Adverse childhood experiences and sources of childhood resilience: a retrospective study of their combined relationships with child health and educational attendance

Receipt of social services intervention in childhood, educational attainment and emergency hospital admissions: longitudinal analyses of national administrative health, social care, and education data in Wales, UK

BACKGROUND

Research consistently finds poorer health and educational outcomes for children who have experienced out-of-home care relative to the general population. Few studies have explored differences between those in care and those in receipt of intervention from social services but not in care. Children receiving social services interventions often experience Adverse Childhood Experiences (ACEs), and deprivation, which are known to negatively impact outcomes. We aimed to estimate the association of different social services interventions with educational outcomes and hospital admissions, while adjusting for ACEs and deprivation.

METHODS

We linked retrospective, routinely collected administrative records from health, education, and social care to create a cohort via the Secure Anonymised Information Linkage (SAIL) databank in Wales, UK. We analysed data for children and household members (N = 30,439) across four different groups: [1] no social care intervention; [2] children in need but not in care (CIN); [3] children on the Child Protection Register but not in care (CPR); [4] children in care - i.e. removed from the family home and looked after by the local authority (CLA). Our primary outcome was education outcomes at age 16 years. Secondary outcomes were all cause emergency hospital admissions, and emergency admissions for external causes/injuries.

RESULTS

Children in receipt of social services intervention were more likely to not attain the expected level upon leaving statutory education at age 16 after adjusting for ACEs and other characteristics (for children who had been in out-of-home care (conditional OR: 1·76, (95%CI) 1·25 - 2·48), in need (2·51, 2·00-3·15) and those at risk (i.e., on the child protection register) (4·04, 2·44 - 6·68). For all-cause emergency admissions, all social care groups were at greater risk compared to children in the general population (children in care (conditional HR: 1·31, 1·01-1·68), children in need (1·62, 1·38 - 1·90), and children at risk (1·51, 1·11 - 2·04).

CONCLUSIONS

All groups receiving social service intervention experience poorer educational and health outcomes than peers in the general population. Children who remain with their home parents or caregivers but are identified as 'in need' or 'at risk' by social care practitioners require further research. Integrated support is needed from multiple sectors, including health, educational and social care.

Resilience after adversity: an umbrella review of adversity protective factors and resilience-promoting interventions

Introduction

Resilience is the dynamic adaptive process of maintaining or recovering mental health from stressors, such as trauma, challenging life circumstances, critical transitions, or physical illnesses. Resilience after adversity can be fostered through protective factors and the implementation of interventions that promote resilience. Hence, it is essential to investigate both protective and vulnerable factors to reduce the negative effects of unfavorable life events and increase resilience through positive risk-response interventions.

Objective

To assess the effect of previous adversity, protecting factors, and resilience-promoting interventions to possess resilience after adversity in a global context.

Methods

The study included English language articles sourced from PubMed, Embase, Scopus, Web of Sciences, the Cochrane Database of Systematic Reviews, Scopus, and Google Scholar published before 15 April 2024. These articles reported the effect of adversity, protecting factors, and/or resilience-promoting interventions to possess resilience after adversity in a global context without a population age limitation. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews. A weighted inverse-variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias, and sensitivity analysis were also assessed.

Results

A total of 44 articles (n = 556,920 participants) were included in this umbrella review. From the random-effects model analysis, the pooled effect of adversity on the development of resilience was 0.25 (p < 0.001). The pooled effects of adversity-protective factors and resilience-promoting interventions after adversity were 0.31 (p < 0.001) and 0.42 (p < 0.001), respectively. The pooled effects of specific adversity protective factors were 0.26, 0.09, 0.05, 0.34, 0.23, and 0.43 for the availability of support, cognitive ability, community cohesion, positive self-perception, religious involvement, and self-regulation, respectively. The pooled effects of specific resilience-promoting interventions were 0.30, 0.21, 0.51, and 0.52 for cognitive behavior therapy (CBT) interventions, mindfulness-based interventions, mixed interventions, and resilience-promoting interventions, respectively.

Conclusion

The findings of this umbrella review revealed that people who experienced early adversity can develop resilience later in life. The study highlights the need to consider adversity protective factors, such as availability of support (family, friends, and school), cognitive ability, community cohesion, positive self-perception, religious involvement, and self-regulation, and resilience-promoting interventions, including CBT interventions, mindfulness-based interventions, and mixed interventions, to enhance resilience promotion programs.

Post-traumatic change and resilience after childhood maltreatment: Impacts on maternal mental health over the postpartum period

BACKGROUND

Mothers with a history of childhood maltreatment (CM) are particularly vulnerable to postpartum mental health changes. Variability in mental health trajectories is present over the first 18-months postpartum. Little is known about the potentially unique impacts of post-traumatic change or resilience on later postpartum mental health.

METHODS

Participants (N = 97) completed questionnaires over the first 18-months postpartum measuring demographic risk, mental health symptoms, traumatic experiences, and resilience. Mothers also completed an interview measure coded for post-traumatic changes at 6-months postpartum. Multinomial logistic regression models examined post-traumatic change and resilience factors as predictors of mothers' longitudinal latent mental health trajectory.

RESULTS

Three classes of latent postpartum mental health emerged: low-symptom, vulnerable, and chronic high-risk. Mothers reporting stronger positive post-traumatic changes were more likely to be in the low-symptom class than the chronic high-risk class (B = -1.082, p = .01). Mothers reporting stronger negative post-traumatic changes were more likely to be in the vulnerable class (B = 0.778, p = .006) or chronic high-risk class (B = 0.906, p = .046) than the low-symptom class. Resilience was not predictive of mental health class.

LIMITATIONS

Findings are correlational, and causal effects between post-traumatic growth and mental health symptoms cannot be assumed. Mothers who consented to the interview may not be fully representative of all women who have experienced CM, limiting generalizability of findings.

CONCLUSIONS

Positive post-traumatic change is associated with reduced psychopathology. These findings may assist in identification of mothers at greater risk of adverse postpartum outcomes and futher inform interventions focused on enhancing positive changes in post-traumatic cognitions.

Systematic review of protective factors related to academic resilience in children and adolescents: unpacking the interplay of operationalization, data, and research method

Identifying protective factors that promote academic resilience is vital. Nevertheless, due to the variations in the operationalizations of academic resilience, timeframes, data sources, and employed research methods, it remains unclear whether the impact of protective factors identified across studies can be attributed to the factors themselves or to these variations. By addressing these uncertainties, this study aims to provide an overview of the protective factors that have been extensively investigated in academic resilience and their degree of influence. A literature search found 119 empirical studies on protective factors in education settings for children and adolescents. The review analyzed five protective factors groups (individual, family, school, peer, community), three operationalizations of academic resilience (simultaneous, progressive, instrumental), two timeframes (longitudinal, non-longitudinal), three data sources (self-collected, national/local assessments, international large-scale assessments), and commonly employed research methods. The studies analyzed in this review yielded mixed results regarding the impact of the examined protective factors, with measurement instruments and statistical power playing a significant role in explaining the variations. Individual and school-level characteristics emerged as the most well-studied protective factors; individual characteristics were often investigated through "instrumental" operationalization and structural equational models, whereas school-level characteristics were typically explored through "simultaneous" or "progressive" operationalizations and multilevel modeling. Approximately 31 and 16% of the studies utilized national assessments and international large-scale assessment data, respectively. Both data sources promoted the exploration of school-level factors, with the former facilitating the exploration of protective factors across time and the latter contributing to the investigation of teaching-related factors.

Do Ethnic Identity, Familial, and Community Contexts Impact the Association Between Adverse Childhood Experiences and Psychopathology Among Latinx Adolescents?

OBJECTIVE

Few studies have explored the interplay of how individual identity, parental, familial, and contextual factors impact associations between Latinx adolescent adversities and psychopathology. This study aimed to examine whether these factors mediate the relationship between adversities and psychopathology in Latinx youth.

