Adverse childhood experiences: Basics for the paediatrician

Childhood adversity and psychopathology: the dimensions of timing, type and chronicity in a population-based sample of high-risk adolescents

BACKGROUND

Research on childhood adversity and psychopathology has begun investigating the dimension of timing, however the results have been contradictory depending on the study population, outcome and how adverse life events (ALEs) were operationalized. Additionally, studies so far typically focus only on a narrow range of psychiatric diagnoses or symptoms. The current cross-sectional study aimed to examine the association between timing, type and chronicity of ALEs and adolescent mental health problems.

METHODS

Adolescents from a population-based cohort oversampled on emotional and behavioral problems (mean age 14.8; range 12-17, N = 861) were included in the current analysis. Primary caregivers were interviewed on what ALEs adolescents experienced. ALEs were defined in two ways: (1) broad operationalization, including school difficulties, parental divorce, and family sickness; and (2) physically threatening abuse only, including physical and sexual violence. After looking at lifetime ALEs, we turned to chronicity, timing and sex differences. We focused on overall psychiatric symptoms as well as specific domains of emotional and behavioral problems, assessed using the Youth Self Report (YSR) and psychotic experiences assessed using the Prodromal Questionnaire-16 (PQ-16). A series of linear models adjusted for sociodemographic and parental factors were used.

RESULTS

Lifetime ALEs were associated with all types of psychopathology, with relatively bigger effect sizes for broad than for physical ALEs. The latter associations were found to be more robust to unmeasured confounding. The 9-12 age period of experiencing both broad and physical ALE's was most saliently associated with any psychopathology. Girls were more at risk after experiencing any ALEs, especially if the adversity was chronic or ALEs took place after the age of 12.

CONCLUSIONS

Broad as well as physical ALEs are associated with psychopathology, especially ALEs experienced during the 9-12 age period. Physical ALEs may be more useful in investigating specific etiological factors than broad ALEs. Sex differences may not emerge in lifetime measures of ALEs, but can be important for chronic and later childhood adversity.

Skin-to-Skin Therapy on High-Frequency Jet Ventilation: A Trauma-Informed Best Practice

Objective

To mitigate trauma for infants on high-frequency jet ventilation by decreasing exposure to noise and facilitating skin-to-skin therapy.

Design

Key drivers were identified, and we designed and implemented equipment and processes through a series of interventions. A mixed methods evaluation was used. Retrospective chart reviews assessed safety (unplanned extubation) and stability parameters. Semi-structured interviews were conducted to understand parent and staff experiences.

Results

Stability parameters demonstrated safe skin-to-skin therapy. Data from the interviews showed that parents and staff experiences focused on safety, connection and healing.

Conclusion

Implementing safe processes to support skin-to-skin therapy during high-frequency jet ventilation is possible. We hope other units will be encouraged to examine their current practices for infants on high-frequency jet ventilation to help mitigate trauma for infants and parents while enhancing staff satisfaction.

Witnessing Parental Arrest As a Predictor of Child Internalizing and Externalizing Symptoms During and After Parental Incarceration

Purpose

One in fourteen children in the United States experiences the incarceration of a parent with whom they have lived. Although prior research has established that witnessing the arrest of a parent is a common occurrence for children of criminal justice-involved parents, child outcomes following such an event are understudied. Little is known about the long-term impacts of witnessing an arrest on children and the extent to which they may vary by child age.

Methods

Using longitudinal data from the Parent Child Study of mothers and fathers incarcerated in state prison, we examine the witnessing of parental arrest as an acute traumatic event and identify the extent to which this type of trauma predicts externalizing and internalizing symptoms for children during their parents' incarceration and following release.

Results

Witnessing a parent's arrest predicted greater internalizing behavior concerns while parents were incarcerated, with a greater magnitude of effect for children under eight years of age. Six months post-release of the parent, children younger than age eight who witnessed the arrest showed significantly higher internalizing and externalizing behaviors. No effect was found for children ages eight years or older.

Conclusion

Implications for future policies to reduce the likelihood of children witnessing parental arrests, as well as the potential benefit of screening for trauma when working with children with incarcerated parents, are discussed.

Screening for Adverse Childhood Experiences in Children: A Systematic Review

CONTEXT

Adverse childhood experiences (ACEs) are associated with increased risk of poor mental health outcomes. Although there is interest in screening for ACEs for early identification and intervention, it is not known whether screening improves outcomes for children.

OBJECTIVE

To systematically review whether screening for ACEs in children leads to an increase in (1) identification of ACEs, (2) referrals to services, (3) increased uptake of services, and (4) improved mental health outcomes for children and parents.

DATA SOURCES

Ovid Medline, PsycINFO, CINAHL, and Center for Clinical and Translational Research electronic databases were searched between 2009 and 2021.

