Adverse Childhood Experiences and Mental Health, Chronic Medical Conditions, and Development in Young Children

Adverse childhood experiences, brain efficiency, and the development of pain symptoms in youth

BACKGROUND

Adverse childhood experiences (ACEs) are often reported by youths with chronic pain, and both ACEs and chronic pain disrupt how information is processed. However, it is unknown whether changes to shared neural networks underlie the relationship between ACEs and the development of pain symptoms. This study explored the relationships between ACEs, brain efficiency, and pain symptomology in youth.

METHODS

A community sample of youths aged 14-18 years underwent MRIs, answered trauma and pain questionnaires, and underwent pain sensory testing, twice, 3 months apart (Nbaseline = 44; Nfollow-up = 42). Sensory testing determined thresholds for mechanical and thermal stimuli. Global and local network efficiencies were evaluated using graph theory. Generalized estimating equations were applied to examine whether brain efficiency moderated the relationships between ACEs, pain intensity, and pain sensitivity (i.e., mechanical detection, heat pain, and temperature change thresholds).

RESULTS

There was a significant interaction between ACEs and global brain efficiency in association with pain intensity (β = -0.31, p = 0.02) and heat pain (β = -0.29, p = 0.004). Lower global brain efficiency exacerbated the relationship between ACEs and pain intensity (θX → Y|W = -1.16 = 0.37, p = 0.05), and heat pain sensitivity (θX → Y|W = -1.30 = 0.44, p = 0.05). Higher global brain efficiency ameliorated the relationship between ACEs and pain intensity (θX → Y|W = 1.75 = -0.53, p = 0.05).

CONCLUSIONS

The relationship between ACEs and pain symptomology was comparable to chronic pain phenotypes (i.e., higher pain intensity and pain thresholds) and may vary as a function of brain efficiency in youth. This stresses the importance of assessing for pain symptoms in trauma-exposed youth, as earlier identification and intervention are critical in preventing the chronification of pain.

SIGNIFICANCE

This article explores the relationship between ACEs, pain symptomology, and brain efficiency in youth. ACEs may affect how the brain processes information, including pain. Youths with lower brain efficiencies that were exposed to more ACEs have pain symptomology comparable to youths with chronic pain. Understanding this relationship is important for the earlier identification of pain symptoms, particularly in vulnerable populations such as youths exposed to trauma, and is critical for preventing the chronification of pain.

Shared decision-making, anxiety, and post-traumatic growth among parents in the context of their child's medical care: The moderating role of parental style

AIM

The importance of parents' involvement in their child's medical care has been extensively discussed in the literature, and studies have indicated the need to expand the active role of parents in decision-making processes regarding such care. However, parents' actual wish to be active and informed in this context remains underexplored. The aim of the current study was to explore this gap by investigating the association between parents' shared decision-making (SDM) experience and their well-being during the course of their child's medical care, with a focus on parents' clinical decision-making style as a possible moderator.

METHOD

A total of 150 parents of children under the age of 18, who utilized various medical care services, participated in the study.

RESULTS

Shared decision-making was found to be associated with parents' anxiety levels during their child's medical treatment, as well as with their post-traumatic growth (PTG). A moderating effect of clinical decision-making style was also found; namely, the relations between SDM, anxiety during the child's treatment, and PTG were different among parents with a passive style than among parents with a shared-active style.

CONCLUSIONS

The findings emphasize the personalized nature of SDM, suggesting that its benefits are associated with parental preferences and attitudes. Healthcare professionals should assess parents' actual desire to be involved in SDM in order to tailor services effectively.

Cognitive and affective links between childhood adversity and psychological adjustment in emerging adults with chronic medical conditions

OBJECTIVE

Childhood adversity has been linked to poor psychological adjustment and decreased emotion regulation (ER) abilities. The extended process model of ER outlines the pivotal role of cognitive appraisals in the generation and expression of emotion as well as the pursuit of ER. The aim of the current study is to examine whether illness-related cognitive appraisals (i.e., illness uncertainty and illness intrusiveness) and emotion dysregulation serially mediate the relationship between childhood adversity and psychological adjustment for emerging adults with chronic medical conditions (CMCs).

METHODS

Participants included 557 undergraduate college students (Mage= 19.53 years, SD = 1.34) enrolled in a Midwestern public university with self-reported CMCs. Participants completed measures of adverse childhood experiences (ACEs), illness uncertainty, illness intrusiveness, emotion dysregulation, anxious symptoms, and depressive symptoms. A path analysis was conducted examining ACEs → cognitive appraisals (i.e., illness uncertainty, illness intrusiveness) → emotion dysregulation → depressive and anxious symptoms.

RESULTS

The overall model was significant and predicted 63.5% of the variability in anxious symptoms and 60.2% of the variability in depressive symptoms. All anticipated direct and indirect paths were significant.

CONCLUSIONS

The current study indicates that greater childhood adversity is indeed associated with negative appraisals of one's CMC, such as greater perceived uncertainty and intrusiveness. Negative illness-related cognitive appraisals thus may limit one's ability to effectively employ adaptive strategies to regulate emotions, which could contribute to greater depressive and anxious symptoms.

Developing Pre-Implementation Strategies for a Co-Designed, Technology-Assisted Parenting Intervention Using the Consolidated Framework for Implementation Research (CFIR) and Expert Recommendations for Implementing Change (ERIC) Approach

BACKGROUND

Adverse childhood experiences (ACEs) are a major risk factor for mental disorders in children. Parenting interventions can mitigate the impact of family-level ACEs and subsequently improve young people's mental health. However, a substantial research-to-practice gap hinders access to, and uptake of, available interventions.

AIM

This study aimed to develop actionable strategies to support the implementation of an evidence-based, co-designed, technology-assisted parenting intervention by understanding potential barriers and facilitators from the perspectives of service providers working with families of children experiencing ACEs.

METHODS

We conducted one-on-one interviews with 14 staff at a community health service (six managers, eight service providers). A theoretical thematic analysis was used. The Consolidated Framework for Implementation Research (CFIR) guided the data collection and analysis of barriers and facilitators. Pre-implementation strategies were informed by The Expert Recommendations for Implementing Change (ERIC) compilation. The CFIR-ERIC matching tool was used to match the CFIR barriers identified by participants in this study with ERIC strategies to overcome these barriers.

RESULTS

Fourteen CFIR constructs were identified as facilitators, and eleven as barriers. By using the CFIR-ERIC tool, eleven strategies to mitigate the barriers were identified. Most strategies were aligned to the ERIC clusters Use evaluative and iterative strategies (n = 4) and Develop stakeholder interrelationships (n = 3).

CONCLUSIONS

The CFIR-ERIC approach offered relevant and concise pre-implementation strategies for addressing potential barriers to implementing a novel, co-designed, technology-assisted parenting intervention for parents of children with ACEs. The identified facilitators support the utility of co-designing interventions as an initial phase in bridging research-to-practice gaps. Healthcare settings aiming to innovate services with technology-assisted parenting interventions to improve child mental health can draw on findings from the current study to guide pre-implementation plans for innovative, technology-assisted parenting interventions to improve child mental health.

Embedding Technology-Assisted Parenting Interventions in Real-World Settings to Empower Parents of Children With Adverse Childhood Experiences: Co-Design Study

BACKGROUND

Adverse childhood experiences are strongly associated with mental disorders in young people. Parenting interventions are available through community health settings and can intervene with adverse childhood experiences that are within a parent's capacity to modify. Technology can minimize common barriers associated with engaging in face-to-face parenting interventions. However, families experiencing adversity face unique barriers to engaging with technology-assisted parenting interventions. Formative research using co-design methodology to provide a deep contextual understanding of these barriers can help overcome unique barriers and ensure these families can capitalize on the benefits of technology-assisted parenting interventions.

OBJECTIVE

This study aims to innovate the parenting support delivered by a community health and social service with technology by adapting an existing, evidence-based, technology-assisted parenting intervention.

METHODS

Staff (n=3) participated in dialogues (n=2) and co-design workshops (n=8) exploring needs and preferences for a technology-assisted parenting intervention and iteratively developing a prototype intervention (Parenting Resilient Kids [PaRK]-Lite). Parents (n=3) received PaRK-Lite and participated in qualitative interviews to provide feedback on their experience and PaRK-Lite's design.

RESULTS

PaRK-Lite's hybrid design leverages simple and familiar modes of technology (podcasts) to deliver intervention content and embeds reflective practice into service provision (microcoaching) to enhance parents' empowerment and reduce service dependency. A training session, manuals, session plans, and templates were also developed to support the delivery of microcoaching. Feedback data from parents overall indicated that PaRK-Lite met their needs, suggesting that service providers can play a key role in the early phases of service innovation for parents.

CONCLUSIONS

The co-designed technology-assisted parenting intervention aims to offer both parents and clinicians a novel and engaging resource for intervening with maladaptive parenting, contributing to efforts to respond to childhood adversity and improve child mental health. Future research in the field of human-computer interaction and health service design can consider our findings in creating engaging interventions that have a positive impact on the well-being of children and families.

The associations between adverse childhood experiences and body pain among middle-aged and older adults: findings from China

BACKGROUND

Adverse Childhood Experiences (ACEs) have been implicated in the development of body pain, yet research on their impact on body pain and its progression remains scarce. This study aimed to examine the associations between ACEs and the presence and areas of body pain, as well as their developmental trajectories among middle-aged and older Chinese adults.

