraction Instrument (MCRAI) which was based on the work of Barnett et al. [Barnett, D., Manly, J. T., & Cicchetti, D. (1993). Defining child maltreatment: The interface between policy and research. In D. Cicchetti & S. L. Toth (Eds.), Advances in applied developmental psychology: Child abuse, child development and social policy (pp. 7–73). Norwood, NJ: Ablex Publishing Corp.] as modified by English and LONGSCAN [English, D. J., & the LONGSCAN Investigators. (1997). Modified maltreatment classification system (MMCS). Retrieved from http://www.iprc.unc.edu/longscan/]. Fifteen items of parental behavior deemed emotionally abusive were coded and organized into four subtypes of emotional abuse (spurning, terrorizing, isolating, exploiting/corrupting) using the Brassard and Donovan (2006) framework.ResultsUsing this coding system, almost 50% of the sample were found to have experienced emotional abuse in contrast to 9% identified at the time of referral by DCFS. Most of the emotionally abused youth also experienced physical abuse (63%) and/or neglect (76%) as well. The most frequent subtype of emotional abuse experienced was terrorizing. Most youth experienced more than one subtype.ConclusionsEmotional abuse, while frequent, was seldom the focus of the child protection services investigation. The nature of this abuse was not minor, but rather likely to be dangerous to the mental health and well-being of these children. Further more emotional abuse, in this sample of young adolescents, at least, was likely to be accompanied by other forms of maltreatment, especially physical abuse and/or neglect. These findings have important implications for practice and the direction of future research.Practice implicationsAll those who interact with child welfare clients must recognize the prevalence of emotional abuse in maltreated children so that appropriate interventions are instituted. Screening for emotional abuse should be part of all intake referrals and when confirmed should be noted in official records. When children are placed, foster parents (both kin and non-kin) need training on the prevalence and consequences of emotional abuse, and strategies to help their foster children recover from the aftermath. When children remain with maltreating parents, emotional abuse should be a focus of the interventions designed to help maltreating parents with more effective parenting strategies and also should be a focus of the interventions designed to help the child recover from the consequences of maltreatment.     

Outcomes related to adverse childhood experiences in college students: Comparing latent class analysis and cumulative risk

The aims of this study were to identify latent classes of adverse childhood experiences (ACEs) in a large sample of college students (N = 8997), investigate the relations between ACEs classes and life functioning, and compare results using latent class analysis to analyses using cumulative risk scores. Nine types of ACEs were assessed (three types of child abuse and six types of household dysfunction). Outcomes were self-report measures of mental health, physical health, alcohol consequences, and academic performance. Latent class analysis (LCA) results indicated that four classes fit the data best across random halves of the sample and were labeled High ACEs, Moderate Risk of Non-Violent Household Dysfunction, Emotional and Physical Child Abuse, and Low ACEs. Comparing across latent classes, the largest differences in outcomes were between the High ACEs and Low ACEs classes. There were no differences in outcomes between the Moderate Risk of Non-Violent Household Dysfunction and Emotional and Physical Child Abuse classes. The largest between-class differences were found for mental health and the smallest differences were found for academic performance. Comparing results using LCA latent classes and cumulative ACEs scores, the differences between the High and Low ACEs latent classes were similar to the differences between those with zero ACEs and those with 5 or more ACEs. Both approaches also accounted for roughly equivalent amounts of variance in all outcomes. Thus, latent class and cumulative risk analyses provided similar results with regard to predicting outcomes of interest among college students.     

Adverse childhood experiences among Latina women and its association with mastery of stress and health

BackgroundAdverse childhood experience (ACE) and intimate partner violence (IPV) have sustained, deleterious effects on physical and mental health. Few studies have examined how to help Latina survivors of ACEs and/or IPV regain control of their health.ObjectiveTo inform interventions for this population, we examined whether mastery of stress and patient activation mediate the relationship between a history of ACE and/or IPV and mental and physical health.Participants and settingWe recruited 235 Latina women (M age = 29.6, SD = 5.75) from primary care clinics.MethodFor this cross-sectional study, we used linear regressions to examine the association between ACEs, history of IPV, and health, and the sobel’s test to determine whether patient activation and mastery of stress mediated the relationships between ACEs, IPV, and health.ResultsMost women reported at least one ACE (61.7%, n = 137) and 22.2% (n = 55) reported a history of IPV. Mastery of stress mediated the relationship between ACE and physical health (b= -3.16 p = .002) and mental health (b= -3.83, p < .001). Mastery of stress also mediated the relationship between history of IPV and physical health (b= -2.62, p = .008) and mental health (b= -2.74, p = .006). Patient activation was not associated with a history of trauma or mental health.ConclusionWhile past experiences of trauma cannot be changed, results from this study suggest that improving an individual’s mastery of stress may be a point of intervention for improving mental and physical health among survivors of ACEs and IPV.     