METHOD

Latinx youth (n = 2,411) data from the Adolescent Brain Cognitive Development (ABCD) Study were used to examine path models with adverse childhood experiences (ACEs) as the predictor and either youth- or caregiver-rated internalizing/externalizing scores over 4 timepoints as the outcome (ages 9-13 years). Models examined 3 potential mediators: (1) ethnic identity, (2) familial context (comprising parental monitoring, family conflict, and caregiver acceptance), and (3) community cohesion. Models were conducted separately for internalizing and externalizing symptoms.

RESULTS

Greater adversity was associated with greater youth- and caregiver-rated internalizing/externalizing psychopathology over time. Greater adversity was associated with lower family functioning and lower ethnic identity, and greater family functioning was associated with lower psychopathology. Family functioning mediated associations between adversity and psychopathology over time (youth-reported internalizing: 95% CI = 0.012-0.019; youth-reported externalizing: 95% CI = 0.020-0.028). In contrast, there was not strong evidence for ethnic identity and community cohesion mediating associations between adversities and psychopathology over time.

CONCLUSION

Unlike previous studies, ethnic identity did not influence the relationship between ACEs and psychopathology over time. Additional research is needed to identify whether possible tensions rise as Latinx youth acculturate into US culture and achieve optimal levels of ethnic identity formation. Providers need to assess specific Latinx parental and familial contexts that may interfere with youth identity formation.

Trajectories of risk and resilience: The role of empathy and perceived social support in the context of early adversity

BACKGROUND

Evidence overwhelmingly suggests that adverse childhood experiences (ACEs) is a risk factor for poor mental health outcomes. However, the specific mechanisms via which ACEs confer an increased risk of psychopathology are less well understood.

OBJECTIVE

The study modelled the effect of empathy and perceived social support (PSS) on mental health outcomes in a mixed clinical and non-clinical population, within the context of exposure to ACEs.

PARTICIPANTS AND SETTING

A total of 575 participants (comprising a treatment-receiving and community-based sample), aged 18 to 65 completed self-report measures assessing early adversity, PSS, empathy, and mental health outcomes.

METHODS

Multiple mediation analyses were used to investigate whether empathy and PSS mediated the relationship between self-reported ACEs and mental health outcomes, and whether affective and cognitive empathy affected differentially the link between emotional neglect and psychological distress.

RESULTS

Results revealed a statistically significant indirect effect of ACEs on adult mental health through affective empathy and PSS. Emotional neglect was the only type of adversity significantly correlated with both dimensions of empathy. The indirect effect of emotional neglect on mental health outcomes via cognitive and affective empathy was also statistically significant.

CONCLUSIONS

Study results highlight the role of affective empathy and PSS as transdiagnostic mechanisms influencing the pathway between early adversity and adult mental health, and the importance of taking these into account when designing interventions aiming to promote well-being among those who have experienced childhood adversity.

The trajectory of anxiety in therapy: The role of ACEs

The connection between adverse childhood experiences (ACEs) and anxiety disorders is well-documented. Additionally, therapy has been shown to be effective at reducing anxiety symptoms. Yet more needs to be known about how ACEs may shape the process of therapy and the trajectory of anxiety symptoms. This study was designed to compare the trajectory of improvement in anxiety symptoms over the course of 12 sessions of therapy in adults (N = 472), who reported more (greater than four) and fewer (fewer than four) ACEs using a multigroup latent growth curve analysis. Data were drawn from the Marriage and Family Therapy Practice Research Network database. Results suggested that the rate of improvement in those with more and fewer ACEs was not significantly different; however, those with more ACEs had a significantly higher average starting point of anxiety symptoms.

Multi-level factors associated with psychological resilience in the face of adverse childhood experiences among Chinese early adolescents

BACKGROUND

Adverse childhood experiences (ACEs) are pervasive and exert enduring negative effects on health throughout one's life. A better understanding of resilience among adolescents with ACEs exposure is crucial to enhance their mental health; however, comprehensive and multifaceted analyses of its associated factors are limited.

OBJECTIVE

This study aimed to investigate multi-level correlates of psychological resilience in Chinese early adolescents exposed to ACEs.

PARTICIPANTS AND SETTING

In a sample of 5724 middle school students, 65.5 % (n = 3749; 49.1 % females; Mage = 13.57, SD = 0.96) reported ACEs during their primary school period and were finally included in this study.

METHOD

Both linear regression and network models were conducted to explore correlates of capacity- and outcome-oriented resilience at the individual (i.e., five personality traits, emotional release, and loneliness), family (i.e., family support and relationships with the mother and father), and school levels (i.e., peer support, teacher support, and relationships with classmates and teachers).

RESULTS

Linear regression analysis revealed that all correlates were associated with capacity- (β ranged from -0.271 to 0.503, PFDR < 0.001 for all) and outcome-oriented resilience (β ranged from -0.516 to 0.229, PFDR < 0.001 for all). Similarly, network analysis revealed that neuroticism, conscientiousness, loneliness, emotional release, extraversion, and the relationship with the mother were directly associated with both capacity- (weights ranged from 0.029 to 0.179) and outcome-oriented resilience (weights ranged from 0.024 to 0.396). However, openness, peer and family support, and relationships with classmates and teachers were directly associated with capacity-oriented resilience (weights ranged from 0.020 to 0.201).

CONCLUSIONS

This study identified the shared and unique associated factors for capacity- and outcome-oriented resilience in the face of ACEs and demonstrated the complex interactions between these factors, which can guide tailored interventions to enhance resilience among Chinese early adolescents with ACEs exposure. Further longitudinal studies may endeavor to confirm our results.

Promotive and protective effects of community-related positive childhood experiences on adult health outcomes in the context of adverse childhood experiences: a nationwide cross-sectional survey in Japan

OBJECTIVE

Although adverse childhood experiences (ACEs) are associated with poor health in adulthood, positive childhood experiences (PCEs) can reduce the risk of negative health outcomes. This study aimed to investigate whether PCEs in the community (CPCEs, ie, trusted adults other than parents, supportive friends, belongingness to school, or community traditions) would have an independent effect on better health outcomes and moderate the association between ACEs and adult illnesses.

DESIGN

Cross-sectional survey.

SETTING

Data were gathered from a nationwide, cross-sectional internet survey conducted in Japan in 2022.

PARTICIPANTS

This study included 28 617 Japanese adults aged 18-82 years (51.1% female; mean age=48.1 years).

PRIMARY AND SECONDARY OUTCOME MEASURES

The associations among self-reported ACEs, CPCEs before the age of 18 years and current chronic diseases (eg, cancer and depression) were investigated using multivariable logistic regression models.

RESULTS

CPCEs were associated with lower odds of adult diseases (such as stroke, chronic obstructive pulmonary disease (COPD), chronic pain, depression, suicidal ideation and severe psychological distress) after adjusting for ACEs. More CPCEs weakened the association between ACEs and adult diseases. Specifically, among those with ACEs, ≥3 CPCEs (vs 0-2 CPCEs) lowered the adjusted prevalence by ≥50% for stroke (2.4% to 1.2%), COPD (2.2% to 0.7%) and severe psychological distress (16.4% to 7.4%).

CONCLUSION

CPCEs could reduce ACE-related risk of poor physical and mental health in later life. Early-life interventions that enhance PCEs in schools and/or neighbourhoods are recommended.

Impact of Adverse Childhood Experiences and Mental Health on School Success in Autistic Children: Findings from the 2016-2021 National Survey of Children's Health

PURPOSE

School is an important developmental setting for children. Adverse childhood experiences (ACEs) are linked to overall lower educational attainment and are more prevalent in children with Autism Spectrum Disorder (ASD) than in their neurotypical peers. The aim of this study is to test the association between ACEs and school outcomes among autistic children and whether mental health conditions explain this association.

METHODS

We combined 2016-2021 data from the National Surveys of Children's Health for children, ages 6-17, identified by parents as having ASD (N = 4,997), to examine the relationship between ACEs and school outcomes (grade progression, school attendance, and engagement). We analyzed depression and anxiety variables to investigate the extent to which mental health can explain the relationships between ACEs and school outcomes.

RESULTS

ACEs were significantly associated with school outcomes. With increased ACEs, autistic children experienced a significant decrease in the odds of school attendance, grade progression and school engagement (p < .05). Furthermore, although depression and anxiety symptoms were significantly associated with school outcomes, they cannot explain away the enduring, strong relationship between ACEs and level of grade progression, engagement, and school success index.