METHODS

We included participants aged 45 years and above from the China Health and Retirement Longitudinal Study (CHARLS) conducted between 2011 and 2018. Retrospective data on ACEs and pain sites were collected with questionnaires. The presence of pain at different body sites was categorized into three areas: head & neck, trunk, and limbs. ACEs consisted of ten types of adverse experiences and were cumulatively scored. For the cross-sectional analysis (2011), logistic regressions were performed to estimate the associations between ACEs and pain presence in specific areas. In the longitudinal analysis (2011-2018), we further applied group-based trajectory modelling (GBTM) to determine the developmental trajectories of body pain. Multinomial logistic regressions were then conducted to estimate the associations between ACEs and pain trajectories.

RESULTS

In the cross-sectional analysis (n = 8157), ACEs were positively associated with the presence of pain in the head & neck (odds ratio [OR] = 3.55, 95% confidence intervals [CI] = 2.37-4.74), trunk (OR = 3.28, 95% CI = 2.47-4.34), and limbs areas (OR = 2.30, 95% CI = 1.77-3.00) compared to no ACEs. These associations varied by sex and residence. In the longitudinal analysis (n = 5188), GBTM identified three developmental trajectories of body pain (n = 9521): high-increasing (7.44%), low-moderate (33.67%) and maintained-low trajectories (58.89%) trajectories. Compared to participants without ACEs, individuals had three ACEs and 4 or more ACEs were consistently associated with low-moderate (three ACEs: OR = 2.26, 95% CI = 1.81-2.83, four or more ACEs: OR = 3.11, 95% CI = 2.51-3.87) and high-increasing (three ACEs: OR = 3.28, 95% CI = 2.03-5.30, four or more ACEs: OR = 6.78, 95% CI = 4.30-10.68) body pain trajectories across sexes and residence.

CONCLUSION

This study highlighted the significant association between ACEs and body pain among middle-aged and older Chinese, emphasizing the importance of preventing or mitigating ACEs as a strategy for the prevention and management of body pain.

Preliminary Evidence for Neuronal Dysfunction Following Adverse Childhood Experiences: An Investigation of Salivary MicroRNA Within a High-Risk Youth Sample

Background/Objectives: Adverse childhood experiences (ACEs) are potent drivers of psychopathology and neurological disorders, especially within minoritized populations. Nonetheless, we lack a coherent understanding of the neuronal mechanisms through which ACEs impact gene expression and, thereby, the development of psychopathology. Methods: This observational pilot study used a novel marker of neuronal functioning (brain-derived micro ribonucleic acids, or miRNAs) collected via saliva to explore the connection between ACEs and neuronal gene expression in 45 adolescents with a collectively high ACE exposure (26 males and 19 females of diverse races/ethnicities, with six cumulative ACEs on average). We aimed to determine the feasibility of using salivary microRNA for probing neuronal gene expression with the goal of identifying cellular processes and genetic pathways perturbed by childhood adversity. Results: A total of 274 miRNAs exhibited reliable salivary expression (raw counts > 10 in > 10% of samples). Fourteen (5.1%) were associated with cumulative ACE exposure (p < 0.05; r's ≥ 0.31). ACE exposure correlated negatively with miR-92b-3p, 145a-5p, 31-5p, and 3065-5p, and positively with miR-15b-5p, 30b-5p, 30c-5p, 30e-3p, 199a-3p, 223-3p, 338-3p, 338-5p, 542-3p, and 582-5p. Most relations remained significant after controlling for multiple comparisons and potential retrospective bias in ACE reporting for miRNAs with particularly strong relations (p < 0.03). We examined KEGG pathways targeted by miRNAs associated with total ACE scores. Results indicated putative miRNA targets over-represented 47 KEGG pathways (adjusted p < 0.05) involved in neuronal signaling, brain development, and neuroinflammation. Conclusions: Although preliminary and with a small sample, the findings represent a novel contribution to the understanding of how childhood adversity impacts neuronal gene expression via miRNA signaling.

Child maltreatment in a high adversity context: Associations of age, type and timing of exposure with psychopathology in middle childhood

BACKGROUND

While cumulative childhood maltreatment (CM) has been linked to psychopathological outcomes, recent studies point to the relevance of the type and timing of exposure. The aim of the current study was to better understand their importance beyond the cumulative burden of CM for psychopathological symptoms in middle childhood.

METHODS

A total of N = 341 children (M = 9.92, SD = 1.51) were interviewed to assess trauma load (UCLA - University of California at Los Angeles Event List), exposure to CM (pediMACE - Maltreatment and Abuse Chronology of Exposure - Pediatric Interview) and different outcomes of psychopathology (UCLA Posttraumatic Stress Disorder Reaction Index, Children's Depression Inventory (CDI), Strengths and Difficulties Questionnaire (SDQ). We employed conditioned random forest regression, incorporating type, timing, and cumulative indicators of CM, to assess the importance of each predictor simultaneously.

RESULTS

Exposure to CM (abuse, neglect and cumulative indicators) exhibited a robust association with psychopathological outcomes. Recent abuse and recent neglect showed most robust associations with outcomes, neglect was stronger related to internalizing problems and timing of exposure showed clear associations with diverse pathological outcomes.

CONCLUSION

Beyond the cumulative burden, type and timing of CM show direct and diverse associations to pathological outcomes in middle childhood. Our results highlight the critical importance of early and detailed identification of CM, particularly recent exposure. This finding is valuable for researchers and clinicians, as it can refine diagnostic assessments and pave the way for effective early intervention strategies for affected children.

Intergenerational transmission of adverse and positive childhood experiences and associations with child well-being

BACKGROUND

Parental adverse childhood experiences (ACEs) contribute to offspring adversity and poor health outcomes, but little is known about whether and to what extent parental positive childhood experiences (PCEs) influence offspring positive experiences and well-being.

OBJECTIVE

To investigate the association between parent and child ACEs and PCEs and their impact on child well-being and psychopathology.

PARTICIPANTS AND SETTING

A national sample of n = 1016 US parents of 1-5-year-olds completed online surveys in September 2019.

METHODS

Mediation analysis in a path modeling framework was used with stratified probability weights for generalizability to the US population.

RESULTS

Each additional parent PCE equated to 0.32 (95 % CI: 0.20, 0.45) increase in child PCEs and each additional parent ACE equated to 0.18 (95 % CI: 0.06, 0.31) increase in child PCEs and 0.13 (95 % CI: 0.08, 0.18) increase in child ACEs. In turn, an increase in 1 child PCE was associated with 0.10-0.16 SD increase in well-being and 0.06-0.10 decrease in psychopathology, and each additional child ACE equated to 0.10-0.18 SD increase in psychopathology.

CONCLUSIONS

Results support the intergenerational transmission of PCEs and ACEs, advancing understanding of the role that parent PCEs play in promoting child PCEs and fostering child well-being. Findings underscore the importance of extending clinical surveillance of ACEs to include PCEs in pediatric and adult healthcare settings. Dual-generation programs that address the negative consequences of parental ACEs may be able to increase their impact by adding a parallel emphasis on PCEs and providing parents with tools to foster PCEs in their children.

Age, Adverse Childhood Experiences, and Health Care Utilization

OBJECTIVES

To assess whether the association of adverse childhood experiences (ACEs) with pediatric health care utilization differs by age.

METHODS

In this retrospective cohort study, we included patients completing primary care ACEs screening between January 2020 and September 2021. Pediatric ACEs and Related Life Events Screener Part 1 scores were categorized 0, 1 to 3, or ≥4 (none, low, and high, respectively). Two multivariable logistic regression models assessed emergency department (ED) and inpatient utilization across all ages 6 months after screening.

RESULTS

Among 37 315 patients, 15.7% visited the ED and 2.5% were hospitalized within 6 months of ACEs screening. Using no ACEs as the reference, infants and toddlers with any ACEs had lower odds of ED and inpatient utilization, whereas older children with any ACEs had higher odds of ED (age-low ACEs: 0.04, P value < .001; age-high ACEs: 0.08, P value < .001) and inpatient (age-low ACEs: 0.06, P value < .001; age-high ACEs: 0.15, P value < .001) utilization and increased each successive year of age.

CONCLUSIONS

The association of ACEs with health care utilization is dependent on age and is more complex than previously described. These trends may inform specific therapeutic strategies for pediatric patients by age.

Characterization of sleep difficulties in maltreated children and adolescents

Numerous studies have identified connections between child maltreatment and sleep-related issues. However, poor is known on potential links between sleep patterns and day-to-day functioning, along with psychopathology in maltreated youths. Additionally, existing research on the relationship between sleep difficulties and maltreatment often lacks investigation into specific sleep difficulty profiles across different age ranges. The current study aimed to determine the prevalence of diverse sleep disturbance profiles in a sample of maltreated children and adolescents, exploring distinct sleep disorder profiles based on sex, age, and the type of maltreatment experienced. Potential variations in adaptive and psychopathological profiles between maltreated children with and without sleep disturbances were also explored. This retrospective study included 91 children and adolescents (56% males, 44% females), aged 6 to 17, with a history of maltreatment (physical maltreatment, sexual abuse, psychological abuse, or neglect), referring for a neuropsychiatric and psychological evaluation at a pediatric hospital. Data were obtained through a retrospective file review. Sleep difficulties were measured through the Sleep Disturbance Scale for Children; cognitive abilities, adaptive skills, and emotional and behavioral features were also investigated. Among maltreated youth, difficulties in initiating and maintaining sleep were the most frequently observed by caregivers. Poor sex differences emerged, whereas adolescents exhibited more daytime somnolence than school-age children. Children with sleep difficulties exhibited more anxiety symptoms and worse global functioning in comparison with children without sleep difficulties.Conclusion: Considering the vital impact of sleep quality on healthy development, practitioners should offer tailored services to child maltreatment victims. Enhancing the sleep quality of these children could help foster their resilience.

