Bidirectional Relations between Adverse Childhood Experiences and Children’s Behavioral Problems

Child and Adolescent Social Work Journal - Research has shown that adverse childhood experiences (ACEs) increase the risk of poor health and well-being, yet less is known about the pathways through...     

Exposure to abuse, neglect, and household dysfunction among adults who witnessed intimate partner violence as children: implications for health and social services

Intimate partner violence (IPV) damages a woman's physical and mental well-being, and indicates that her children are likely to experience abuse, neglect and other traumatic experiences. Adult HMO members completed a questionnaire about adverse childhood experiences (ACEs) including childhood abuse, neglect, and household dysfunction. We used their responses to retrospectively assess the relationship between witnessing intimate partner violence and experiencing any of the 9 ACEs and multiple ACEs (ACE score). Compared to persons who grew up with no domestic violence, the adjusted odds ratio for any individual ACE was approximately two to six times higher if IPV occurred (p < 0.05). There was a powerful graded increase in the prevalence of every category of ACE as the frequency of witnessing IPV increased. In addition, the total number of ACEs was increased dramatically for persons who had witnessed IPV during childhood. There was a positive graded risk for self-reported alcoholism, illicit drug use, i.v. drug use and depressed affect as the frequency of witnessing IPV increased. Identification of victims of IPV must include screening of their children for abuse, neglect and other types of adverse exposures, as well as recognition that substance abuse and depressed affect are likely consequences of witnessing IPV. Finally, this data strongly suggest that future studies, which focus on the effect of witnessing IPV on long-term health outcomes, may need to take into consideration the co-occurrence of multiple ACEs, which can also affect these outcomes.     

Examining exposure to adverse childhood experiences and later outcomes of poor physical and mental health among South Carolina adults

Recent research on adverse childhood experiences (ACEs) has used factor analysis to categorize ACEs. Further research is needed to determine if these previously identified factors are related to specific health outcomes. Using data obtained from the 2014–2015 South Carolina Behavioral Risk Factor Surveillance System, this study assessed the association between categories (household dysfunction; emotional and physical abuse; sexual abuse) and combinations of categories of ACEs on mental and physical health outcomes in adulthood (n = 15,638). Respondents who had all three categories of abuse were much more likely to report poor health and mental distress. Sexual abuse in childhood increased the odds of reporting poor health and mental distress; some ACEs may have stronger associations to long term health than others. These findings can help lead to effective and targeted prevention or intervention strategies that incorporate the new insight on the combination of ACE categories that are likely to co-occur.     

Examining Racial Differences in Internalizing and Externalizing Diagnoses for Children Exposed to Adverse Childhood Experiences

Clinical Social Work Journal - A substantial evidence base has established both that adverse childhood experiences (ACEs) deleteriously impact youth mental health outcomes and that racial biases in...     

Adverse Childhood Experiences and Grade Retention in a National Sample of US Children*

Adverse childhood experiences (ACEs) include extreme economic hardship, abuse, neglect, household and family dysfunction, and exposure to community violence. Children with ACEs are at a higher risk of developing mental, physical, and developmental disorders that can lead to difficulty in school. Using the 2012 National Survey of Children's Health, we use multivariate logistic regression to examine the association between ACEs and grade retention and the moderating effects of race/ethnicity on this relationship. Results indicate that specific ACEs are related to higher rates of grade retention (economic hardship, parental incarceration, neighborhood violence, and witnessing domestic violence). Children reporting three or more ACEs were at a significantly higher risk of grade retention compared to children with zero reported ACEs. Further, patterns differed among black children in the sample with higher numbers of ACEs not increasing retention rates for black children compared to white children. This study improves our understanding of the relationship between ACEs and grade retention, but also raises questions about differing patterns among racially and ethnically diverse student populations that warrants further study.     

Direct and Indirect Pathways From Adverse Childhood Experiences to High School Dropout Among High‐Risk Adolescents

Adverse childhood experiences (ACEs) are associated with an increased risk for school dropout. This study examined pathways from childhood adversity to school dropout through academic, behavioral, emotional, and social pathways. Data were collected prospectively from 728 adolescents and their caregivers who participated in the Longitudinal Studies of Child Abuse and Neglect and from child protective services records. Path analyses revealed a direct association between ACEs and dropout, as well as indirect effects through poor reading achievement and elevated externalizing problems. ACEs were associated with elevated internalizing problems, which were negatively associated with dropout. However, ACEs were not associated with peer influences. Implications of the identified mechanisms in the ACEs and school dropout association for future preventive interventions are discussed.     