CONCLUSION

Our findings suggest ACEs predict school success among autistic children, with mental health conditions appearing to mediate the relationship between ACEs and key factors in school success. Efforts should be made to proactively identify and address the impact of ACEs and associated mental health conditions among autistic students.

Depressive symptoms mediate associations of adverse childhood experiences and chronic lung diseases: A mediation effect analysis

BACKGROUND

Adverse childhood experiences (ACEs) have been found to be related to the risk of chronic lung diseases (CLDs). However, the role of depressive symptoms (DS) in this link has not been fully examined. The present study aimed to explore the mediating effect of DS on the relationship between ACEs and CLDs.

METHODS

Data for this retrospective cohort study were obtained from participants enrolled in the China Health and Retirement Longitudinal Study (CHARLS). To assess DS, the 10-item Center for Epidemiological Research Depression Scale was utilized. Logistic regression was employed to explore the associations between ACEs and DS, ACEs and CLDs, as well as depressive symptoms- chronic lung diseases (DS-CLDs). Mediation analysis was conducted to assess the mediating role of DS in the relationship between ACEs and CLDs.

RESULTS

A total of 12,277 participants, comprising 5942 males and 6335 females, were included in this study. Logistic regression analysis identified associations between ACEs and the risk of DS, CLDs, and DS-CLDs. Mediating effect analysis demonstrated that DS had partial mediating effects on the association between CLDs and 7 ACEs, including feel alone, peer bullied, self-reported poor health status, health limitations, death of siblings, physical abuse, and parental mental health. Additionally, DS fully mediated the relationship between CLDs and hunger.

CONCLUSIONS

Our study establishes a significant association between ACEs and CLDs, as well as with DS and DS-CLDs in the elderly population. Furthermore, DS acts as a mediating factor in the ACEs and CLDs relationship.

A role for adverse childhood experiences and depression in preeclampsia

Introduction

Adverse childhood experiences (ACEs) are a measure of childhood adversity and are associated with life-long morbidity. The impacts of ACEs on peripartum health including preeclampsia, a common and dangerous hypertensive disorder of pregnancy, remain unclear, however. Therefore, we aimed to determine ACE association with peripartum psychiatric health and prevalence of preeclampsia using a case-control design.

Methods

Clinical data were aggregated and validated using a large, intergenerational knowledgebase developed at our institution. Depression symptoms were measured by standard clinical screeners: the Patient Health Questionnaire-9 (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS). ACEs were assessed via survey. Scores were compared between participants with (N = 32) and without (N = 46) prior preeclampsia.

Results

Participants with ACE scores ≥4 had significantly greater odds of preeclampsia than those with scores ≤ 3 (adjusted odds ratio = 6.71, 95% confidence interval:1.13-40.00; p = 0.037). Subsequent speculative analyses revealed that increased odds of preeclampsia may be driven by increased childhood abuse and neglect dimensions of the ACE score. PHQ-9 scores (3.73 vs. 1.86, p = 0.03), EPDS scores (6.38 vs. 3.71, p = 0.01), and the incidence of depression (37.5% vs. 23.9%, p = 0.05) were significantly higher in participants with a history of preeclampsia versus controls.

Conclusions

Childhood sets the stage for life-long health. Our findings suggest that ACEs may be a risk factor for preeclampsia and depression, uniting the developmental origins of psychiatric and obstetric risk.

The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology

Although dysregulated stress biology is becoming increasingly recognized as a key driver of lifelong disparities in chronic disease, we presently have no validated biomarkers of toxic stress physiology; no biological, behavioral, or cognitive treatments specifically focused on normalizing toxic stress processes; and no agreed-upon guidelines for treating stress in the clinic or evaluating the efficacy of interventions that seek to reduce toxic stress and improve human functioning. We address these critical issues by (a) systematically describing key systems and mechanisms that are dysregulated by stress; (b) summarizing indicators, biomarkers, and instruments for assessing stress response systems; and (c) highlighting therapeutic approaches that can be used to normalize stress-related biopsychosocial functioning. We also present a novel multidisciplinary Stress Phenotyping Framework that can bring stress researchers and clinicians one step closer to realizing the goal of using precision medicine-based approaches to prevent and treat stress-associated health problems.

Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a stystematic review and meta-analysis

Background: Adverse childhood experiences (ACEs) have been shown to negatively affect health in adulthood. Estimates of associations between ACEs and chronic painful conditions are lacking.Objectives: This systematic review and meta-analysis aimed to evaluate associations between exposure to ACEs and chronic pain and pain-related disability in adults.Methods: We searched 10 electronic databases from inception to February 2023. We included observational studies assessing associations between direct ACEs (childhood sexual, physical, emotional abuse, or neglect) alone or in combination with indirect ACEs (witnessing domestic violence, household mental illness), and adult chronic pain (≥3 months duration) and pain-related disability (daily activities limited by chronic pain). Pairs of reviewers independently extracted data and assessed study risks of bias. Random-effect models were used to calculate pooled adjusted odds ratios [aOR]. Tau square [T2], 95% prediction intervals [95%PI] and I2 expressed the amount of heterogeneity, and meta-regressions and subgroup meta-analyses investigated sources of heterogeneity (PROSPERO: CRD42020150230).Results: We identified 85 studies including 826,452 adults of which 57 studies were included in meta-analyses. Study quality was generally good or fair (n = 70). The odds of reporting chronic pain in adulthood were significantly higher among individuals exposed to a direct ACE (aOR, 1.45, 95%CI, 1.38-1.53). Individuals reporting childhood physical abuse were significantly more likely to report both chronic pain (aOR, 1.50, 95CI, 1.39-1.64) and pain-related disability (1.46, 95CI, 1.03-2.08) during adulthood. Exposure to any ACEs alone or combined with indirect ACEs significantly increase the odds of adult chronic painful conditions (aOR, 1.53, 95%CI, 1.42-1.65) and pain-related disability (aOR, 1.29; 95%CI, 1.01-1.66). The risk of chronic pain in adulthood significantly increased from one ACE (aOR, 1.29, 95%CI, 1.22-1.37) to four or more ACEs (1.95, 95%CI, 1.73-2.19).Conclusions: Single and cumulative ACEs are significantly associated with reporting of chronic pain and pain-related disability as an adult.

Introducing Routine Assessment of Adverse Childhood Experiences For Looked-After Children: The Use and Properties of the Trauma and Adverse Life Events (TALE) Screening Tool

The present study aims to illustrate the process of developing, implementing, and clinically validating a new assessment measure, the Trauma and Adverse Life Events (TALE) screening tool, to assess Adverse Childhood Experiences (ACEs) among looked-after children. The TALE was developed by adapting existing ACEs measures to reflect the experiences of looked-after children. The TALE was completed by the local authority social worker for 218 children placed with Five Rivers Child Care (a UK fostering agency, residential, and educational care provider). Reliability was examined and exploratory factor analysis was conducted. Correlations between TALE scores, background variables, and psychosocial wellbeing using the carer-report Strengths and Difficulties Questionnaire (SDQ) and Child Dissociative Checklist (CDC) were also explored. The TALE was found to have acceptable reliability (α = .71). A three-factor solution was found which explained 46.24% of the variance, with factors labelled 'Direct Experience of Abuse', 'Witnessing Harm', and 'Household Dysfunction'. Exposure score was significantly associated with total difficulties score on the SDQ (rs = .24, p < .001) and Impact score was associated with the SDQ's impact score (rs = .33, p < .001). Exposure and Impact scores were both positively correlated with CDC scores (rs = .16, p = .021 and rs = .22, p = .002). This paper presents evidence of the importance of screening looked-after children for ACEs and demonstrates that the TALE is a valid and reliable tool for this purpose. Adverse and traumatic experiences were highly prevalent in this population and appeared to be closely related with children's psychosocial wellbeing. Results emphasise the importance of routine assessment of past experiences within trauma-informed psychological care and intervention planning for looked-after children.