Exposure to Adverse Childhood Experiences Predicts Increased Neurobehavioral Symptom Reporting in Adults with Mild Traumatic Brain Injury

The objective of this study was to understand whether exposure to adverse childhood experiences (ACEs) before 18 years of age predicts increased neurobehavioral symptom reporting in adults presenting for treatment secondary to persistent symptoms after mild traumatic brain injury (mTBI). This cross-sectional study identified 78 individuals with mTBI from 2014 to 2018 presenting for treatment to an outpatient multidisciplinary rehabilitation clinic. Neurobehavioral symptom inventory (NSI-22) scores were collected on admission, and ACEs for each patient were abstracted by medical record review. A linear regression model was used to assess if an individual who experienced at least one ACE before age 18 resulted in significantly different neurobehavioral scores compared with those not reporting any history of an ACE before age 18. Participants who reported at least one ACE before age 18 had significantly increased NSI-22 scores on admission to the rehabilitation clinic compared with patients without history of ACEs (mean difference 10.1, p = 0.011), adjusted for age and gender. For individuals presenting for treatment after mTBI, a history of ACEs before age 18 was associated with increased neurobehavioral symptoms.

Variations in the association between adverse childhood experiences (ACEs) and depression by age at first occurrence of ACEs

BACKGROUND

Adverse childhood experiences (ACEs) are known to be associated with depression. However, the extent to which such association varies by age at the first occurrence of ACEs remains unexplored. The objectives of this study are: (1) To describe the association between ACEs and depression among university students in China, and; (2) to assess the extent to which the mentioned association varied by age at first ACE.

METHODS

We conducted a self-administered survey among university students in southern China and analyzed the data using descriptive statistics and multivariate logistic regression.

RESULTS

We found significant associations between ACEs and depression prevalence, particularly when comparing students with three or more ACEs vs. students with no ACEs (62% vs. 36%; Adjusted OR = 3.49; 95% CI = 1.99, 6.12). Stratified analyses showed that the association was particularly strong among students who first experienced ACEs at age 0-6 years (66% vs. 36%; Adjusted OR = 4.05; 95% CI = 1.90, 8.59), but was non-significant among those who first experienced ACEs at age 13-18 years (31% vs. 36%; Adjusted OR = 0.99; 95 CI = 0.24, 4.08).

CONCLUSION

The strength of the associations between ACEs and depression varied by the age at first ACE. However, the cross-sectional study design, potential information bias, and lack of generalizability should be considered as caveats in the interpretation of the study findings.

How do Differences in Adolescent and Caregiver Reports of Adolescent Adverse Childhood Experiences Relate to Adolescent Depression?

Objective

To compare adolescent and caregiver reports of adolescent adverse childhood experiences (ACEs) and their relationship with current adolescent depression and to analyze the relationship between ACEs and depression.

Methods

We recruited 46 adolescent-caregiver dyads from a large, inner-city medical center's adolescent medicine clinic. Adolescents and caregivers completed the Center for Youth Wellness ACE questionnaire, encompassing traditional ACEs (eg, abuse, neglect, household dysfunction) and nontraditional ACEs (eg, foster care, parental death, exposure to community violence). Adolescents also completed the Patient Health Questionnaire-9A (PHQ-9A) depression screening tool.

Results

Among adolescents, 14 (30%) reported no traditional ACEs, 11 (24%) reported 1, and 21 (46%) reported more than 1. Regarding nontraditional ACEs, 16 (35%) reported none, 11 (24%) reported 1, and 19 (41%) reported more than 1. Caregiver reports consistently indicated lower ACEs compared with adolescent self-reports (P < .005). For the PHQ-9A scores, 26 (57%) of adolescents showed no or minimal depression, 14 (30%) mild, and 6 (13%) moderate depression. A moderate positive correlation emerged between PHQ-9A scores and self-reported traditional ACEs (rs = 0.5, P < .001) and nontraditional ACEs (rs = 0.49, P < .001). In addition, a positive correlation was observed between the absolute differences in adolescent and caregiver reports of traditional ACEs and PHQ-9A scores (n = 46, ρ = 0.51, P < .001).

Conclusions

As the differences in ACE reports between adolescents and caregivers increased, there was a corresponding increase in adolescent depression scores. It is essential to incorporate comprehensive ACE screening and encourage open communication between adolescents and caregivers, which may improve mental health outcomes.

Adverse Childhood Experiences Moderate the Relationship Between Pain and Later Suicidality Severity Among Youth: A Longitudinal High-Risk Cohort Study

Pain in adolescence can lead to the development of serious mental health issues, including suicidality. This risk may be strengthened among youth exposed to more adverse childhood experiences (ACEs; abuse, neglect, household challenges). This longitudinal study examined the role of ACEs in the relationship between pain and later suicidality onset and severity among a cohort of adolescents at risk for developing mental health problems. Participants were 139 healthy youth (Mage = 13.74 years, standard deviation = 1.56, 64% female) between the ages of 11 to 17 years, recruited based on parental history of depression or anxiety. Youth completed validated measures of internalizing symptoms, ACEs, and pain characteristics at baseline and follow-up diagnostic interviews 9 and/or 18 months later to assess for onset and severity of suicidality. After controlling for demographics, baseline internalizing symptoms, and ACEs, worse pain interference and increased ACEs at baseline predicted increased suicidality severity at follow-up. Moderation analyses revealed that there was a significant interaction between ACEs and pain interference and pain intensity. Increased pain interference (b = 7.65, P < .0001) or intensity (b = 6.96, P = .0003) was only associated with increased suicidality severity at follow-up in youth with high levels of ACEs. This study demonstrates that ACEs strengthen the relationship between pain and later suicidality severity among youth at risk of developing mental health problems. Findings underscore the critical need to adopt a trauma-informed lens to pediatric pain prevention and treatment (eg, screening for ACEs) and for the pain to be on the child's mental health agenda. PERSPECTIVE: This article provides evidence that, while pain is a risk factor for future increased suicidality severity, it is a particularly strong risk factor in youth who experienced increased childhood adversity. These results may help identify youth at greatest risk for suicidality.

School Violence Exposure as an Adverse Childhood Experience: Protocol for a Nationwide Study of Secondary Public Schools

BACKGROUND

Poor mental health and adverse childhood experiences (ACEs) predict extensive adverse outcomes in youth, including increases in long-term risk for chronic disease and injury, impaired emotional development, and poor academic outcomes. Exposure to school violence, specifically intentional gun violence, is an increasingly prevalent ACE. The anticipation of school shootings has led to the implementation of school safety and security interventions that may increase anxiety, depression, and other indicators of poor mental well-being among students and staff alike. Despite this, the association between exposure to existing school safety interventions and early adolescent student mental health outcomes, while accounting for one's history of ACEs, has not been previously investigated.

OBJECTIVE

The study protocol described here aims to determine whether there is a significant difference in the prevalence of mental health outcomes, perceived school safety, and academic engagement between adolescent students (grades 6-12) at schools who have experienced a school shooting and those who have not; whether existing interventions to promote school safety and security are associated with poor mental health outcomes among students and school staff; and what the strength of the association between school safety interventions and mental health outcomes among students and teachers is in schools that have experienced a school shooting versus schools that have never experienced a school shooting.

METHODS

This observational study will collect cross-sectional survey data from a nationwide sample of students, teachers, and principals at 12 secondary public schools across the United States. The participants come from 6 randomly selected exposure schools that have either experienced a recent (<2 years ago) intentional school shooting or have experienced an intentional school shooting less recently (>2 years ago). Data from these schools are being directly compared with 6 secondary schools that have never experienced a school shooting.

RESULTS

Institutional review board approval for this research project was obtained and the study subsequently began its recruitment and data collection phase in January 2024. Data collection is currently ongoing and the expected completion date is January 2025. The analytic plan is designed to determine if the strength of the association between school safety interventions and mental health outcomes differs among students and school staff in schools with varying levels of school violence exposure. Analyses will be used to evaluate the role of ACEs on the relationships among exposure to an intentional school shooting, exposure to school safety strategies, and student outcomes (ie, mental health and well-being, perceptions of school safety, and educational outcomes).

CONCLUSIONS

The results from this study promise to generate meaningful and novel findings on the extent to which having a prior history of ACEs moderates the relationships among exposure to intentional school gun violence, school safety strategies, and student outcomes (ie, mental health and well-being, and perceptions of school safety).

TRIAL REGISTRATION

ClinicalTrials.gov NCT06153316; https://clinicaltrials.gov/study/NCT06153316.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56249.

Parental Preconception Adversity and Offspring Mental Health in African Americans and Native Americans in the United States: A Systematic Review

This systematic review examines the impact of parental preconception adversity on offspring mental health among African Americans (AAs) and Native Americans (NAs), two populations that have experienced historical trauma and currently experience ethnic/racial mental health disparities in the United States. PsycINFO, PubMed, CINAHL, Scopus, and Web of Science were searched for studies that included at least two generations of AAs or NAs from the same family, measured parental preconception adversity and their offspring's mental health, and examined the association between these variables. Over 3,200 articles were screened, and 18 articles representing 13 unique studies were included in this review. Among the studies with samples that included AAs (n = 12, 92%), 10 (83%) reported a significant association between parental preconception adversity and adverse offspring mental health. The only study with a sample of NAs (n = 1, 8%) also reported a significant association between these variables. Although the literature suggests that parental preconception adversity is associated with offspring mental health among AAs and NAs, it must be interpreted in the context of the small number of studies on this topic and the less-than-ideal samples utilized-just one study included a sample of NAs and several studies (n = 6, 46%) used multi-ethnic/racial samples without testing for ethnic/racial disparities in their results. A more rigorous body of literature on this topic is needed as it may help explain an important factor underlying ethnic/racial mental health disparities, with important implications for interventions and policy.