A longitudinal investigation of protective factors for bereaved maltreated youth

BackgroundMaltreated youth are at an elevated risk for the development of problem behaviors. Coping with the death of a family member or close friend during adolescence, referred to as bereavement, is a stressful event that could potentiate risk linked to maltreatment. However, developmental research suggests that youth adjustment is a product of multiple risk and protective factors. Although maltreated youth who experience loss may be particularly vulnerable to behavior problems, personal and contextual factors may attenuate or exacerbate youths’ risk for internalizing and externalizing psychopathology.ObjectiveThe overarching goal of this study is to examine individual, family, and community-level protective factors for maltreated youth who experience bereavement. Specifically, we aim to examine the effect of age 12 bereavement on age 16 internalizing and externalizing psychopathology, and to investigate the moderating role of multi-level protective factors at ages 14 and 16.MethodsThe study consisted of a sample of 800 youth (52.4% female, 45.1% African-American) drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), collected from 1998 to 2011.ResultsMaltreated youth who experienced significant loss were at increased risk for externalizing symptoms, compared to non-bereaved maltreated youth (β = 0.085, p < .05). Individual future orientation (β = 0.103, p < .05) family future orientation (β = −0.120, p < .05), parental monitoring (β = −0.123, p< .01), and neighborhood collective efficacy (β = −0.126, p < .01) each significantly moderated the association between bereavement and externalizing symptoms.ConclusionsThese results have implications for future interventions aimed towards reducing problem behaviors in adolescents with a history of child maltreatment and who experience bereavement.     

The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction

OBJECTIVE: Childhood abuse and other adverse childhood experiences (ACEs) have historically been studied individually, and relatively little is known about the co-occurrence of these events. The purpose of this study is to examine the degree to which ACEs co-occur as well as the nature of their co-occurrence. METHOD: We used data from 8,629 adult members of a health plan who completed a survey about 10 ACEs which included: childhood abuse (emotional, physical, and sexual), neglect (emotional and physical), witnessing domestic violence, parental marital discord, and living with substance abusing, mentally ill, or criminal household members. The bivariate relationship between each of these 10 ACEs was assessed, and multivariate linear regression models were used to describe the interrelatedness of ACEs after adjusting for demographic factors. RESULTS: Two-thirds of participants reported at least one ACE; 81%-98% of respondents who had experienced one ACE reported at least one additional ACE (median: 87%). The presence of one ACE significantly increased the prevalence of having additional ACEs, elevating the adjusted odds by 2 to 17.7 times (median: 2.8). The observed number of respondents with high ACE scores was notably higher than the expected number under the assumption of independence of ACEs (p <.0001), confirming the statistical interrelatedness of ACEs. CONCLUSIONS: The study provides strong evidence that ACEs are interrelated rather than occurring independently. Therefore, collecting information about exposure to other ACEs is advisable for studies that focus on the consequences of a specific ACE. Assessment of multiple ACEs allows for the potential assessment of a graded relationship between these childhood exposures and health and social outcomes.     

The relationship between adverse childhood experiences,healthcare utilization,cost of care and medical comorbidities

BackgroundPrior research suggests that those experiencing adverse childhood experiences (ACEs) may be higher utilizers of the healthcare system. The frequency and financial impact of kept, cancelled and no-showed visits is largely unknown.ObjectiveTo examine the impact of adverse childhood experiences (ACEs) on healthcare utilization in a sample of US adults.Participants and SettingTwo thousand thirty-eight adult patients who completed an ACE screening within the behavioral health department of a medium sized, Midwestern healthcare system during 2015–2017 were included.MethodsData was extracted retrospectively from 1-year post ACE screen.ResultsIndividuals with high ACEs (4+) made more but kept fewer appointments than those with no or moderate (1–3) ACEs (p < 0.0001). Individuals with high ACES had more late-cancelled and no-showed appointments compared to those with no ACEs (p’s < .0001). Relationships were significant even after controlling for age, gender, and insurance type. 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 care coordinator than those with moderate or no ACEs (p’s < .05)ConclusionsResults from this study should be used to inform providers and health care systems on the effects of adversity on patterns of utilization of health care and encourage innovative strategies to better address the needs of these patients.     

Life as she knows it: The effects of adverse childhood experiences on intimate partner violence among women prisoners

Most incarcerated women suffer from adverse childhood experiences (ACEs), such as abuse (e.g., physical, sexual, emotional), neglect, (e.g., physical, emotional), and chaotic home environments (e.g., witnessing domestic violence), and adult intimate partner violence (IPV). Yet the majority of research on the relationship between ACEs and IPV has been limited to non-incarcerated populations. Using data from a stratified random sample of all incarcerated women in Oklahoma (n = 355), we explore the relationships between individual, cumulative, and clusters of ACEs as they relate to multiple forms of IPV in adulthood utilizing a feminist life course theory approach. Our findings indicate that individual ACEs, high accumulation of ACEs (five or more), and clusters of ACEs are linked to simple assault, aggravated assault, sexual abuse, and psychological abuse in adult intimate relationships in the pre-prison lives of women prisoners suggesting strong support for the use of a feminist life course theory approach in understanding these relationships.