Impacts of child sexual abuse: The mediating role of future orientation on academic outcomes

BACKGROUND

Child Sexual Abuse (CSA) has significant impacts on an individual's physical and mental well-being including substance use, depression, anxiety, post-traumatic stress disorder, relationship issues, as well as sexual revictimization in adulthood. Positive future orientation is associated with higher educational outcomes and successful goal attainment, but CSA survivors have lower educational attainment and less employment opportunities leading to less financial security in adulthood.

OBJECTIVE

Our study seeks to examine whether future orientation mediates the relationship between CSA and academic outcomes using data from the Kaplan Longitudinal and Multigenerational Study (KLAMS).

PARTICIPANTS & SETTING

KLAMS is a U.S. based panel study which captures information about the mental health, relationships, academic outcomes, and deviant behavior of two generations of family members at multiple points in time. In the present study, we use data from two separate interviews with the children (N = 2084) of the original respondents.

METHODS

We estimated a series of regressions using generalized structural equation modeling to examine the relationship between child sexual abuse, future orientation, and three different types of academic outcomes.

RESULTS

Youth who experienced sexual abuse had lower grades in school, were more likely to drop out, and had lower levels of education than children with no history of sexual abuse. Negative future orientation mediated the relationship between child sexual abuse and all three outcomes.

CONCLUSIONS

In support of existing research, we found child sexual abuse has a negative impact on positive future orientation, and positive future orientation contributes to better academic outcomes.

Burnout and secondary traumatic stress in staff working with people with intellectual disabilities: The role of adverse childhood experiences, resilience and trauma-informed organisational climate

BACKGROUND

There has been extensive research into adverse childhood experiences (ACEs), however, less consideration has been given to the prevalence and impact of ACEs for staff working with people with intellectual disabilities.

METHOD

Participants were staff employed by agencies that care for people with intellectual disabilities. An online survey collected demographic information and measures of ACEs, resilience, trauma-informed organisational climate, burnout and secondary traumatic stress. Correlation, regression, mediation and moderation analyses were used.

RESULTS

81.7% of 109 participants had experienced at least one ACE. Burnout, secondary traumatic stress and resilience were greater in the present study than in comparable samples. Trauma-informed organisational climate significantly predicted burnout and secondary traumatic stress. Resilience significantly predicted burnout.

CONCLUSIONS

Staff working with people with intellectual disabilities are likely to have experienced ACEs. Working in a trauma-informed organisational climate and resilience may be effective avenues for reducing burnout and secondary traumatic stress.

Association between adverse childhood experiences and social integration among older people in Japan: Results from the JAGES study

Social integration, network, and support are beneficial to health. However, there is little evidence of the association between adverse childhood experiences (ACEs) and social integration in later life. This study investigates the association between ACE history and social integration in older people. We used data from the Japan Gerontological Evaluation Study (JAGES) 2013, which conducted a self-reported survey of functionally independent people aged ≥ 65 years from 30 municipalities across Japan and yielded information on ACE history. We conducted a Poisson regression analysis with robust error variances to assess the association between ACE history and social integration, adjusting for sex, age, childhood economic hardship, adult socioeconomic status, health status, living status, and trust in others. The number of respondents with at least one incident of ACE was approximately 36.8%. The prevalence ratios for those who reported a history of ACEs were as follows: housebound 1.495 (95% confidence interval [CI]: 1.19-1.88), small network size 1.146 (95% CI: 1.10-1.19), low network contact 1.059 (95% CI: 1.00-1.059), non-membership sports group 1.038 (95% CI: 1.00-1.07), and non-membership hobby group 1.06 (95% CI: 1.03-1.09). Among older people in Japan, a history of ACEs is inversely associated with social integration. These findings support the life course approach and suggest that adverse events in early life may have an impact on social life in old age. In order to promote healthy aging, it is important to recognize the significant impact of early-life adversities that can extend into later life.

Adverse childhood experiences: impacts on adult mental health and social withdrawal

Background

Adverse childhood experiences (ACEs) have been found to negatively impact adult mental health outcomes. Numerous studies have highlighted on ACEs in family and community settings. However, few have examined the impact of ACEs in school settings, despite the potential influence on social participation. Hikikomori, characterized by severe social withdrawal, was first studied in Japan and has gained recognition in recent years. The present study aims to present the concept of ACEs specific to schools and investigate the impact of both school ACEs and traditional ACEs on adult mental health and Hikikomori.

Methods

A total of 4,000 Japanese adults, aged 20-34, were recruited through an Internet survey form. All data were obtained in October 2021. Participants answered questions regarding their ACEs in the family (10 items), school ACEs (five teacher-related items and two bullying-related items), depressive/anxiety symptoms, and Hikikomori (remaining at home for more than 6 months).

Results

A significant association with depressive/anxiety symptoms was shown in both ACEs and school ACEs. An increase of one point in the ACE scores was associated with a 24% increase in the risk of depressive/anxiety symptoms. School ACE scores also demonstrated a significant association with depressive/anxiety symptoms, with an increase of one point associated with a 44% increase in the risk of these symptoms. As for Hikikomori, a significant association was shown in the school ACEs only: a 29% increased risk of Hikikomori for every one-point increase in school ACE scores. Both school ACE scores for teacher-related and bullying-related factors revealed a significant association with Hikikomori; the rates of increased risk were 23 and 37%, respectively.

Conclusion

These results suggest that school ACEs, rather than ACEs in the family, are associated with the risk of Hikikomori. School ACEs are important for social adaptation, and reducing traumatic experiences in school settings may have the potential to prevent problems in later life, specifically in terms of social participation.

Maternal adverse childhood experiences on child growth and development in rural Pakistan: An observational cohort study

Maternal adverse childhood experiences (ACEs) have significant impacts on the next generation with links to negative birth outcomes, impaired cognitive development, and increased socioemotional problems in children. However, not all types or levels of adversity are similarly deleterious and research from diverse contexts is needed to better understand why and how intergenerational transmission of adversity occurs. We examined the role of maternal ACEs on children's growth, cognitive, and socioemotional development at 36 months postpartum in rural Pakistan. We used data from 877 mother-child dyads in the Bachpan Cohort, a birth cohort study. Maternal ACEs were captured using an adapted version of the ACE-International Questionnaire. Outcomes at 36 months of age included child growth using the WHO growth z-scores, fine motor and receptive language development assessed with the Bayley Scales of Infant and Toddler Development, and socioemotional and behavioral development measured with the Ages and Stages Questionnaire: Socioemotional and Strengths and Difficulties Questionnaire. To estimate the associations between maternal ACEs and child outcomes, we used multivariable generalized linear models with inverse probability weights to account for sampling and loss to follow-up. Over half of mothers in our sample (58%) experienced at least one ACE. Emotional abuse, physical abuse, and emotional neglect were the most commonly reported ACEs. We found null relationships between the number of maternal ACEs and child growth. Maternal ACEs were associated with higher fine motor and receptive language development and worse socioemotional and behavioral outcomes. Maternal ACE domains had similarly varying relationships with child outcomes. Our findings highlight the complexity of intergenerational associations between maternal ACEs and children's growth and development. Further work is necessary to examine these relationships across cultural contexts and identify moderating factors to mitigate potential negative intergenerational effects.

Family and Neighborhood Resilience Are Associated with Children's Healthcare Utilization

OBJECTIVE

To evaluate the association of external factors of resilience, neighborhood, and family resilience with healthcare use.

STUDY DESIGN

A cross-sectional, observational study was conducted using data from the 2016-2017 National Survey of Children's Health. Children aged 4-17 years were included. Multiple logistic regression was used to determine aOR and 95% CIs for association between levels of family resilience, neighborhood resilience and outcome measures: presence of medical home, and ≥2 emergency department (ED) visits per year while adjusting for adverse childhood experiences (ACEs), chronic conditions, and sociodemographic factors.

RESULTS

We included 58 336 children aged 4-17 years, representing a population of 57 688 434. Overall, 8.0%, 13.1%, and 78.9% lived in families with low, moderate, and high resilience, respectively; 56.1% identified their neighborhood as resilient. Of these children, 47.5% had a medical home and 4.2% reported ≥2 ED visits in the past year. A child with high family resilience had 60% increased odds of having a medical home (OR, 1.60; 95% CI, 1.37-1.87), and a child with moderate family resilience or resilient neighborhood had a 30% increase (OR, 1.32 [95% CI, 1.10-1.59] and OR, 1.31 [95% CI, 1.20-1.43], respectively). There was no association between resilience factors and ED use, although children with increased ACEs had increased ED use.