Patterns of Adverse Childhood Experiences and Neurocognitive Development

Importance

Early life adversity is associated with higher risk of many adult health problems, including mental illness, substance abuse, suicide attempt, and chronic diseases. Many previous studies investigated adversities one at a time or investigated the health toll associated with the cumulative number of adversities.

Objective

To examine the co-occurrence of adversities among children and how specific patterns of adversities are associated with neurocognitive development.

Design, Setting, and Participants

This cohort study used data from the Collaborative Perinatal Project (CPP), which enrolled a national sample of women during pregnancy and followed their offspring to ages 7 to 8 years, between 1959 and 1974. The CPP was a community-based study conducted in 12 US medical centers. The CPP sample was ascertained through prenatal clinics and is diverse with respect to race and socioeconomic status. Data analysis was performed from August 2023 to March 2024.

Exposures

A latent class analysis was conducted of 12 adverse childhood experiences that occurred between birth and 7 years to identify common patterns of childhood adversities.

Main Outcomes and Measures

Five neurocognitive tests were used to measure children's visual-motor, sensory-motor, auditory-vocal, intelligence quotient, and academic skills.

Results

The analysis sample included 49 853 offspring (25 226 boys [50.6%]); 24 436 children (49.0%) had low probability of experiencing any adversity, whereas the remaining half were classified into 5 groups reflecting distinct patterns of childhood adversities: parental harshness and neglect, 1625 children (3.3%); parental separation and poverty, 8731 children (17.5%); family instability, 3655 children (7.3%); family loss, instability, and poverty, 1505 children (3.0%); and crowded housing and poverty, 9901 children (19.9%). Children in 4 of these groups had lower neurocognitive scores than children with a low probability of experiencing adversity, with standardized mean differences ranging from -0.07 (95% CI, -0.11 to -0.03) to -0.86 (95% CI, -1.06 to -0.65).

Conclusions and Relevance

These findings suggest that adverse childhood experiences are associated with deficits in children's neurocognitive functions. It is important to understand the complexity in children's exposure to adversity and the resulting developmental consequences, as well as the underlying mechanisms, to help support children exposed to adversity and foster healthier and resilient trajectories of development.

Childhood Environmental Instabilities and Their Behavioral Implications: A Machine Learning Approach to Studying Adverse Childhood Experiences

Adverse childhood experiences (ACEs) include a range of abusive, neglectful, and dysfunctional household behaviors that are strongly associated with long-term health problems, mental health conditions, and societal difficulties. The study aims to uncover significant factors influencing ACEs in children aged 0-17 years and to propose a predictive model that can be used to forecast the likelihood of ACEs in children. Machine learning models are applied to identify and analyze the relationships between several predictors and the occurrence of ACEs. Key performance metrics such as AUC, F1 score, recall, and precision are used to evaluate the predictive strength of different factors on ACEs. Family structures, especially non-traditional forms such as single parenting, and the frequency of relocating to a new address are determined as key predictors of ACEs. The final model, a neural network, achieved an AUC of 0.788, a precision score of 0.683, and a recall of 0.707, indicating its effectiveness in accurately identifying ACE cases. The model's ROC and PR curves showed a high true positive rate for detecting children with two or more ACEs while also pointing to difficulties in classifying single ACE instances accurately. Furthermore, our analysis revealed the intricate relationship between the frequency of relocation and other predictive factors. The findings highlight the importance of familial and residential stability in children's lives, with substantial implications for child welfare policies and interventions. The study emphasizes the need for targeted educational and healthcare support to promote the well-being and resilience of at-risk children.

A formative evaluation of 'Mind Matters: Overcoming Adversity and Building Resiliency' with Hispanic adolescents prior to and during Covid-19

Youth living in poverty are more likely to experience cumulative stressors including multiple adverse childhood events. Further, the Covid-19 pandemic has disproportionality affected Hispanic youth and communities, leading to unprecedented levels of trauma. This research responded to a need for a youth resiliency-building program in an urban and impoverished area with a majority Hispanic population. We conducted a formative evaluation of a youth intervention entitled Mind Matters: Overcoming Adversity and Building Resilience, which aims to help youth overcome adversity and to build resilience via psychoeducation and skill development. Just prior to the pandemic in the United States (August-December, 2019), youth (N=12) participated in Mind Matters as part of an after-school program. Immediately following, we utilized focus groups to solicit youth's perspectives on the acceptability of the program, what they had learned, content areas they liked best, and their recommendations for program improvement. Follow-up phone interviews were also conducted three months later (March 2020) while youth were at home as a result of the pandemic. Youth enjoyed the program and were able to apply skills learned to cope with stress in their daily lives and across ecological contexts. Findings point to the program as particularly well-suited to older adolescents. During the pandemic, most youth continued to utilize self-soothing and mindfulness skills to emotionally self-regulate while facing challenges related to home schooling. Findings highlight the importance of trauma-resiliency programming for youth and offer recommendations to practitioners utilizing the Mind Matters program.

A retrospective cohort study analyzing the changes in early childhood development during the COVID-19 pandemic

OBJECTIVE

To investigate early childhood development (ECD) outcomes in different subgroups before and during the COVID-19 pandemic.

STUDY DESIGN

A retrospective cohort study of children 3-58 months of age whose caregivers completed a Survey of Well-being of Young Children (SWYC) as part of a well child visit (WCC). The data were divided into two phases: pre-pandemic (September 2018 - February 2020), and during pandemic (September 2020 - February 2022). The difference in the proportion of forms with Meets Expectations interpreted scores on the SWYC Developmental Milestones pre-pandemic versus during the pandemic timeframe overall and among subgroups were reported. Hypotheses were tested using logistic regression with repeated measures.

RESULTS

14,550 patients were included in the sample for analysis with 52,558 SWYC form observations. There was no difference in the odds of a Meets Expectations interpreted score before and after the pandemic for the entire sample, OR 0.99 (95 % CI: 0.94-1.04). There was evidence of decreased odds of an interpreted score of Meets Expectations for the following subgroups: male, Hispanic/Latino ethnicity, ages of 24, 30 or 36 months at WCC, Medicaid insurance, 2nd HOUSES Quartile, requiring interpreter, single parent household, young maternal age, maternal substance abuse, and race identified as Native Hawaiian/Pacific Islander, American Indian/Native Alaskan or Other.

CONCLUSION

Decreased odds of meeting developmental milestones during the pandemic were evident in certain high risk sub-groups revealing unequal distribution of suboptimal developmental outcomes within our population during the pandemic that may be exacerbating existing inequities impacting development in children.

Differential Cortical Volume and Surface Morphometry in Youth With Chronic Health Conditions

Up to 1 in 3 youth in the United States have a childhood-onset chronic health condition (CHC), which can lead to neurodevelopmental disruptions in cognitive functioning and brain structure. However, the nature and extent of structural neurobiomarkers that may be consistent across a broad spectrum of CHCs are unknown. Thus, the purpose of this study was to identify potential differences in brain structure in youth with and without chronic physical health conditions (e.g., diabetes, hemophilia). Here, 49 T1 structural magnetic resonance imaging (MRI) images were obtained from youth with (n = 26) and without (n = 23) CHCs. Images were preprocessed using voxel-based morphometry (VBM) to generate whole-brain voxel-wise gray matter volume maps and whole-brain extracted estimates of cortical surface area and cortical thickness. Multi-scanner harmonization was implemented on surface-based estimates and linear models were used to estimate significant main effects of the group. We detected widespread decreases in brain structure in youth with CHCs as compared to controls in regions of the prefrontal, cingulate, and visual association areas. The insula exhibited the opposite effect, with cases having increased surface area as compared to controls. To our knowledge, these findings identify a novel structural biomarker of childhood-onset CHCs, with consistent alterations identified in gray matter of regions in the prefrontal cortex and insula involved in emotion regulation and executive function. These findings, while exploratory, may reflect an impact of chronic health stress in the adolescent brain, and suggest that more comprehensive assessment of stress and neurodevelopment in youth with CHCs may be appropriate.

Psychometrics of psychosocial behavior items under age 6 years: Evidence from Nebraska, USA

Because healthy psychosocial development in the first years of life is critical to lifelong well-being, governmental, and nongovernmental organizations are increasingly interested in monitoring psychosocial behaviors among populations of children. In response, the World Health Organization is developing the Global Scales of Early Development Psychosocial Form (GSED PF) to facilitate population-level psychosocial monitoring. Once validated, the GSED PF will be an open-access, caregiver-reported measure of children's psychosocial behaviors that is appropriate for infants and young children. This study examines the psychometric validity evidence from 45 items under consideration for inclusion in the GSED PF. Using data from N = 836 Nebraskan (USA) children aged 180 days to 71 months, results indicate that scores from 44 of the 45 (98%) items exhibit positive evidence of validity and reliability. A bifactor model with one general factor and five specific factors best fit the data, exhibited strong reliability, and acceptable model fit. Criterion associations with known predictors of children's psychosocial behaviors were in the expected direction. These findings suggest that measurement of children's psychosocial behaviors may be feasible, at least in the United States. Data from more culturally and linguistically diverse settings is needed to assess these items for global monitoring.

The Association of Adverse Childhood Experiences with Long-term Mood and Anxiety Disorders After Childhood Traumatic Brain Injury: A Population-based Case-Control Study

OBJECTIVE

To assess the association between ACEs and the development of psychiatric disorders by age 25 among individuals who sustained TBI prior to age 10.

DESIGN

Population-based case-control study.

SETTING

Olmsted County, Minnesota.

PARTICIPANTS

566 individuals (N=566) who sustained a TBI prior to age 10 were identified and classified using a validated TBI classification system. Among these individuals, cases with a subsequent mood or anxiety disorder prior to age 25 were identified through clinical diagnostic codes and manual record review. For each case, a 1:1 matched control was randomly selected from individuals with a pediatric TBI who did not have a mood/anxiety disorder prior to the matched case's mood/anxiety disorder.