Adverse Childhood Experiences and Disordered Gambling: Assessing the Mediating Role of Emotion Dysregulation

Adverse childhood experiences (ACEs), such as sexual and physical abuse, have been established as risk factors for the development of disordered gambling. The underlying mechanism by which ACEs influence disordered gambling, however, remains unknown. The aims of the present research were to comprehensively investigate ten types of childhood adversity and their relationships to disordered gambling in adulthood, and to test whether emotion dysregulation mediated the relationship between ACEs and disordered gambling. A sample of community gamblers (N = 414) completed self-report measures of ACEs, emotion dysregulation, and gambling severity. Results revealed a significant association between all but one type (physical abuse) of ACEs and disordered gambling. Further, the results highlighted the cumulative impact of ACEs on gambling. Specifically, individuals who experienced three or more types of ACEs were more than three times as likely to report disordered gambling as compared to individuals with no history of childhood adversity. Importantly, as hypothesized, emotion dysregulation mediated the relationship between ACEs and disordered gambling. Findings from this research describe the association between ACEs and gambling and indicate a causal link between childhood adversity and disordered gambling. Results suggest that treatment initiatives may do well to address both ACEs and emotion dysregulation in the treatment of problem gambling.     

A multivariate analysis of adverse childhood experiences and health behaviors and outcomes among college students

Objective: This study investigated associations between adverse childhood experiences (ACE) prior to age 18 years and multiple health behaviors (eg, cigarette and other substance use) and outcomes (eg, obesity, depression) for a large college sample. Participants: 2,969 college students from seven universities in the state of Georgia were included in the analysis. Methods: Web-based surveys were completed by students (45–60 minutes) during the spring semester, 2015. Results: Findings indicate that more ACEs are associated with higher levels of depressive symptoms, ADHD symptoms, cigarette use, alcohol use, marijuana use, and BMI, in addition to lower levels of fruit and vegetable intake, and sleep. Conclusion: ACEs may carry forward in the lifespan to influence a range of unhealthy outcomes among college students. College intervention programs may benefit by recognizing the pervasiveness of ACEs and their associations with health behaviors and outcomes, and include interventions across more than one health behavior.     

Pressure to Attend Therapy,Dyadic Adjustment,and Adverse Childhood Experiences: Direct and Indirect Effects on the Therapeutic Alliance in Couples Therapy

In this study we examine the role that pressure to attend therapy, dyadic adjustment, and adverse childhood experiences (ACEs) play in developing the therapeutic alliance. A total of 351 couples received treatment as usual at three family therapy training clinics. Participants rated predictor variables at intake and alliance at the fourth session. Results of a path analysis indicate that each partner's dyadic adjustment is directly associated with the quality of her or his own alliance. In addition, when male partners report more ACEs and pressure to attend treatment, their own alliance scores decrease. Additionally, when one partner reports feeling pressure to attend therapy, the other partner's alliance decreases. Finally, for males, there is an indirect effect of dyadic adjustment on alliance through pressure to attend therapy. These results suggest that clinicians should routinely assess relationship adjustment, how pressured each partner is feeling to attend treatment, and ACEs; as these may impact alliance quality.     

Adverse childhood experiences and life opportunities: Shifting the narrative

Substantial research shows that early adversity, including child abuse and neglect, is associated with diminished health across the life course and across generations. Less well understood is the relationship between early adversity and adult socioeconomic status, including education, employment, and income. Collectively, these outcomes provide an indication of overall life opportunity. We analyzed data from 10 states and the District of Columbia that used the adverse childhood experiences (ACE) module in the 2010 Behavioral Risk Factor Surveillance System to examine the association between ACEs and adult education, employment, and income. Compared to participants with no ACEs, those with higher ACE scores were more likely to report high school non-completion, unemployment, and living in a household below the federal poverty level. This evidence suggests that preventing early adversity may impact health and life opportunities that reverberate across generations. Current efforts to prevent early adversity might be more successful if they broaden public and professional understanding (i.e., the narrative) of the links between early adversity and poverty. We discuss our findings within the context of structural policies and processes that may further contribute to the intergenerational continuity of child abuse and neglect and poverty.     