CONCLUSIONS

Children from resilient families and neighborhoods have an increased odds of receiving care in a medical home after adjusting for the effects of ACEs, chronic conditions, and sociodemographic factors, but no association was seen with ED use.

The Association Between Adverse Childhood Experiences and Different Types of Offending Behavior: An Examination Across Two Generations of British Males

Research has established a relationship between trauma exposure, often conceptualized as Adverse Childhood Experiences (ACEs), and offending, with some evidence suggesting that both trauma and offending can be transmitted from one generation to the next. Further, while some evidence suggests that experiencing a high number of ACEs is associated with different types of offenses, it is not known whether these associations are similar across generations. The current study aims to address this gap in knowledge by examining the effects of ACEs on different offense types across two generations, utilizing data from a longitudinal study of British male participants and their male children. Results suggest that high ACE scores are associated with several offense types within generations, but the effect of parental ACEs on the subsequent generation's offending was weak. Alongside a discussion of these findings, study limitations and future research directions are also presented.

Comparison of behavioral activation/inhibition systems, emotional regulation difficulties, and selective attention in adolescents with and without parents

Existing literature has established a relationship between adverse childhood experiences and negative outcomes in cognitive and affective functioning. However, further research is needed to thoroughly understand and validate these findings. In this regard, the current study aimed to compare behavioral activation/inhibition systems, emotional regulation difficulties, and selective attention in adolescents with and without parents. A sample of 70 adolescents (M age = 16.36, SD = 1.09, 48.57% female) with caretakers from schools and 55 parentless adolescents (M age = 16.58, SD = 1.28, 52.00% female) from orphanage centers in Tehran were recruited and completed the measures tapping behavioral activation/inhibition systems, emotion dysregulation difficulties, and selective attention. The results revealed that parentless adolescents exhibited significantly higher levels of behavioral activation/inhibition scores, emotion regulation difficulties, and impaired selective attention. These findings suggest that the absence of parents during the early years of life may have detrimental effects on behavioral inhibition and activation systems, emotional regulation abilities, and selective attention capabilities. The implications of these findings are further discussed.

Social participation, psychological resilience and depression among widowed older adults in China

BACKGROUND

Depression has become a challenging public health problem, and the loss of a spouse is one of the main causes of depression in older adults. Social participation and psychological resilience are protective factors that reduce depressive symptoms in adults. The purpose of this study was to explore the influences of social participation and psychological resilience on the depression of Chinese widowed older adults.

METHODS

We carried out a cross-sectional study on 790 community-dwelling widowed older adults in Shaanxi, China, in 2019. A structured face-to-face interview was used to collect data. We used the ordinary least squares model (OLS), the generalized propensity score matching (GPSM) and the mediation model to test the relationship between social participation, psychological resilience and depression.

RESULTS

We find a U-shaped relationship between social participation and depression, with the increase in social participation scores, the average depression level decreased and then increased. The psychological resilience of the widowed older adults was negatively associated with depression. The higher their psychological resilience, the lower their depression level. Among the four factors of psychological resilience, factor 2 (optimism and positive acceptance of change) and factor 3 (secure relationships and tolerance of negative affect) of psychological resilience were protective factors for depression after adjusting for demographic variables and physical health conditions. Psychological resilience plays a mediating role, as evident in factor 2 and factor 3 mediating the relationship between social participation and depression.

CONCLUSION

An appropriate level of social participation will relieve the depression of widowed older adults. Social participation can reduce the depression level of widowed older adults by improving their psychological resilience. Community and family could reduce depression by intervening in the social participation of widowed older adults. Active social participation is crucial because it has a protective and resilient impact, which can help people recover from the stress of losing a spouse.

The Courage to Care: Teacher Compassion Predicts More Positive Attitudes Toward Trauma-Informed Practice

PURPOSE

With greater awareness of the prevalence and impact of childhood trauma and adversity, teachers are now assuming a more active role in creating emotionally healthy environments and responding to student distress. However, supporting trauma-affected students can be a source of amplified teacher stress. Compassion has been identified as a promising construct for frontline professionals in terms of promoting psychological wellbeing, and increasing the sensitivity to detect, tolerate and respond to distress in others. It has also been identified as an important aspect of trauma-informed practice. Nevertheless, the role of compassion in teachers' attitudes towards, and readiness for implementing trauma-informed practices has not yet been explored. This study aimed to address this gap.

METHODS

A sample of 377 primary and post-primary teachers in Ireland completed the Attitudes Related to Trauma-Informed Care Scale, the Professional Quality of Life Scale, the Self-Compassion Scale, and a socio-demographic survey.

RESULTS

Teachers were found to hold generally positive attitudes toward trauma-informed care. They exhibited low to moderate levels of secondary traumatic stress and burnout, and notably high levels of compassion satisfaction, indicating that they tend to embrace their caring role and find meaning and purpose in their work. Regression analyses showed that compassion satisfaction was the strongest predictor of positive attitudes toward trauma-informed care, followed by self-compassion. Older teachers were more likely to display positive attitudes toward trauma-informed care, whilst teachers in single-sex boys' schools held attitudes that were less favorable.

CONCLUSION

This study suggests potential benefits for both teachers and students of positioning compassion at the center of educational policy and practice. The results are contextualized within the Irish and international educational landscape.

School- and community-level protective factors for resilience among chronically maltreated children in Japan

PURPOSE

Few studies have investigated how school- and community-level modifiable factors might enhance resilience, defined as an ability to recover from and cope with adversity, among chronically maltreated pre-adolescent children. This study aims to investigate school and community factors that can increase children's resilience following maltreatment.

METHODS

We used data from the Adachi child health impact of living difficulty (A-CHILD) Study, a population-based prospective longitudinal study starting with first-grade children in all public elementary schools in Adachi City, Tokyo, Japan in 2015. Children who experienced chronic maltreatment while in 1st and 4th grades and whose resilience scores were available at those grades were included in the analysis (N = 789). Crude and multiple regressions were used to examine associations of child-reported school factors (i.e., school social capital, number of friends to consult with) and community factors (i.e., having a non-parental role model and supportive adult, having a third place, which is defined as a place other than home to spend time after school) with parent-reported resilience at 4th grade. These regressions were also performed stratified by sex.

RESULTS

School social capital and having a non-parental role model at 4th grade were positively associated with resilience after adjusting covariates, including resilience at 1st grade [coefficient = 3.63, 95% confidence intervals (CI) 2.26-4.99; coefficient = 2.52, 95% CI 0.57-4.38, respectively]. Analysis by sex revealed that having a supportive adult, but not a role model, was associated with resilience among girls (coefficient = 5.50, 95% CI 0.20-10.8).

CONCLUSIONS

The findings suggest that school and community factors can promote resilience following child maltreatment, and these factors are different between boys and girls.

Latina mothers' perspectives on adverse experiences and protection of Latinx youth in an agricultural community

BACKGROUND

Adverse Childhood Experiences (ACEs) are a measure of childhood toxic stress that have a dose-dependent relationship with many adult health outcomes. While ACEs have been validated across diverse populations to measure neglect, abuse, and family dysfunction, they do not specifically assess trauma related to racism/xenophobia and immigration. 54% of Latinx youth in the United States are immigrants or children of immigrants and a large group with potentially unmeasured trauma. This study looks beyond ACEs to identify adverse and protective factors for healthy development among Latinx youth in an agricultural community through the perspectives of their mothers.

METHODS

Twenty mothers of adolescent participants in A Crecer: the Salinas Teen Health Study (a prospective cohort study of 599 adolescents) completed semi-structured interviews in Spanish. Interviews focused on mothers' perspectives on community resources, parenting strategies, parenting support systems, and their future aspirations for their children. Four coders completed iterative rounds of thematic coding drawing from published ACEs frameworks (original ACEs, community ACEs) and immigrant specific adverse events arising from the data.