INTERVENTIONS

Not applicable MAIN OUTCOME MEASURES: Development of a mood/anxiety disorder.

RESULTS

Among the 114 matched pairs of individuals with a TBI prior to age 10, a subsequent mood/anxiety diagnosis was significantly associated with a history of 10 of 14 ACE categories and with having an ACE score ≥1 (odds ratio 5.17; 95% confidence interval 2.78-9.59).

CONCLUSIONS

This is the first population-based study to the authors' knowledge showing that among children who sustained a TBI prior to age 10, those who experienced ACEs are at increased risk of developing a mood or anxiety disorder.

Parental Adverse Childhood Experiences and Post-PICU Stress in Children and Parents

OBJECTIVES

Hospitalization in a PICU is a stressful experience for children and their parents, with many experiencing posttraumatic stress disorder (PTSD) after discharge. Risk factors may include preillness traumatic events, such as adverse childhood experiences (ACEs). We sought to assess the feasibility of screening ACEs in parents of children admitted to a PICU, their prevalence, and their association with post-PICU PTSD symptoms in them and their children.

DESIGN

Single-center prospective observational study.

SETTING

Urban academic children's hospital from January to December 2021.

PATIENTS

One hundred forty-five children (2-18 yr old, admitted ≥ 2 d) and their parents.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Data on parental demographics, ACEs, coping skills, and PICU environmental stressors, as well as patient clinical data, were collected. One month after PICU discharge, parents completed inventories assessing PTSD symptoms in them and their children. Bivariate and logistic regression analyses were used to explore associations of ACEs with post-PICU PTSD. Of 145 enrolled parents, 95% completed the ACE questionnaire, 58% of whom reported greater than or equal to 1 ACE, and 14% had substantial (≥ 4) ACEs. Parent and patient follow-up was 79% and 70%, respectively. Sixteen percent of parents had provisional PTSD. Regression analysis showed parents with greater than or equal to 4 ACEs had 10 times greater odds of parental PTSD, compared to parents with less than 4 ACEs, (adjusted odds ratio [aOR] = 10.2; 95% CI, 1.03-100.9; p = 0.047). Fifty-six percent of patients screened at risk for PTSD. There was no association between substantial parental ACEs and patients' risk for PTSD (aOR = 3.5 [95% CI, 0.56-21.31]; p = 0.18).

CONCLUSIONS

ACEs were common among parents of critically ill children. Having substantial parental ACEs was associated with provisional parental PTSD after their child's PICU admission, but not with PTSD in the children. Family-centered care that seeks to mitigate post-PICU stress should be mindful of the potential relevance of parental ACEs.

Risks of adverse childhood experiences on healthcare utilization and outcomes in early childhood

BACKGROUND

The American Academy of Pediatrics recommends all pediatricians to be ready to implement trauma-informed care, including the mitigation of impacts of Adverse Childhood Experiences (ACEs) through screening and identification of at-risk population. Reliable survey tools and knowledge of the consequences of ACEs are needed.

OBJECTIVE

This study examines the healthcare utilization and diagnoses captured in insurance claims in association with the number of ACEs recorded by the Family Map Inventories (FMI). The FMI offers a comprehensive family assessment, which includes child ACEs (FMI-ACEs) using prospective, proxy risk indicators.

PARTICIPANTS AND SETTING

Low-income families (N = 1647) with children aged three to five years who completed the FMI were linked to their insurance records.

METHODS

Multivariable logistic and generalized linear regression models were fitted to explore the association between the number of ACEs (FMI-ACEs scores) and healthcare utilization and health outcomes.

RESULTS

Children were exposed at rates of 32.4 % to zero, 31.7 % to one, 19.7 % to two, and 16.3 % to three or more ACEs. The FMI-ACEs scores were associated with greater use of non-preventive outpatient visits, filled prescriptions, and overall use of healthcare. Incidences of adjustment disorders were 4 times and attention-deficit conducts were 2 times higher among children with the highest FMI-ACEs scores than those with zero FMI-ACEs.

CONCLUSIONS

This study marks the first effort to conduct insurance claims data review to ascertain association between a survey measure of ACEs and health utilization and diagnosed conditions. The association of ACEs risk screening and healthcare utilization and diagnoses was observed.

Applying after-action reviews to child and family teams to improve mental health service linkage within child welfare services: a study protocol

BACKGROUND

Half of child-welfare-involved children and adolescents meet the criteria for at least one mental health diagnosis. This project proposes to improve successful mental health service linkage in child welfare services (CWS) by adapting and testing the after-action review (AAR) team effectiveness intervention to augment the child and family team (CFT) services' intervention. Despite being both required and a collaborative approach to service planning, CFT meetings are implemented with questionable fidelity and consistency, rarely including the voice of children and families as intended.

METHODS

Using a parallel group trial design, with non-equivalent comparison groups, and qualitative and quantitative methodology, this study will tailor and assess the impact of the AAR on enhancing CFT outcomes. The authors will conduct a qualitative needs assessment targeting the ongoing implementation of the CFT services intervention in a large, publicly funded, CWS system. A qualitative inquiry consisting of interviews and focus groups with key stakeholders will result in the preparation of an action plan to address identified gaps between the current and desired CFT services intervention outcomes. The AAR implementation strategy will be adapted and tailored to address the CFT services' intervention needs. To test the effectiveness of the AAR on improving outcomes associated with the CFT services intervention, we will utilize blocked randomization of four CWS caseworkers from two CWS system regions to either the intervention condition (CFT + AAR) or standard implementation (CFT as usual). The authors will collect data from the CWS caseworkers and additional CFT members via web-based surveys. Mechanisms of the AAR team effectiveness intervention for CFT implementation will be assessed.

DISCUSSION

By inclusion of child and family voice, the AAR-enhanced CFT should lead to increased fidelity to the CFT intervention and greater levels of parental satisfaction with the service and shared decision-making, thus resulting in enhanced follow-through with service plans and linkage to mental health treatment services for children. The knowledge gained by this randomized clinical trial has the potential to benefit service delivery and integration for CWS leaders, caseworkers, formal and informal CFT member support persons, parents/caregivers, and children with open cases. Improving intervention effectiveness, both at the system and family levels, is crucial for practice efficiencies and improved child and family outcomes.

TRIAL REGISTRATION

NCT05629013. Approval date: November 28, 2022 (version 1).

TRIAL SPONSOR

University of California, San Diego.

RESPONSIBLE PARTY

Danielle Fettes.

Exclusionary School Discipline and School Achievement for Middle and High School Students, by Race and Ethnicity

Importance

There are racial and ethnic inequities in exclusionary school discipline (ESD) (ie, a disciplinary action that removes students from their classroom or school environment, eg, referrals, suspensions, and/or expulsions) practices in the US. Exclusionary school discipline has been associated with negative education, health, and criminal justice outcomes.

Objectives

To investigate whether experiencing an ESD event was associated with decreased grade point average (GPA) and whether minoritized students (eg, Black or Latine [description used in database]) are disproportionately affected compared with White students.

Design, Setting, and Participants

In a cohort study using retrospective administrative longitudinal data of children in the 6th to 10th grades (August 18, 2014, to May 26, 2017) in a large, single urban school district in California, linear mixed models were applied to compare the timing of the first exclusionary event and the average change in GPA and evaluate the relative variation among minoritized students experiencing an exclusionary event. Data analysis was conducted from August 18, 2018, to August 21, 2023.

Exposure

Year at which students experienced first ESD events over the study period.

Main Outcomes and Measures

The primary outcome of interest was change in average grade point average (GPA); students' GPA averaged across courses was averaged across each year.

Results

Of the 16 849 students (8756 [52.0%] male), 21.4% experienced at least 1 ESD event. The mean (SD) age was 14.3 (1.6) years, and 7.5% identified as Black, 25.6% Latine, and 10.0% White. Black and Latine students experienced exclusionary events at nearly 10 and 3 times more than White students (mean [SD]: Black, 6.69 [12.80] events; Latine, 2.01 [6.18] events; White, 0.71 [4.46] events; P < .001). When controlling for gender, maternal educational level, race and ethnicity, and school year, having experienced an ESD event in the first year was associated with an average decrease in GPA by 0.88 (95% CI, -0.91 to -0.84) points compared with no ESD events; experiencing ESD events also had significant differences in the second (-0.63 [95% CI, -0.67 to -0.59]) and third (-0.52 [95% CI, -0.57 to -0.47]) years. Black and Latine race and ethnicity was associated with the greatest decrease in GPA compared with White students (Black, -0.56 [95% CI, -0.61 to -0.51]; Latine, -0.51 [95% CI, -0.54 to -0.47]; P < .001).

Conclusion and Relevance

This study observed racial and ethnic inequities in ESD prevalence and its association with educational attainment. The findings suggest that it may be beneficial for pediatricians and other health care professionals to screen for exclusion, as experiencing ESD events may affect health across the life course. In addition, it may be useful to categorize ESD events as an adverse childhood experience and abolish the practice from schools as a disciplinary measure.

