A Developmental Psychopathology Perspective on Adverse Childhood Experiences (ACEs): Introduction to the Special Issue

Das „innere Klima“ regulieren in Zeiten globaler Erwärmung

Regulating the "Inner Climate" in Times of Global Warming "Climate protection is child protection". This statement by the German Psychological Society ("DGPs-Stellungnahme_KiJu_Klima, 2023) vividly illustrates the negative effects of climate change on children's psyches. According to the Sinus-Youth study (Calmbach et al., 2024), climate anxiety ranks second in the hierarchy of adolescent anxieties, immediately following the fear of war. Asbrand, Peter, Calvano, and Dohm (2024) have demonstrated that young people are significantly burdened by climate fears. While there are numerous descriptions of the problem, this article focuses on potential solutions. The present article focusses on two such approaches: START (Stress-Traumasymptoms-Arousal-Regulation-Treatment) (Dixius u. Möhler, 2016) and START-Kids (Stress-Arousal-Regulation-Treatment for Kids) (Dixius u. Möhler, 2023). START is intended for adolescents aged 13 and above, while START-Kids is designed for children between the ages of 6 and 12. The feasibility of these programs has been demonstrated in clinical settings and in several schools (Munz et al., under review). In clinical evaluation studies, emotional strain and stress were found to be significantly reduced. This article provides a brief overview of these new resilience-promoting programs an example of the START-Kids working materials from a handout for families.

Adverse Childhood Experiences (ACEs) in 252 Board-Certified Plastic Surgeons: Prevalences, ACE Clustering, and Effects on Adult Health and Behaviors, Including Self-Defined Depression, Work Addiction, and Burnout

BACKGROUND

The CDC/Kaiser Adverse Childhood Experiences (ACE) study documented that ACEs predict adult health and self-harming behaviors. ACEs have been documented in physicians and are higher in physicians treated for problematic behavior. Plastic surgeons have never been assayed.

OBJECTIVES

Might ACE prevalences in plastic surgeons predict their adult health and/or behavior?

METHODS

A total of 252 ABPS-certified plastic surgeons (72% men, 28% women) completed the 10-question CDC/Kaiser ACE survey by deidentified email. Data were collected on adult health and behaviors previously associated with ACEs in the literature.

RESULTS

In total 42% of plastic surgeons had 1 or more ACEs; 9.9% had 4 or more. Emotional abuse was 2 times higher than the control CDC/Kaiser population, although other ACEs were lower. Gender differences existed: female surgeons suffered more sexual abuse (17% vs 8%), physical neglect (7% vs 1%), violence against their mothers (7% vs 2%), and self-defined burnout (32% vs 17%). ACEs occurred in clusters. Total ACEs predicted autoimmune disorders, chronic pain/fatigue, self-defined depression, irritable bowel, antidepressant/anxiolytic use, alcohol abuse, >3 marriages, >10 sexual partners, sex and work addiction, eating disorders, and self-defined burnout (all P < .020). Emotional abuse predicted alcohol abuse. Sexual abuse predicted sex addiction. Emotional neglect predicted autoimmune disease, antidepressant/anxiolytic use, eating disorder, and work addiction. Physical neglect predicted chronic fatigue/chronic pain, depression, and burnout (all P < .001 or less).

CONCLUSIONS

Adverse childhood experiences occurred in 42% of our 252-member plastic surgeon cohort and predicted 13 adult illnesses and self-harming behaviors that can impair surgeons' lives and performances. This may facilitate their recognition and treatment.

Association Between Parental Adverse Childhood Experiences and Offspring's Risk of Suboptimal Health: A Systematic Review and Meta-Analysis

Previous reviews and meta-analysis have not adequately explored the impact of specific parental adverse childhood experiences (ACEs) subtypes on offspring's health. This updated systematic review and meta-analysis aimed to investigate the association between parental ACE subtypes and various offspring health outcomes. A comprehensive search was conducted in electronic databases including PubMed, Web of Science, the Cochrane Library, WANFANG, and China National Knowledge Infrastructure for studies published in English and Chinese from January 1, 1998, until July 18, 2023. Two independent reviewers screened studies, extracted data, and assessed study quality using the Newcastle-Ottawa Scale. A random-effects model was applied to generate pooled odds ratios (ORs) and 95% confidence interval (95% CI). A total of 47 eligible studies were included in the final analysis. Overall, parental ACEs were significantly associated with several offspring's health outcomes, including preterm birth (PTB), low birth weight (LBW), total developmental delay, social-emotional problems, and behavioral problems (total, externalizing and internalizing behaviors), with ORs ranging from 1.06 to 3.02. Specific subtypes of parental ACEs, such as household dysfunction, sexual abuse, and physical abuse (but not emotional abuse) were significantly associated with PTB. Household dysfunction was notably linked to delayed cognition ability in offspring. Parental sexual abuse, physical abuse, emotional abuse, and emotional neglect were significantly correlated with social-emotion problems, with the expception of household dysfunction. Regarding total behavioral problems, parental household dysfunction, physical abuse, emotional abuse, physical neglect, and peer bullying were all significantly associated with children's behavioral issues, except for emotional neglect. There is a positive correlation between parental household dysfunction, sexual abuse, physical abuse, emotional abuse, emotional neglect, physical neglect, peer bullying, and neighborhood-related adversity and their children's externalizing behavior problems. These findings underscore the significant impacts of parental ACEs on multiple adverse health outcomes in children, with specific parental ACEs subtypes exerting unique effects. This highlight the significance of comprehending the intergenerational effects of different ACE subtypes, and emphasizes the urgency of interventions to address these issues.