RESULTS

Mothers in this study reported adverse experiences captured within community-level ACEs but also distinct experiences related to intergenerational trauma and immigrant-related adversities. The most cited community-level ACEs were housing instability and community violence. Immigrant related adversities included experiences of systemic racism with loss of resources, political instability limiting structural resources, and language-limited accessibility. These were exacerbated by the loss of family supports due to immigration related family-child separation including deportations and staggered parent-child migration. Having experienced intergenerational trauma and systemic oppression, mothers discussed their strategies for building family unity, instilling resilience in their children, and improving socioeconomic opportunities for their family.

CONCLUSIONS

Latina mothers shared the impacts of immigrant-related experiences on systemic inequities in the United States which are currently missing from the ACEs framework. Immigrant specific adverse events include language-limited accessibility, or family-child separations, and policies impacting structural resources for immigrant families. Mothers highlighted their capacity to build resilience in their children and buffer impacts of systemic racism. Community-tailored interventions can build on this foundation to reduce health disparities and promote health equity in this population.

Understanding the effects of adverse childhood experiences on older people

There is increasing recognition that adverse childhood experiences are linked to suboptimal mental and physical health in later life. Despite this, there has been little research into the effects of adverse childhood experiences on older people. This article gives an overview of the long-term mental and physical effects of adverse childhood experiences and discusses how childhood trauma may manifest in older people. The author also discusses how nurses and unpaid family carers may themselves have been exposed to adverse childhood experiences and how this may affect their caring role. It is crucial that nurses adopt a trauma-informed approach to the care of older people to take account of possible adverse childhood experiences and prevent re-traumatisation.

Injury, illness, and emotion: A review of the motivational continuum from trauma through recovery from an ecological perspective

Image 1.

Intergenerational associations of adverse and positive maternal childhood experiences with young children's psychosocial well-being

Background: Maternal adverse childhood experiences (ACEs) are believed to have negative consequences on offspring health. However, positive childhood experiences (PCEs) may be concurrent with ACEs, and little is known about how ACEs and PCEs transmit intergenerationally in the context of each other.Objective: To explore the independent effect of maternal ACEs and PCEs on offspring psychosocial well-being and how ACEs and PCEs are intergenerationally transmitted in their context.Method: Data were 2587 mother-child dyads in Anhui provinces of China. Mothers retrospectively reported their ACEs and PCEs, as well as provided demographic characteristics and their children's psychosocial well-being. Logistic regression models were performed to explore the associations of maternal ACEs and PCEs with offspring psychosocial well-being.Results: Separate unadjusted logistic regression models showed that children with mothers reported high ACEs scores were more likely to have psychosocial challenges (total difficulties and prosocial problems), while children whose mothers reported high PCEs scores were less likely to have psychosocial challenges. When we added maternal ACEs and PCEs to a same model, we found that PCEs slightly neutralised the negative effects of ACEs on offspring's total difficulties and prosocial problems. When stratified by sample, mothers with high PCE scores and higher maternal ACEs were related with a higher risk of offspring total difficulties; mothers with low levels of ACEs and high PCEs tend to report a lower risk of offspring total difficulties.Conclusions: Results suggest that PCEs are positively and intergenerationally transmitted. Results suggest that PCEs are positively and intergenerationally transmitted. More programme should be provided to increase maternal PCEs. When preventing the intergenerational transmission of ACEs, specific interventions should be provided to mothers with different levels of PCEs.

“Realizing the problem wasn’t necessarily me”: the meaning of childhood adversity and resilience in the lives of autistic adults

Purpose

Methods

Results

Conclusion

Exploring the Relationship Between Modifiable Protective Factors and Mental Health Issues Among Children Experiencing Adverse Childhood Experiences Using a Resilience Framework

The purpose of this study was to examine whether the National Scientific Council on the Developing Child (NSCDC) resilience framework statistically predicted whether a child with 4 or more adverse childhood experiences (ACEs) ever had a mental health issue. The study also explored which NSCDC modifiable resilience factors had the strongest relationship with mental health issues among children with 4 or more ACEs. Utilizing the 2019 National Survey of Children's Health, secondary data analysis was conducted using a sample of 1,225 children between 6 and 17 years old that had experienced 4 or more ACEs. Logistic regression examined whether the NSCDC framework was associated with a lower likelihood of mental health issues in school-aged children. Analysis found that the NSCDC framework predicted whether children with 4 or more ACEs ever had a mental health issue. Self-regulation had the strongest relationship with whether a child with 4 or more ACEs ever had a mental health issue. A supportive parent/caregiver relationship was also associated with a lower likelihood of ever having a mental health issue. The results demonstrate the promise of the NSCDC framework and modifiable protective factors to mitigate the impact of ACEs on mental health outcomes. Interventions that teach children skill-based self-regulation and parent/caregiver co-regulation while providing safe and supportive environments can build self-regulation to overcome ACEs. Promoting resilience-building parent-child relationships also have the potential to build resilience to mitigate ACEs.

Suicidal behaviours (ideation, plan and attempt) among school-going adolescents: A study of prevalence, predisposing, and protective factors in Saint Vincent and the Grenadines

Suicide occurs throughout life and is among the leading causes of death among adolescents globally. Aside from the growing literature on this serious mental health issue, little is known about the prevalence of suicide and the variables that predispose and protect adolescents against it in Saint Vincent and the Grenadines. We analysed the Global School-based Student Health Survey data collection among school-going adolescents in Saint Vincent and the Grenadines to explore the prevalence, risk and protective variables associated with suicidal behaviours. We observed prevalence rates of 26%, 26%, and 19% for suicide ideation, plan, and attempt, respectively. Furthermore, sex (being male) and having parents or guardians who understand the problems and worries of adolescents served as protective factors against all three suicide behaviours. However, we observed truancy, cigarette smoking, bullying victims (on/off school property), being cyberbullied, loneliness, and worry as risk factors for suicide ideation among adolescents. Risk for suicide plan was predicted by truancy, cigarette smoking, physical fight, bullying victims (on/off school property), being cyberbullied, loneliness, and worry. After controlling for other factors, truancy, amphetamine or methamphetamine use, cigarette smoking, physical fight, bullying victims (on/off school property), serious injury, close friends, loneliness, and worrying about life issues predicted suicide attempt risk among adolescents in Saint Vincent and the Grenadines. Early identification and suicide prevention interventions focusing on identified protective and risk factors may help minimise the prevalence of suicide behaviours among school-going adolescents in Saint Vincent and the Grenadines.

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.

Does screening or routine enquiry for adverse childhood experiences (ACEs) meet criteria for a screening programme? A rapid evidence summary

BACKGROUND

Adverse childhood experiences (ACEs) are traumatic events in childhood that can have impacts throughout life. It has been suggested that ACEs should be 'screened' for, or routinely enquired about, in childhood or adulthood. The aim of this work is to review evidence for this against the United Kingdom National Screening Committee (UKNSC) programme criteria.

METHODS

A rapid review of evidence on ACEs screening was conducted using the approach of the UKNSC.

RESULTS

Good quality evidence was identified from meta-analyses for associations between ACEs and a wide range of adverse outcomes. There was no consistent evidence on the most suitable screening tool, setting of administration, and time or frequency of use. Routine enquiry among adults was feasible and acceptable to service users and professionals in various settings. A wide range of potentially effective interventions was identified. Limited evidence was available on the potential for screening or routine enquiry to reduce morbidity and mortality or possible harms of screening.

CONCLUSIONS

Based on the application of available evidence to UKNSC screening criteria, there is currently insufficient evidence to recommend the implementation of a screening programme for ACEs. Further research is needed to determine whether routine enquiry can improve morbidity, mortality, health and wellbeing.

Potential effects of adverse childhood experiences on school engagement in youth: a dominance analysis

Background

Adverse childhood experiences (ACEs) can have severe negative impacts on childhood and adult health via worsened school engagement and educational outcomes. This study seeks to identify the relative importance of various ACEs in predicting school engagement.