[Adverse Childhood Experiences in Mothers and Intergenerational Family Violence]

For children, own adverse experiences, as well as their exposure to intimate partner violence poses a severe risk for health and development. In order to answer the question of intergenerational transmission of family violence, adverse childhood experiences in mothers are considered to be a significant risk factor for the occurrence of child maltreatment and intimate partner violence in families, which, however, has been little studied in Germany. Therefore, this paper uses cross-sectional data of 5.646 mothers that was taken fromthe representative study "Kinder in Deutschland - KiD 0-3". Multiple binary-logical regression models were calculated in order to examine the influence ofmaternal adverse childhood experiences on various forms of family violence. As a result, 823 mothers (9,3 %) reported adverse childhood experiences; 157 (2,8 %) admitted that their child had already been exposed to physical harm or harsh punishment, and 168 (3,0%) reported intimate partner violence since the birth of their child, respectively 493 (8,7 %) since any past relationship. Taking demographic and socioeconomic factors into account, the occurrence of all three forms of violence becamemore likely inmothers with adverse childhood experiences: physical harm of the child (OR = 2,78, p ≤ 0,001), current intimate partner violence of themother (OR = 3,76, p ≤ 0,001), as well as her lifetime experiences in general (OR = 3,67, p ≤ 0,001). Therefore, the support and guidance of families (e.g., by early childhood interventions) should take into account the connection between negative maternal childhood experiences, as well as familial forms of violence, and, if applicable, make generous preventative offers. In case of signs for familial violence, additional protective steps should be applied.

Associated factors to depression diagnosed during incarceration in Peruvian male prisoners: a sub-analysis of the national census of prison population

PURPOSE

Depression has become a major health concern, particularly in developing countries. This disorder is highly prevalent among certain vulnerable populations, such as prisoners. In Peru, prisons are overcrowded, and the health of prisoners is neglected. Thus, this study aims to estimate the prevalence of depression diagnosed during incarceration in male inmates from all Peruvian prisons and assess its associated factors.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional study was conducted based on the secondary data analysis of the National Census of Prison Population 2016 in Peru. This study included records of prisoners who reported whether they were diagnosed with depression by a health-care professional after admission into the prisons. Descriptive, bivariate and multivariable analyses were performed.

FINDINGS

Of the 63,312 prisoners included in this study, 1,007 reported an in-prison diagnosis of depression by a health-care professional, which represents a prevalence of 1.59%. Substance use disorder (adjusted prevalence ratio [aPR] 3.10; 95% confidence interval [CI]: 1.91-5.03), hypertension (aPR 7.20; 95% CI: 6.28-8.24) and previous discrimination (aPR 1.97; 95% CI: 1.62-2.40) were strongly associated with depression, even when adjusting for multiple confounders. Other directly associated variables were, for example, violence during childhood, infrequent visits in prison and diabetes.

ORIGINALITY/VALUE

The right of prisoners to adequate health care is being neglected in Peru. Mental health is a cornerstone of health quality. Acknowledging which factors are associated with depression in prison is important to implement strategies to improve the mental health of prisoners.

The school counselor's role in addressing ACEs: an intervention strategy

Children growing up with unemployed parents may be at higher risk of adverse childhood experiences (ACEs). The role of school counselors in identifying and providing services to children at risk of ACEs is important. In addition, the intervention strategy is expected to bridge the role between schools and the government in overcoming the risks of ACEs in the community.

Implementing Integrated Early Childhood Mental Health Services in Primary Care: Relationships, Vision, and Sustainability

The Massachusetts Multi-City Young Children's System of Care Project was a federally funded program to provide integrated early childhood mental health (ECMH) services in primary care for families of very young children (birth-six years old) with Serious Emotional Disturbances across three cities in Massachusetts, U.S.A. This study describes lessons learned from the implementation of this program and makes recommendations for best practices to improve the delivery and efficacy of ECMH services in primary care settings. Staff and leadership (n = 35) from 11 agencies (primary care practices, community service agencies, and local health departments) that co-implemented this program participated in focus groups and semi-structured key informant interviews. Thematic analysis was used to characterize specific facilitators and barriers to successfully implementing system-wide programming for ECMH. Four main themes were identified: (1) Strong multilevel working relationships are critical for integration, (2) Capacity-building activities can be leveraged to improve implementation, (3) Financial challenges are a primary barrier to building efficacious systems of care, and (4) Flexibility and resourcefulness can help overcome logistical challenges in integration. Implementation lessons learned may serve as guidance for other states and institutions in the U.S. seeking to improve the integration of ECMH services into primary care. They may also provide strategies to adapt and scale these interventions to improve the mental health and well-being of young children and their families.

Potentially Traumatic Events, Socioemotional and Adaptive Functioning: Associations with Self-Regulatory Skills in a Community Sample of Primarily Black and Latinx 3-5-year-olds

Early childhood is a heightened risk period for exposure to potentially traumatic events (PTEs) and a critical period for the development of foundational self-regulatory competencies that have potential cascading effects on future socioemotional functioning. This cross-sectional study examined associations between PTE exposure and socioemotional and adaptive functioning, and self-regulatory skills, in a community-based sample of 280 primarily Black and Latinx 3-5-year-olds. Results supported direct relations between PTE exposure and socioemotional and adaptive functioning. Attentional regulation was associated with PTEs and internalizing behaviors, externalizing behaviors, and adaptive behaviors. There was also a significant association of emotional regulation on the relationship between PTEs and internalizing and externalizing behaviors, but not adaptive functioning. Findings have implications for early intervention and educational and public policy, including the importance of scaffolding the development of self-regulatory skills among preschoolers with high PTE exposure.

Assessment of Adverse Childhood Experiences in the South Bronx on the Risk of Developing Chronic Disease as Adults

Background Adverse childhood experiences (ACEs) have a negative impact on health outcomes. Using a cross-sectional study design, our objective was to identify the prevalence of ACEs among residents of South Bronx and the increased relationship between such childhood stressors and the prevalence of both chronic disease and modifiable high-risk behavior in adulthood. Methods We recruited patients from a hospital-based, adult primary care clinic in the metropolitan area of the South Bronx. A prospectively designed, observational study recruited patients in a consecutive fashion to conduct a cross-sectional survey between September 2017 and January 2018. The demographic representation comprises a low socioeconomic sector of urban New York City, with low education and immigrant population. A modified ACE questionnaire that included nine ACE categories (Physical Abuse, Sexual Abuse, Household Substance Abuse, Separation from Parents, Incarcerated Household Member, Parental Separation/Divorce, and Bullying) in addition to questions on demographics, high-risk behavior, and diagnosis of chronic disease. Our primary objective was to gather the incidence of ACEs organized by domains. Secondary objectives were to demonstrate any expected increase (as odds ratios (ORs)) in chronic disease or maladaptive social habits when compared to patients with no ACEs within the cohort. The OR for the associations was calculated with logistic regression. Individual logistic regression models for each chronic disease, high-risk behavior, and demographics were used to measure the exposure response of the nine ACE categories.  Results A total of 454 patients completed the survey. The average age was 53.1±14.2 years, and females were 49% of the sample. Hispanics were at 61% followed by Blacks at 34%. Participants reported high-risk behavior at 24%, had a high prevalence of chronic illness (82%), and had ACE events at 70%. We found a significant relationship between ACE events and having a chronic disease diagnosis and engagement in high-risk behavior with higher odds of reporting chronic illnesses among participants with exposure to childhood stressors (OR 1.26, 95% confidence interval 1.1-1.5, p=0.002). Of the nine ACE categories, many were independently associated with one or more chronic diseases in adulthood. Conclusion According to our survey data, ACE events in our patient population were more prevalent (30% with four or more exposures), higher than the proposed average of one out of six Americans with four or more exposures nationally according to national statistics. These childhood stressors appeared to have a strong association with the development of high-risk behavior and chronic illnesses.

Contextualizing the impact of prenatal alcohol and tobacco exposure on neurodevelopment in a South African birth cohort: an analysis from the socioecological perspective

Background

Alcohol and tobacco are known teratogens. Historically, more severe prenatal alcohol exposure (PAE) and prenatal tobacco exposure (PTE) have been examined as the principal predictor of neurodevelopmental alterations, with little incorporation of lower doses or ecological contextual factors that can also impact neurodevelopment, such as socioeconomic resources (SER) or adverse childhood experiences (ACEs). Here, a novel analytical approach informed by a socio-ecological perspective was used to examine the associations between SER, PAE and/or PTE, and ACEs, and their effects on neurodevelopment.

Methods

N = 313 mother-child dyads were recruited from a prospective birth cohort with maternal report of PAE and PTE, and cross-sectional structural brain neuroimaging of child acquired via 3T scanner at ages 8-11 years. In utero SER was measured by maternal education, household income, and home utility availability. The child's ACEs were measured by self-report assisted by the researcher. PAE was grouped into early exposure (<12 weeks), continued exposure (>=12 weeks), and no exposure controls. PTE was grouped into exposed and non-exposed controls.

Results

Greater access to SER during pregnancy was associated with fewer ACEs (maternal education: β = -0.293,p = 0.01; phone access: β = -0.968,p = 0.05). PTE partially mediated the association between SER and ACEs, where greater SER reduced the likelihood of PTE, which was positively associated with ACEs (β = 1.110,p = 0.01). SER was associated with alterations in superior frontal (β = -1336.036, q = 0.046), lateral orbitofrontal (β = -513.865, q = 0.046), caudal anterior cingulate volumes (β = -222.982, q = 0.046), with access to phone negatively associated with all three brain volumes. Access to water was positively associated with superior frontal volume (β=1569.527, q = 0.013). PTE was associated with smaller volumes of lateral orbitofrontal (β = -331.000, q = 0.033) and nucleus accumbens regions (β = -34.800, q = 0.033).

Conclusion

Research on neurodevelopment following community-levels of PAE and PTE should more regularly consider the ecological context to accelerate understanding of teratogenic outcomes. Further research is needed to replicate this novel conceptual approach with varying PAE and PTE patterns, to disentangle the interplay between dose, community-level and individual-level risk factors on neurodevelopment.