Adolescents in residential treatment: The prevalence of ACEs,substance use and justice involvement

Abstract

Although associations between developmental trauma, juvenile justice involvement and youth substance use have been previously reported in the published literature, the interconnection among these three factors has not been adequately studied. This article describes the interconnection among these three factors and calls for greater attention to the role of adverse childhood experiences (ACEs) in the diagnosis and treatment of youth who present with histories of substance use and/or offending behavior. Pilot data are presented that show high rates of self-reported trauma exposure, substance use history, justice involvement, and mental health problems in a sample of adolescents in residential treatment. The data point to the need for residential treatment centers to consider trauma histories in developing treatment plans for youth with current and prior substance use and offending behavior.     

Adverse childhood experiences,post-traumatic stress disorder symptoms,and self-reported stress among traditional and nontraditional college students

Abstract

Objective: To investigate the relationships between adverse childhood experiences (ACEs), post-traumatic stress disorder symptoms (PTSD-S), and self-reported stress among college students. Participants: A total of 236 undergraduate students enrolled in nursing courses participated. Method: Using a correlational design, participants completed questionnaires online. To examine PTSD moderation between ACE and self-reported stress, multiple regression was employed. Stress outcomes were examined using a 4-group variable. Mean differences in stress response between these four groups were examined. Differences in ACE, PTSD-S, and stress response between traditional and nontraditional students were also examined. Results: PTSD-S moderated the relationship between ACEs, and self-reported stress. This indicates that students who report PTSD-S following childhood adversity perceive higher levels of stress. Nontraditional and traditional students differed in their responses to the ICLRE scale. Conclusion: Individuals who report PTSD-S following childhood adversity perceive higher levels of stress later in life. Stress reduction programs may be beneficial for students.     

To reduce stigma,describing ACEs is better than “words matter”: Study

“Words matter” is the refrain of anti‐stigma proponents in the United States, who state that person‐first language will improve attitudes toward drug users. But a recent study conducted in the U.K. has found that portraying people as having adverse childhood experiences (ACEs) does far more to reduce stigma than changing language, which does nothing.     

Lemonade for Life—A pilot study on a hope-infused,trauma-informed approach to help families understand their past and focus on the future

The Adverse Childhood Experiences' (ACEs) research provided groundbreaking evidence that events that occur early in life can impede core life capabilities and lead to significant negative social, behavioral, and physical outcomes. While the research is widely known, the translation and application for use with families has been lacking. In response to this gap, Lemonade for Life was developed to help professionals who work directly with families understand how to use the ACEs research as a tool to build hope and resilience. A developmental evaluation was conducted to learn about how Lemonade for Life participants integrate ACEs in their work with families, as well as whether and how the Lemonade for Life training and materials influenced their work. Focus group and survey data were collected from 24 home visitors and parent educators and parent educators, who participated in a Lemonade for Life training. Findings indicate that Lemonade for Life may be a useful tool for translating ACEs research into practice with families. Participants perceived that following the integration of what they learned through Lemonade for Life into their work, the families they served were more engaged in services and better able to understand their past experiences and current life circumstances. Results suggest a continued need to assess and focus on the hope and mindset of professionals who work directly with families to optimize opportunities for change.     

Healing from childhood sexual abuse: a theoretical model

Childhood sexual abuse is a prevalent social and health care problem. The processes by which individuals heal from childhood sexual abuse are not clearly understood. The purpose of this study was to develop a theoretical model to describe how adults heal from childhood sexual abuse. Community recruitment for an ongoing broader project on sexual violence throughout the lifespan, referred to as the Sexual Violence Study, yielded a subsample of 48 women and 47 men who had experienced childhood sexual abuse. During semistructured, open-ended interviews, they were asked to describe their experiences with healing from childhood sexual abuse and other victimization throughout their lives. Constructivist grounded theory methods were used with these data to develop constructs and hypotheses about healing. For the Sexual Violence Study, frameworks were developed to describe the participants' life patterns, parenting experiences, disclosures about sexual violence, spirituality, and altruism. Several analytic techniques were used to synthesize the findings of these frameworks to develop an overarching theoretical model that describes healing from childhood sexual abuse. The model includes four stages of healing, five domains of functioning, and six enabling factors that facilitate movement from one stage to the next. The findings indicate that healing is a complex and dynamic trajectory. The model can be used to alert clinicians to a variety of processes and enabling factors that facilitate healing in several domains and to guide discussions on important issues related to healing from childhood sexual abuse.     