Methods

We analyzed data from the National Survey of Children’s Health for school-aged children (ages 6-17) for 2018 and 2019. The primary outcome was school engagement, measured through three variables: repeating a grade, doing required homework, and caring about doing well in school. We conducted three logistic regression models with dominance analyses to identify the relative importance of ACE variables in predicting school engagement outcomes.

Results

In unadjusted and adjusted dominance analyses, parental incarceration was the most important ACE in predicting repeating a grade. Living in a household in which it was hard to cover basics like food or housing was the most important ACE in predicting doing required homework and caring about doing well in school.

Discussion

Our study points toward the large influence of out-of-school factors on school engagement. Parental incarceration and economic hardship, the most important predictors of engagement, are issues that can be addressed and mitigated through policy interventions. With limited funds available for education and public health interventions, it is crucial that these two ACEs be priority considerations when developing policy. A multi-faceted approach that reduces the incarcerated population, encourages economic well-being, and emphasizes early-childhood education has the potential to significantly improve school engagement in vulnerable populations and ultimately advance social equity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14524-8.

The Efficacy of a Resilience-Enhancement Program for Mothers Based on Emotion Regulation: A Randomized Controlled Trial in Japan

This study evaluated the efficacy of a brief (four 2-h sessions) group-based resilience-enhancement program focused on emotion regulation in Japan. Mothers (n = 123) of children aged 3-6 years were recruited in two prefectures and allocated with stratified randomization by the prefecture to either a bi-weekly intervention or treatment as usual. Mothers self-reported online at pre/post-intervention and at 2-month follow-up. Analysis of covariance was used to compare groups. At post-intervention and 2-month follow-up, the intervention group mothers showed significant improvements compared to the control group in resilience (p < 0.001/p = 0.001), self-esteem (p = 0.008/p = 0.001), anger control toward the child (p < 0.001/p = 0.012), and positive attribution toward the child's misbehavior (p < 0.001/p = 0.003). The partners of mothers in both groups answered the same questionnaire at the same timepoints without participating in either program; no differences between groups were found. This study was the first randomized controlled trial investigating how a resilience-enhancement program improves maternal resilience, emotion regulation, and cognition toward children and themselves. This preliminary study provides evidence that improving resilience may reduce the risk of child maltreatment. Further research regarding implementing this intervention in the community is warranted.

Positive Childhood Experiences Associate with Adult Flourishing Amidst Adversity: A Cross Sectional Survey Study with a National Sample of Young Adults

The purpose of this study was to examine the prevalence of PCEs among young adults in Mainland China and the extent to which the cumulative number of PCEs moderates the associations between ACEs and flourishing in adulthood. Between August and November 2020, we used convenience and snowball sampling to recruit 9468 young adults, ages 18-35, enrolled in undergraduate or graduate programs at universities in Mainland China to participate in a survey, which included measures on flourishing, exposure to ACEs and PCEs, and demographic characteristics. Approximately 92% of participants reported experiencing seven to nine PCEs, with harmonious family relationships (96.9%), feeling supported by friends (96.8%) and being treated fairly at school (96.3%) being the most common PCEs reported. Results of the multiple regression indicated that the cumulative number of PCEs statistically significantly moderated the relation between the cumulative number of ACEs and flourishing (interaction term b = -0.060 [-0.071, -0.049], p < 0.001, adjusted R² = 0.183); as the number of ACEs increased up through eight ACEs, decreases in flourishing were smaller among those with higher numbers of PCEs. PCEs are common among young adults from Mainland China and serve a potential buffering effect against exposure to ACEs.

School Readiness of Children Exposed to Family and Domestic Violence

Children have a universal right to live free from exposure to family and domestic violence (FDV). Children exposed to FDV can experience long-term effects on their physical and psychological health and their social competencies including social, emotional, and cognitive skills and behaviours that underpin successful social adaptation and academic achievement. The aim of this study was to investigate if children exposed to FDV were more likely to be vulnerable on school readiness measures compared to those children who were not exposed. Our cohort study used de-identified individual-level administrative data of children born during 2002-2010, in Western Australia, who were identified in police and hospital records as being exposed to FDV during 2002-2015. Univariate and multivariate logistic regression was used to estimate the odds of vulnerability in Australian Early Development Census (AEDC) outcomes of children exposed to FDV compared to a non-exposed cohort. After adjusting for demographic characteristics, children exposed to FDV had higher odds than non-exposed children of being vulnerable in all five AEDC domains: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school-based) and communication skills and general knowledge. Exposed children have an increased likelihood of vulnerability in all five AEDC domains: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school-based) and communication skills and general knowledge. Comprehensive multiagency early intervention for children exposed to FDV is required to mitigate the impact on outcomes, and ultimately the need to prevent FDV is needed.

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.

Family, Neighborhood and Parent Resilience Are Inversely Associated With Reported Depression in Adolescents Exposed to ACEs

OBJECTIVE

To examine the association of 1) extrinsic resilience factors and 2) adverse childhood experiences (ACEs) with a caregiver reported diagnosis of depression in a nationally representative sample of adolescents.

METHODS

A cross sectional analysis of the 2016-2017 National Survey of Children's Health, restricted to adolescents 12 to 17 years old was conducted. The dependent variable was caregiver reported depression: no current diagnosis vs. current diagnosis of depression. Independent variables were reported ACEs dichotomized as lower (0-3) or higher (4 or more), and specific resilience factors: family resilience, neighborhood cohesion and caregiver emotional support. Resilience factors were analyzed as a composite score dichotomized as lower (0-3) or higher (4 or more) and individually. Purposeful selection multivariable logistic regression model building was used to estimate the associations between reported diagnosis of depression, ACEs and resilience factors adjusting for demographic covariates.

RESULTS

Study sample consisted of 29,617 (weighted N = 24,834,232) adolescents, 6% with current reported diagnosis of depression, 8% with higher ACEs and 91% with higher resilience. Family resilience, neighborhood cohesion and caregiver emotional supports were each independently associated with lower odds of reported diagnosis of depression. However, with all resilience factors in the model, only family resilience and neighborhood cohesion (specifically school safety) remained significantly associated with lower odds of reported diagnosis of depression.

CONCLUSION(S)

In this nationally representative sample, family resilience and neighborhood cohesion were associated with lower odds of a reported diagnosis of depression even with confounding ACEs exposure. These factors may be important targets for future intervention.

Adverse Childhood Experiences and Education Outcomes among Adolescents: Linking Survey and Administrative Data

It is well established that adverse childhood experiences (ACEs) are associated with detrimental health outcomes in adulthood. Less is known about the relationships between ACEs and education outcomes and among adolescents. The aim of this study was to examine the associations between ACEs and adolescents' self-reported education outcomes and provincial education assessments among adolescents in Manitoba, Canada. Data were gathered from 1002 adolescents who participated in the Well-Being and Experiences (WE) Study. A subsample of the adolescents (84%) consented to having their WE survey data linked to administrative education databases. Binary and multinomial logistic regression models were computed to examine associations between ACE history and self-reported education outcomes and provincial education assessments, adjusting for sociodemographic variables. Adolescents with an ACE history had significantly increased likelihood of having ever been suspended from school (adjusted odds ratio (aOR) = 3.33, 95% CI 1.60-6.92), of lower grades (adjusted relative risk ratio (aRRR) = 3.21, 95% CI 1.42-7.29), and of chronic school absenteeism (aRRR = 2.45, 95% CI 1.28-4.68) compared with adolescents without an ACE history after adjusting for sociodemographic variables. Findings from this study illuminate the important relationship between childhood adversity and poor education outcomes assessed directly by adolescents. Increasing awareness of the public health risk associated with ACEs and education outcomes may inform education policy and school-based interventions.