The intersection of adverse childhood experiences and mental health concerns for youth involved in the child welfare system

The present study sought to identify if there is distinct mental health symptomology among child welfare-involved youth depending on the category of adverse childhood experiences (ACEs) endorsed. A chart review of child welfare-involved youth (N = 129, ages 8-16) and caregiver reported ACEs and mental health/trauma symptoms was conducted. A K-means cluster analysis used ACE scores to identify groups of youth along two dimensions: household dysfunction and child abuse/neglect. The first cluster identified had low ACE scores outside of their system involvement (n = 62), the second predominantly endorsed household dysfunctions (n = 37), and the third predominantly endorsed abuse/neglect (n = 30). One-way analysis of variance tests revealed that youth in the systems-only cluster differed from youth in the other groups, while the two high ACE category groups did not differ from each other on mental health/trauma symptoms. These results have important implications for the screening and treatment referral processes in the child welfare system.

Care When It Counts: Establishing Trauma-Sensitive Care as a Preventative Approach for 0-3-Year-Old Children Suffering from Trauma and Chronic Stress

Adverse childhood experiences are an important societal concern. Children aged 0-3 are particularly vulnerable to unpredictable chronic stress due to the critical period for brain development and attachment. Trauma-sensitive care is a preventative approach to reduce the burden of stressful experiences by committing to positive relationships. Professional caregivers are ideally placed to offer trauma-sensitive care; however, earlier research reveals that the tools they need to consciously apply trauma-sensitive care principles are missing. The current study organized living labs (co-creative research method) to present trauma-sensitive care as a preventative approach aimed at children aged 0-3. Two living labs were organized in Belgium and Hungary, where professional caregivers collaborated to create a protocol that offers guidelines on how to implement trauma-sensitive care. The resulting protocol included a theoretical foundation on trauma as well as a translation of these guidelines into practical recommendations. The protocol was evaluated by incorporating it into a training intervention delivered to 100 professional caregivers from childcare organizations across four European countries. The protocol received positive feedback from participants, with results indicating a self-reported increase in knowledge, attitude and practice of trauma-sensitive care principles. We conclude that this trauma-sensitive care protocol is a promising answer to the needs of professional caregivers working with children aged 0-3.

The influence of adverse and positive childhood experiences on young people's mental health and experiences of self-harm and suicidal ideation

BACKGROUND

Few studies have examined the interaction of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) with mental health outcomes in nationally representative European populations.

OBJECTIVE

The primary objective was to test models of resilience through investigating associations between ACEs and PCEs and young people's risk of common mood and anxiety disorders, self-harm and suicidal ideation.

PARTICIPANTS AND SETTING

Data were from the Northern Ireland Youth Wellbeing Survey (NIYWS), a stratified random probability household survey conducted between June 2019 and March 2020. Analysis is based on data from adolescents aged 11-19 years (n = 1299).

METHOD

Logistic regression was used to test the direct effects of ACEs and PCEs on mental health outcomes and the moderating effect of PCEs at different levels of ACE exposure.

RESULTS

Prevalence rates of mental health outcomes were: common mood and anxiety disorders (16 %); self-harm (10 %); suicidal ideation (12 %). ACEs and PCEs both independently predicted common mood and anxiety disorders, self-harm and suicidal ideation. Every additional ACE increased the likelihood of a common mood and anxiety disorder (81 %), self-harm (88 %) and suicidal ideation (88 %). Every additional PCE reduced common mood and anxiety disorders (14 %), self-harm (13 %) and suicidal ideation (7 %). There was no moderating effect of PCEs on ACEs and mental health outcomes.

CONCLUSION

The findings suggest that PCEs act largely independently of ACEs and that initiatives to increase PCEs can assist in the prevention of mental health problems.

Understanding the roles of the healthcare and child welfare systems in promoting the safety and well-being of children

Introduction

The accurate identification and appropriate investigation of child maltreatment is a key priority for promoting the optimal health and development of children. Healthcare providers are often well-positioned professionals to report suspected child abuse and neglect, and, therefore, interact regularly with child welfare workers. Little research has examined the relationship between these two groups of professionals.

Methods

We interviewed healthcare providers and child welfare workers in order to examine the referral and child welfare investigation processes to understand strengths and identify areas of improvement for future collaboration. Thirteen child welfare workers from child welfare agencies and eight healthcare providers from a pediatric tertiary care hospital in Ontario, Canada were interviewed to meet the study's objectives.

Results

Healthcare providers spoke about positive experiences making reports, factors impacting reporting decisions, areas for improvement (e.g., difficulties communicating, lack of collaboration, and disruption of therapeutic alliance), training, and professional roles. For interviews with child welfare workers, identified themes included healthcare professionals' perceived expertise and understanding the role of child welfare. Both groups brought up the need for increased collaboration as well as systemic barriers and legacies of harm.

Discussion

Our core finding was a reported lack of communication between the groups of professionals. Other identified barriers in collaboration included a lack of understanding of each other's roles, hesitation for healthcare providers making reports, as well as legacies of harm and systemic inequities in both institutions. Future research should build on this examination by including the voices of healthcare providers and child welfare workers to identify sustainable solutions for increased collaboration.

Adverse childhood experiences and sipping alcohol in U.S. Children: Findings from the Adolescent Brain Cognitive Development study

The objective of this study was to explore the relationship between accumulating adverse childhood experiences (ACEs) and sipping alcohol in a large, nationwide sample of 9-to-10-year-old U.S. children. We analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study (2016-2018). Of 10,853 children (49.1 % female), 23.4 % reported ever sipping alcohol. A greater ACE score was associated with a higher risk of sipping alcohol. Having 4 or more ACEs placed children at 1.27 times the risk (95 % CI 1.11-1.45) of sipping alcohol compared to children with no ACEs. Among the nine distinct ACEs examined, household violence (Risk Ratio [RR] = 1.13, 95 % CI 1.04-1.22) and household alcohol abuse (RR = 1.14, 95 % CI 1.05-1.22) were associated with sipping alcohol during childhood. Our findings indicate a need for increased clinical attention to alcohol sipping among ACE-exposed children.

The Effects of Severe Childhood Physical and Sexual Abuse on Adult Socioeconomic Prosperity

Our study utilizes Adverse Childhood Experience (ACE) scores to estimate the relationship between forced sexual intercourse and physical abuse on socioeconomic outcomes in adulthood. ACEs have been shown to have long-term negative impacts on health, mental health, and cognition. We expand upon the literature that analyzes the effects of ACEs on human capital investment and adult socioeconomic outcomes by focusing on the ACE scores pertaining to repeated physical and forced sexual abuse in childhood. Specifically, we estimate probit models using data from the Behavioral Risk Factor Surveillance System to measure the marginal effects of childhood sexual abuse (CSA) and physical abuse on the probability of high school completion, unemployment, and the likelihood of living in poverty in adulthood. We find adults who suffered physical abuse in childhood are more likely to live in poverty. Adult survivors of CSA are less likely to finish high school and more likely to live in poverty. The likelihood of high school noncompletion increases when the individual suffered both forms of abuse. We also find that only those who suffered both forms of abuse in childhood had a greater likelihood of being unemployed and high school noncompletion. We find the negative socioeconomic impact in adulthood is larger for women than for men, implying gender heterogeneity in outcomes of CSA and physical abuse. Researchers should control for the correlation between sexual abuse and physical abuse in childhood, particularly in women, when estimating their effects on socioeconomic outcomes.

Adverse childhood experiences in children with fetal alcohol spectrum disorders and their effects on behavior

BACKGROUND

Children with fetal alcohol spectrum disorders (FASD) have high rates of adverse childhood experiences (ACEs). ACEs are associated with a wide range of health outcomes including difficulty with behavior regulation, an important intervention target. However, the effect of ACEs on different areas of behavior has not been well characterized in children with disabilities. This study describes ACEs in children with FASD and how they impact behavior problems.

METHODS

A convenience sample of 87 caregivers of children (aged 3 to 12) with FASD participating in an intervention study reported on their children's ACEs using the ACEs Questionnaire and behavior problems on the Eyberg Child Behavior Inventory (ECBI). A theorized three-factor structure of the ECBI (Oppositional Behavior, Attention Problems, and Conduct Problems) was investigated. Data were analyzed using Pearson correlations and linear regression.

RESULTS

On average, caregivers endorsed 3.10 (SD = 2.99) ACEs experienced by their children. The two most frequently endorsed ACE risk factors were having lived with a household member with a mental health disorder, followed by having lived with a household member with a substance use disorder. Higher total ACEs score significantly predicted a greater overall frequency of child behavior (intensity scale), but not whether the caregiver perceived the behavior to be a problem (problem scale) on the ECBI. No other variable significantly predicted the frequency of children's disruptive behavior. Exploratory regressions indicated that a higher ACEs score significantly predicted greater Conduct Problems. Total ACEs score was not associated with Attention Problems or Oppositional Behavior.

DISCUSSION

Children with FASD are at risk for ACEs, and those with higher ACEs had a greater frequency of problem behavior on the ECBI, especially conduct problems. Findings emphasize the need for trauma-informed clinical care for children with FASD and increased accessibility of care. Future research should examine potential mechanisms that underlie the relationship between ACEs and behavior problems to optimally inform interventions.

Association of Adverse Childhood Experiences with Heart Conditions in Children: Insight from the 2019-2020 National Survey of Children's Health

Adverse Childhood Experiences (ACEs) have been associated with a higher risk of developing cardiovascular diseases and premature mortality in adults.

OBJECTIVES

We evaluated the associations between ACEs and heart diseases among children in the United States.

METHODS

Data on children ages 0 to 17 years reported by parents/guardians to have current heart conditions were analyzed. Using Stata version 17 software, descriptive statistics were generated for the demographic characteristics and the various health outcomes using the chi-square of independence. Multivariate logistic regression models were employed to determine the associations between ACEs and heart conditions, the severity of heart conditions, and overall health status.