Healing from Childhood Sexual Abuse: A Theoretical Model

Childhood sexual abuse is a prevalent social and health care problem. The processes by which individuals heal from childhood sexual abuse are not clearly understood. The purpose of this study was to develop a theoretical model to describe how adults heal from childhood sexual abuse. Community recruitment for an ongoing broader project on sexual violence throughout the lifespan, referred to as the Sexual Violence Study, yielded a subsample of 48 women and 47 men who had experienced childhood sexual abuse. During semistructured, open-ended interviews, they were asked to describe their experiences with healing from childhood sexual abuse and other victimization throughout their lives. Constructivist grounded theory methods were used with these data to develop constructs and hypotheses about healing. For the Sexual Violence Study, frameworks were developed to describe the participants' life patterns, parenting experiences, disclosures about sexual violence, spirituality, and altruism. Several analytic techniques were used to synthesize the findings of these frameworks to develop an overarching theoretical model that describes healing from childhood sexual abuse. The model includes four stages of healing, five domains of functioning, and six enabling factors that facilitate movement from one stage to the next. The findings indicate that healing is a complex and dynamic trajectory. The model can be used to alert clinicians to a variety of processes and enabling factors that facilitate healing in several domains and to guide discussions on important issues related to healing from childhood sexual abuse.     

Long‐Term Physical Health Consequences of Adverse Childhood Experiences

This study examined associations between adverse childhood family experiences and adult physical health using data from 52,250 U.S. adults aged 18 to 64 from the 2009 to 2012 Behavioral Risk Factor Surveillance System. We found that experiencing childhood physical, verbal, or sexual abuse, witnessing parental domestic violence, experiencing parental divorce, and living with someone who was depressed, abused drugs or alcohol, or who had been incarcerated were associated with one or more of the following health outcomes: self‐rated health, functional limitations, diabetes, and heart attack. Adult socioeconomic status and poor mental health and health behaviors significantly mediated several of these associations. The results of this study highlight the importance of family‐based adverse childhood experiences on adult health outcomes and suggest that adult socioeconomic status (SES) and stress‐related coping behaviors may be crucial links between trauma in the childhood home and adult health.     

Childhood Maltreatment,Bullying Victimization,and Psychological Distress Among Gay and Bisexual Men

Sexual minority men report higher psychological distress than heterosexual men, including depression and anxiety. Research suggests that these health disparities may be due to the heightened stressors that gay, lesbian, and bisexual individuals experience. Some of these stressors occur early on in life, such as childhood abuse and bullying, and may include stressors that are topically related to sexual minority status, such as anti-gay bullying and teasing for gender nonconformity to masculine gender norms. We tested a structural equation model on the association between negative childhood experiences and adult psychological distress among 304 gay and bisexual men. The model fit the data well, and demonstrated an indirect effect of negative childhood experiences on adult psychological distress via dysfunctional thoughts toward oneself. The results integrate the childhood abuse and anti-gay bullying victimization literatures by showing that both forms of adverse childhood experiences are associated with adult psychological distress. The findings suggest the benefit of treatments to reduce negative, dysfunctional thoughts among gay and bisexual men who have experienced adverse childhood events.     

Negotiating narratives surrounding children's mental health diagnoses: Children and their contribution to the discourse

Despite increasing numbers of children diagnosed with mental health disorders, there is limited research on how children come to understand these diagnoses in childhood. This study examines the retrospective accounts of emerging adults who were diagnosed with mental health disorders in childhood to better understand how they made sense of their diagnoses over time. In-depth, semi-structured interviews were conducted with 42 emerging adults (ages 18 to 22) who were diagnosed with attention deficit hyperactivity disorder (ADHD), depression, generalized anxiety disorder (GAD), and/or bipolar disorder in childhood. Interviews elicited participants' experiences learning about their diagnoses and suggestions for how diagnoses should best be explained to children. Findings demonstrate that participants actively sought and obtained information about their diagnoses over time. They negotiated narratives from several sources, including parents, teachers, mental health professionals, peers, siblings, the media, reading materials, and the Internet. Many of those who embraced medical accounts of their diagnoses did so as they obtained in-depth medical information over time. Meanwhile, those whose parents were open and communicative without using medical narratives suggest it is possible to share information with children without utilizing the terminology of “disorder.” Participants emphasize the importance of being open with children and providing them assurances, explaining that their problems are legitimate, common, and “not their fault.” Implications for social work practice are discussed.