Child maltreatment and asthma

A growing body of evidence suggests a potential link between child maltreatment and asthma. Determining whether and how child maltreatment causes or worsens asthma would have major implications for disease prevention and treatment, as well as public health policy. In this article, we examine epidemiologic studies of child maltreatment and asthma and asthma-related outcomes, review the evidence for potential mechanisms underlying the child maltreatment-asthma association, and discuss future directions. To date, a child maltreatment-asthma link has been reported in most studies of children and adults, though the type of maltreatment associated with asthma has differed across studies. Such discrepant findings are likely explained by differences in study design and quality. All studies have been limited by potential under-reporting of child maltreatment and selection bias, and nonthorough assessment of asthma. Despite these limitations, the aggregate evidence from epidemiologic studies suggests a possible causal link between child maltreatment and asthma, though the relative contributions of various types of maltreatment (physical, sexual, emotional, or neglect) are unclear. To date, there is insufficient evidence of an association between child maltreatment and lung function in children or adults. Limited evidence further suggests that child maltreatment could influence the development or severity of asthma through direct effects on stress responses and anxiety- or depressive-related disorders, immunity, and airway inflammation, as well as indirect effects such as increased obesity risk. Future prospective studies should aim to adequately characterize both child maltreatment and asthma, while also assessing relevant covariates and biomarkers of stress, immune, and therapeutic responses.

An Evaluation of Whole-School Trauma-Informed Training Intervention Among Post-Primary School Personnel: A Mixed Methods Study

Students' ability to reach their potential in school-both behaviourally and academically - is linked to their educator's knowledge of child and adolescent development, childhood adversity and trauma, and how these impact learning and behaviour. However, teacher pre-service training programmes often offer inadequate instruction to meet the needs of trauma-impacted students. The purpose of the study was to investigate the benefits of professional development training in trauma-informed approaches on school personnel attitudes and compassion fatigue. There is a paucity of research on whole-school trauma-informed approaches and most have methodological limitations via the absence of a control group. In addressing this gap, the study is one of the first to utilise a control group in the research design to ensure findings are robust. The study utilised a quasi-experimental wait-list control pre-post intervention design to evaluate the efficacy of trauma-informed professional development training. We compared attitudes and compassion fatigue among 216 school personnel (n = 98 intervention, n = 118 comparison) utilising the Attitudes Related to Trauma-Informed Care (ARTIC) scale and the Professional Quality of Life scale (Pro-QoL). Quantitative data was supplemented by qualitative focus group data. Findings demonstrated that school-personnel within the intervention group reported significant improvements in attitudes related to trauma-informed care, and a significant decrease in burnout at 6-month follow-up. Our findings demonstrate that with minimum training on the dynamics of trauma, personnel attached to a school can become more trauma-informed and have more favourable attitudes towards trauma-impacted students and consequently be less likely to experience burnout.

Health Care Burden and Expenditure Associated with Adverse Childhood Experiences in Tennessee and Virginia

To estimate attributable burden and costs of conditions associated with exposure to Adverse Childhood Experiences (ACEs) in Tennessee (TN) and Virginia (VA) during 2017. This is a cross-sectional study of individuals aged 18+ having exposure to ACEs using Behavioral Risk Factor Surveillance System (BRFSS) data. Eight chronic diseases (asthma, obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), depression, cardiovascular disease, and arthritis) and two risk factors (smoking and drinking) associated with ACEs were analyzed. Pearson's chi-square tests analyzed the association between ACEs, risk factors and chronic diseases. The population attributable risks (PAR) were estimated for the ACEs related diseases and risk factors and combined with health care expenses and Disability Adjusted-Life-Years (DALYs). Among those who experienced at least 1 ACE in TN, 10% had COPD, 17% had diabetes, 36% had obesity, and 30% had depression. Individuals who experienced at least 1 ACE in VA had higher percentages for COPD, obesity and depression diseases compared to those who had no ACE (p< .0001). ACEs' exposure resulted in a burden of about 115,000 years and 127,000 years in terms of DALYs in TN and VA, respectively. The total health spending associated with ACEs based on PARs was about $647 million ($165 per adult) and $942 million ($292 per adult) in TN and VA respectively. The total costs associated with ACEs was about $15.5 billion ($3948) per person) and $20.2 billion ($6288 per person) in TN and VA, respectively. This study emphasizes the need to reduce ACEs due to high health and financial costs.

Psychographic segmentation to identify higher-risk teen peer crowds for health communications: Validation of Virginia's Mindset Lens Survey

Audience segmentation is necessary in health communications to ensure equitable resource distribution. Peer crowds, which are macro-level teen subcultures, are effective psychographic segments for health communications because each crowd has unique mindsets, values, norms, and health behavior profiles. These mindsets affect behaviors, and can be used to develop targeted health communication campaigns to reach those in greatest need. Though peer crowd research is plentiful, no existing peer crowd measurement tool has been formally validated. As such, we developed and validated Virginia's Mindset Lens Survey (V-MLS), a mindset-based teen peer crowd segmentation survey to support health communication efforts. Using an online convenience sample of teens (N = 1,113), we assessed convergent and discriminant validity by comparing the V-MLS against an existing, widely-used peer crowd survey (I-Base Survey^®) utilizing a multi-trait multi-method matrix. We also examined the V-MLS's predictive ability through a series of regressions using peer crowd scores to predict behaviors, experiences, and traits relevant to health communication campaign planning. The V-MLS demonstrated reliability and convergent and discriminant validity. Additionally, the V-MLS effectively distinguished teen peer crowds with unique health behaviors, experiences, and personal traits. When combined with appropriate information processing and campaign development frameworks, this new tool can complement existing instruments to inform message framing, tone, and style for campaigns that target at-risk teens to increase campaign equity and reach.

Trauma-Directed Interaction (TDI): An Adaptation to Parent-Child Interaction Therapy for Families with a History of Trauma

Parent-Child Interaction Therapy (PCIT) is one of the strongest evidence-based treatments available for young children and their families. Research has supported the use of PCIT for children with a history of trauma; however, the treatment does not directly address trauma in the child. PCIT is a dyadic treatment; yet, the impact of the carer’s trauma on the carer-child relationship is not assessed or incorporated into treatment. For these reasons, therapists, families, agencies, and funders tend to view PCIT as a trauma treatment with skepticism. PCIT therapists who currently address trauma within the intervention do so without a standardized approach. Trauma-Directed Interaction (TDI) is an adaptation developed to directly address these concerns. TDI maintains the key elements and theoretical underpinnings of PCIT while adding sessions to cover psychoeducation about trauma, carer response to a child’s trauma reactions (SAFE skills), and coping skills to aid both the child and the carer to manage trauma activators (COPE skills). The TDI module creates a consistent strategy for PCIT therapists to address trauma, thus allowing research and replication which will advance the dual fields of PCIT and family trauma. The theoretical conceptualization of TDI is presented along with next steps in its evaluation.

An evaluation of a short film promoting kindness in Wales during COVID-19 restrictions #TimeToBeKind

BACKGROUND

In response to successive COVID-19 restrictions in Wales, the Welsh ACE Support Hub launched the #TimeToBeKind campaign in March 2021. The campaign used a short film broadcast on national television and promoted on social media to encourage behaviour change for kindness. We evaluated the #TimeToBeKind campaign film to identify whether watching the film would result in increased intention to act in ways that promote kindness to others and if intentions were associated with being emotionally affected by the film.

METHODS

A mixed methods evaluation was employed, using a short online survey and interaction with the film on the Twitter social media platform. The online survey measured public (n = 390) attitudes towards the film including feelings invoked, and behavioural intentions for acts of kindness as a result of viewing the film. Tweets which interacted with the film (n = 59; likes, re-tweets or comments), and tweet sentiment (positive, negative, or neutral) towards the film were also explored.

RESULTS

The majority of participants reported positive attitudes to the film and agreed that they understood the campaign message (91.8%). 67.9% reported that the film made them feel upset or sad and for 22.6% the film resonated with their lockdown experience. As a result of seeing the film, 63.6% reported intentions to be kinder to others, 65.6% intended to try and help other members of their community, and 70.5% were more likely to check in on friends, family and neighbours. A higher proportion of individuals who were emotionally affected by the film (e.g. upset or sad, hopeful or encouraged, gained something positive) and those for whom the film resonated with their lockdown experience reported increased kindness behavioural intentions as a result of seeing the film.

CONCLUSIONS

Film can be an effective tool to promote behaviour change for kindness. Films that provoke strong emotional reactions can still be perceived positively and lead to behaviour change. With the COVID-19 pandemic accelerating a move online for many, the findings of the present evaluation are relevant to how public health messaging can adapt and utilise this space to target individuals and promote behaviour change.