Parents of Child Psychiatric Patients Report More Adverse Childhood Experiences Compared with Community Samples

Adverse childhood experiences (ACEs) have already been associated, in some studies, with various diverse psychosocial abnormalities in later life. However, it is still unclear whether ACEs reported by biological parents differ from ACE scores in community samples. Background/Objectives: The aim of this study was to investigate the extent to which parents of a patient sample differ from a community sample in terms of reporting childhood experiences. In addition, the connection between parental negative traumatic experiences and their children's reporting of these experiences should be examined in more detail. Methods: In total, 256 child psychiatric patients (73.8% female and 26.2% male) aged 4-18 years (mean [M] = 13.26 years, standard deviation [SD] = 2.73) were retrospectively examined for post-traumatic stress symptoms (using the CATS questionnaire). In addition, 391 caregivers, 316 of whom were biological parents, completed the ACE questionnaire on adverse childhood experiences. The frequencies of ACEs of the parents, the traumatic experiences of the patients and their cumulative occurrence were evaluated descriptively. Results: A total of 139 (73%) mothers reported at least one negative experience in childhood. In contrast, 65 fathers (52%) reported at least one negative experience in childhood. Mothers most frequently mentioned separation from a parent (38.7%), while fathers cited emotional abuse as the most frequent negative experience. These ACE scores were significantly higher than those reported from community samples. Post-traumatic stress disorder was diagnosed in 75 (29.3%) of the 256 patients. A total of 44.6% of children of mothers and 53.8% of children of fathers reporting at least one ACE showed a CATS score above the cut-off. Conclusions: Parents of child psychiatric patients show higher scores of adverse childhood experiences than a community sample with the same population background. Further empirical studies in parents of child psychiatric patients and a larger sample seem mandatory in the face of these results.

Adverse childhood experiences and psychological maladjustment in adolescence: The protective role of epistemic trust, mentalized affectivity, and reflective functioning

INTRODUCTION

Adverse childhood experiences (ACEs) are psychosocial factors acknowledged as significant contributors to health consequences later in adolescence, including psychological maladjustment. The research suggests that, at a transdiagnostic and transtheoretical level, working on restoring epistemic trust (ET), mentalized affectivity (MA), and reflective functioning (RF) in adolescents with ACEs assumes a central role in the therapeutic process. However, there are still few studies that attempted to investigate the specific role of these sociocognitive factors in the detrimental positive association between levels of experienced ACEs during childhood and psychological maladjustment in nonclinical adolescents.

METHODS

A community sample of 306 Italian cisgender adolescents (61.4% assigned females at birth; age range 13-19 years old; Mage = 16.1, SD = 1.64) self-reported ACEs (Childhood Trauma Questionnaire-Short Form), psychological maladjustment (Strengths and Difficulties Questionnaire), ET (Epistemic Trust, Mistrust and Credulity Questionnaire), MA (Brief-Mentalized Affectivity Scale for Adolescence), and RF (Reflective Functioning Questionnaire). A multiple mediation regression analysis has been performed to explore the association between ACEs and psychological maladjustment through the interaction with socio-cognitive factors.

RESULTS

ACEs are positive predictors of psychological maladjustment later in adolescence. Regardless of gender differences, epistemic mistrust and credulity, processing and expressing emotions, and uncertainty about mental states mediated this association, while epistemic trust, identifying emotions, and certainty about mental states did not configure as significant mediators.

CONCLUSION

Findings suggest that ET disruptions and deficits in RF are risk factors, while MA is a protective factor within the link between ACEs and psychological maladjustment in adolescence. These links help to specify the role of sociocognitive factors in the development of mental problems in adolescents who have been exposed to adverse experiences in childhood.

Commentary: Early intervention for conduct problems as a child protection strategy - reflections on Nobakht et al. (2023)

Adverse childhood experiences (ACEs), including child maltreatment and interparental aggression, are known to have far-reaching consequences for mental health across the lifespan. Emerging evidence, such as that reported by Nobakht et al. (Journal of Child Psychology and Psychiatry, 2023), indicates that child conduct problems (e.g. oppositional defiant disorder, conduct disorder) may not only result from adversity but also contribute to it through transactional cascades that amplify risk for adversity over time. This commentary addresses some of the key implications of this evidence for translation into practice. It is argued that child conduct problems can be viewed as modifiable determinants of adversity and that the early identification and treatment of child conduct problems may allow for the early identification and reduction of risk for numerous ACEs.