STUDY SELECTION

Studies were included if researchers screened for current ACEs in children aged 0 to 12 years and they had a control comparison.

DATA EXTRACTION

Information was extracted, including study characteristics, sample demographics, screening tool characteristics, referral rates to services, uptake rates, and mental health outcomes.

RESULTS

A total of 5816 articles were screened, with 4 articles meeting inclusion criteria. Screening for ACEs increases identification of adversity and may increase referrals to services. There are limited data about whether this leads to an increase in referral uptake by families. There are no reported data addressing mental health outcomes.

LIMITATIONS

There are few published control trials of moderate quality.

CONCLUSIONS

There is limited evidence that screening for ACEs improves identification of childhood adversity and may improve referrals. If we are to realize the hypothesized benefits of ACEs screening on child and parent mental health, it is essential to understand the barriers for families taking up referrals.

Family Context Assessment in Middle Childhood: A Tool Supporting Social, Educational, and Public Health Interventions

Quality of the family context has an important role in the physical and mental health of children; that is why it is important to have reliable and updated tools. This study aims to design and validate a new tool, the Haezi Etxadi Family Assessment Scale 7-11 (HEFAS 7-11), to assess family context quality in middle childhood. A sample of two cohorts of 772 Spanish families with children aged between 7 and 11 (M = 9.39 years; SD = 1.57; 51.2% girls), participated in the study. Results showed good psychometric properties for the instrument and the confirmatory factor analysis showed a five individual subscales structure: 1. Promotion of Cognitive and Linguistic Development (α = 0.79); 2. Promotion of Socio Emotional Development (α = 0.83); 3. Organization of Physical Environment and Social Context (α = 0.73); 4. Parental Stress & Conflict (α = 0.75); and 5. Parental Profile Fostering Child Development (α = 0.80). The association between HEFAS 7-11 and Trial Making Test was also analyzed to determine the concurrent validity of the instrument. The new scale shows its potential in the fields of research, social and educational, to know those variables that need to be promoted under the approach of positive parenting from a public health perspective.

Guardians at the Gate: Early Adversity, Neurocognitive Development, and the Role of the Pediatrician in the Era of COVID-19

Adverse childhood experiences (ACEs) profoundly impact neurocognitive development. Specifically, when these events occur during critical periods of brain plasticity, a time of significant synaptogenesis, neural pruning, and myelination, typical neurodevelopment can become derailed. Adverse childhood experiences promote morphological changes in neuronal microcircuitry which may lead to diminished cognitive flexibility, inattention, increased impulsivity, decreased school readiness, and disruptive behaviors. In this regard, the current COVID-19 pandemic represents an especially complex adverse experience that disturbs a child's social milieu and support network, likely interfering with brain maturation and executive function. Here, we take a neurodevelopmental approach to argue for the critical role that pediatricians must fulfill in mitigating the potentially detrimental consequences of COVID-19. We call for ACE screening and anticipatory guidance in the primary care setting, and the use of validated interventions and skills to bolster resilience, when ACEs are identified. We present a clinical workflow for the physician to proactively assess, identify, stratify, and address the severity of ACEs worsened by COVID-19. We discuss home-based activities and resources for children and adolescents to promote stress reduction, connectiveness, and self-awareness and create a more positive environment to maximize neurodevelopmental potential in the face of the ongoing pandemic.

Adverse childhood experiences-household stressors and children's mental health: a single centre retrospective review

OBJECTIVE

To determine the prevalence of reported 'household stressor' adverse childhood experiences (ACEs) in families of children presenting with neurodevelopmental, behavioural or emotional difficulties and to determine whether family vulnerabilities, individually or cumulatively, were associated with particular clinical symptomatology.

DESIGN

Retrospective chart review followed by statistical analysis of family stressors and clinical symptomatology.

SETTING

A community paediatric clinic in Australia.

PARTICIPANTS

All 267 children who attended an initial paediatric appointment during 2018.

RESULTS

162 (60.7%) children had been exposed to one or more household stressor ACEs, including 116 (43.4%) children exposed to parental mental illness. Behavioural disturbance occurred in 144 (53.9%) children and externalising behaviours (other than attention deficit hyperactivity disorder) were more frequent than internalising behaviours. Externalising and internalising behaviours were associated with individual and cumulative household stressor ACEs. Most other symptomatology apart from genetic/neurological conditions, autistic symptoms and some developmental delays appeared to be partially associated with ACEs.

CONCLUSION

Household stressor ACEs were common, frequently occurred concurrently, and were associated with much of the symptomatology, in this cohort. Parental mental illness was the most prevalent stressor and behavioural disturbance the most prevalent symptomatology. These findings may have implications for clinical practice and service provision.