RESULTS

There were 826 children with current heart conditions from a total of 68,753 surveyed children. This corresponded to an estimated 780,000 (1.13%) children living with heart conditions in the U.S. On multivariate logistic models, several ACEs, including household economic hardship, parental/guardian's alcohol/drug abuse, severe mental health illness of parents/guardians, racial/ethnic discrimination, exposure to neighborhood violence, and accumulation of two or more ACEs, were significantly associated with heart diseases among children. Though the accumulation of two or more ACEs did not have a significant association with the severity of heart condition, it was significantly associated with caregiver reports of undesirable overall health status.

CONCLUSIONS

ACEs are significantly associated with heart conditions among children and contribute to unfavorable overall health status among children with heart conditions in the U.S. There is a need for policies and programs that will promptly identify ACEs and mitigate their negative impact on children.

Association of Adverse Childhood Experiences and Resilience With Obesity, High Blood Pressure, and Parental Report of Behavioral Health Symptoms in Children: A Cross Sectional Study

The interplay between Adverse Childhood Experiences (ACEs) and resilience on health in children is not well understood. Parents completed 3 questionnaires: ACEs, Child and Youth Resilience Measure (CYRM), and the Pediatric Symptom Checklist-17(PSC-17). BMI and blood pressure were measured. 19.8% of children had 4 or more ACEs, resilience ranged from 25 to 51, 14.3% had a positive PSC-17 score, 25.6% were obese, 3.1% had systolic hypertension, and 1.2% had diastolic hypertension. Higher ACEs (ACE OR: 1.398, 95% CI = 1.044-1.893, P = .026) and lower resilience (Resilience OR: 0.740, 95% CI 0.668-0.812; P = 1.13 × 10^-9) were predictive of increased reports of behavioral health symptoms, but not obesity or hypertension. The personal resilience subscale was a predictor of positive PSC-17 score (OR 0.646, 95% CI = 0.546-0.749, P = 3.18 × 10^-8); relationship subscale was not. Cultivating resilience, especially personal aspects, may provide an effective intervention for behavioral health symptoms in children.

Honoring the past and charting the future: The International Society of Psychiatric Mental Health Nurses' commitment to advance diversity and equity in mental health care

For more than two decades, the International Society of Psychiatric Nurses has dedicated its efforts to improving mental health care services worldwide, focusing on leveraging the psychiatric nursing workforce and advocating to eradicate systemic health disparities. Part of this labor included creating a culturally centered initiative, the Position Statement on Diversity, Cultural Competence and Access to Mental Health Care to fortify the cultural awareness of ISPN members to improve health-care quality delivered to diverse individuals, families, and communities across the life span and to improve these populations' access to mental health care.

Adverse childhood experiences and child behavioral health trajectory from early childhood to adolescence: A latent class analysis

BACKGROUND

Adverse childhood experiences (ACEs) profoundly influence child development. Different patterns of ACEs among boys and girls may be associated with different developmental trajectories.

OBJECTIVE

This study aimed to identify patterns of ACEs at age three and tested the associations of these patterns with child behavioral health problems from age three to age fifteen.

PARTICIPANTS AND SETTING

This study used data (N = 4898) from the Fragile Families Child Wellbeing Study.

METHODS

First, this study conducted latent class analysis (LCA) across ten indicators of ACEs at age 3. LCA was conducted separately for boys and girls. Second, class membership was tested for associations with child internalizing symptoms and externalizing behaviors (ages three, five, nine, and fifteen years).

RESULTS

LCA identified five classes of ACEs for girls: low ACEs, parental separation, financial difficulty, chaotic home, and child maltreatment. LCA for boys, however, identified a six-class solution, in which there was a physical abuse-only class, while also a sixth high ACEs class that included both physical and emotional abuse. Classes with the most ACEs often had the highest symptomology (internalizing symptoms ranging from 0.24 to 0.56; externalizing ranging from 0.36 to 1.00; ps < .05). However, differences in behavioral health were detected depending on the patterns of ACES. At ages nine and fifteen, the financial difficulty group also had high symptomatology (internalizing symptoms ranging from 0.23 to 0.43; externalizing from 0.23 to 0.46; ps < .05).

CONCLUSIONS

Findings provide implications including the need to examine ACEs heterogeneity and address financial difficulty as a substantial ACE.

The Impact of Adverse Childhood Experiences and Community Violence Exposure on a Sample of Anxious, Treatment-Seeking Children

Screening for adverse childhood experiences (ACEs) can help prevent and reduce adverse outcomes on child development, including increased risk for anxiety disorders. Emerging studies strongly support the inclusion of community-level adversities in ACE screeners to consider diverse contexts and populations. Recent studies suggest that community violence exposure (CVE) may have a distinct impact on youth mental health. Although recent studies have examined the association between ACEs, CVE, and mental health in primary care settings, this association has not been examined on treatment-seeking children in urban mental health settings. The present study employs a mediation model using the PROCESS macro to examine community violence exposure mediating the effect on the association between ACEs and somatic symptoms (SS) on a sample of anxious treatment-seeking children. A total of 98 participants (Mage = 11.7, SD = 3.79, 51.6% males, 54.1% ethnic minority children) who sought services at a specialized anxiety clinic completed self-report measures. Results indicated that exposure to ACEs is associated with endorsement of somatic symptoms as a result of reporting hearing, witnessing, or experiencing CVE. Evidence of mediation was found in a statistically significant indirect effect of ACEs on SS through CREV (Effect = .17, 95% CI = .069-.294). These findings support recent evidence that CVE is a distinct ACE as it contributes to toxic stress similar to individual-level ACEs. The use of a comprehensive ACE screening that includes CVE is warranted, particularly when working with culturally and socioeconomically diverse populations, as it would better capture a broader range of adversities across demographic groups.

Adverse Childhood Experiences: Mental Health Consequences and Risk Behaviors in Women and Men in Chile

Studies conducted worldwide indicate that adverse childhood experiences (ACEs) are among the most intense and frequent sources of stress, considerably influencing mental and physical health while also resulting in risk behaviors in adulthood.

METHODOLOGY

We used data from the Pilot National Survey of Adversity and Sexual Abuse in Childhood (2020), conducted by CUIDA UC, which comprises the Adverse Childhood Experiences International Questionnaire [ACE-IQ] (Adapted). The cross-sectional methodology used made it possible to directly calculate the prevalence of adverse childhood experiences in the population sampled, at a single point in time. We performed a bivariate and univariate descriptive analysis, a correlation analysis, and a multivariate analysis, all of which will be detailed in the section entitled "General Data Analysis Procedure".

RESULTS

We found equally high rates of adverse childhood experiences in men and women, with community violence exhibiting the highest prevalence. We found significant low- to moderate-sized associations between the multiple types of ACEs considered and mental health problems, substance use problems, criminal behaviors, and intrafamily violence (IFV), which differed between men and women. Significant correlations were detected between the ACE score and mental health, substance use, criminal behaviors, and IFV in both men and women. Importantly, ACEs were found to be predictors of all of these variables, with differences observed between men and women.

CONCLUSIONS

Nearly all participants reported having had at least one ACE and more than half reported had four or more ACEs. Those who had had four or more ACEs were more likely to report problems throughout their life. Having an ACE of any type was found to be a better predictor of mental health problems and IFV in men than in women and might be a stronger risk factor for substance use and criminal behaviors in women than in men.

Intimate Partner Violence Exposure and Adolescent Mental Health Outcomes: The Mediating Role of Housing Insecurity

The present study investigated pathways from childhood exposure to mothers' intimate partner violence (IPV) to adolescent depression and anxiety. Further, the study examined whether housing insecurity mediated the link from IPV exposure to mental health outcomes. Data came from the Years 5, 9 and 15 interviews of the Fragile Families and Child Well-being Study; the analytic sample was limited to mothers with at least partial custody of children (N = 2,425). Structural equation modeling with latent variables investigated research questions. Confirmatory factor analysis (CFA) identified observed indicators for latent constructs, and a path analysis tested direct and indirect pathways from IPV exposure to adolescent depression and anxiety. IPV exposure at age five was associated with increased housing insecurity at age nine, which was associated with increased adolescent depression and anxiety at age 15. Although IPV exposure was not directly associated with either mental health outcome, housing insecurity mediated the link from IPV exposure to adolescent depression. Findings point to the long-term consequences of exposure to intimate partner violence in childhood, highlighting pathways to mental disorder in adolescence. The present study emphasizes the need for policies that protect survivors of IPV from eviction and homelessness, empower them to leave abusers without fear of losing their housing, and promote healthy child development in the wake of family violence.

Omar ZT, Segun E, Evbayekha EO, Abolurin A, Egberuare EO, Ezegbe HC, Adegbosin A, Adedeji AG, Angaye EG, Izundu IC, Oyelade BO. Impact of Adverse Childhood Experiences on Resilience and School Success in Individuals With Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder

Adolescents with emotional and behavioral disorders face known academic challenges and poor life outcomes. It was imperative to explore and find if the new diagnostic criterion for diagnosing autism profoundly affects educational outcomes and resilience in individuals diagnosed with co-occurring autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). The literature is robust on the impact of adverse childhood experiences (ACEs) on educational outcomes and resilience in adolescents with no history of disability. Still, there remains a dearth of literature explaining, with no ambiguity, the complex relationships between ACEs and resilience, school engagement, and success in individuals with co-occurring ASD and ADHD. This study reviews the existing scholarships on the topic. The significance of this review is that it informs healthcare providers, rehabilitation counselors, and educators about the need for early identification of individuals with ASD and ADHD with a background in ACEs. This will enable interventions early enough to ensure they are more resilient and can obtain improved success in school-related and outside-school activities and eventually improved quality of life.