Adverse Childhood Experiences and ADHD Diagnosis at Age 9 Years in a National Urban Sample

Genetic and phenotypic evidence of the predictive validity of preschool parent reports of hyperactivity/impulsivity and inattention

To determine the validity of parent reports (PRs) of ADHD in preschoolers, we assessed hyperactivity/impulsivity (HI) and inattention (IN) in 1114 twins with PRs at 1.5, 2.5, 4, 5, 14, 15, and 17 years, and teacher-reports at 6, 7, 9, 10, and 12. We examined if preschool PRs (1) predict high HI/IN trajectories, and (2) capture genetic contributions to HI/IN into adolescence. Group-based trajectory analyses identified three 6-17 years trajectories for both HI and IN, including small groups with high HI (N = 88, 10.4%, 77% boys) and IN (N = 158, 17.3%, 75% boys). Controlling for sex, each unit of HI PRs starting at 1.5 years and at 4 years for IN, increased more than 2-fold the risk of belonging to the high trajectory, with incremental contributions (Odds Ratios = 2.5-4.5) at subsequent ages. Quantitative genetic analyses showed that genetic contributions underlying preschool PRs accounted for up to a quarter and a third of the heritability of later HI and IN, respectively. Genes underlying 1.5-year HI and 4-year IN contributed to 6 of 8 later HI and IN time-points and largely explained the corresponding phenotypic correlations. Results provide phenotypic and genetic evidence that preschool parent reports of HI and IN are valid means to predict developmental risk of ADHD.

Developmental Neuroendocrinology of Early-Life Stress: Impact on Child Development and Behavior

Our internal balance, or homeostasis, is threatened or perceived as threatened by stressful stimuli, the stressors. The stress system is a highly conserved system that adjusts homeostasis to the resting state. Through the concurrent activation of the hypothalamic-pituitary-adrenal axis and the locus coeruleus/norepinephrine-autonomic nervous systems, the stress system provides the appropriate physical and behavioral responses, collectively termed as "stress response", to restore homeostasis. If the stress response is prolonged, excessive or even inadequate, several acute or chronic stress-related pathologic conditions may develop in childhood, adolescence and adult life. On the other hand, earlylife exposure to stressors has been recognized as a major contributing factor underlying the pathogenesis of non-communicable disorders, including neurodevelopmental disorders. Accumulating evidence suggests that early-life stress has been associated with an increased risk for attention deficit hyperactivity disorder and autism spectrum disorder in the offspring, although findings are still controversial. Nevertheless, at the molecular level, early-life stressors alter the chemical structure of cytosines located in the regulatory regions of genes, mostly through the addition of methyl groups. These epigenetic modifications result in the suppression of gene expression without changing the DNA sequence. In addition to DNA methylation, several lines of evidence support the role of non-coding RNAs in the evolving field of epigenetics. In this review article, we present the anatomical and functional components of the stress system, discuss the proper, in terms of quality and quantity, stress response, and provide an update on the impact of early-life stress on child development and behavior.

Patterns of Adverse Childhood Experiences and Psychiatric Disorders Among Adolescents with ADHD: A Latent Class Analysis

There is limited existing research on whether specific combinations of Adverse Childhood Experiences (ACEs) are associated with different psychiatric disorders among adolescents with ADHD. This study aimed to address this gap by identifying classes of ACEs and examining their association with behavioral problems, anxiety, and depression in adolescents with ADHD aged 11-17 (n = 1,806), using data from the 2018 National Survey of Children's Health (NSCH). A latent class analysis revealed a four-class solution: (1) low-risk ACEs (61.6%), (2) moderate-risk ACEs (25.2%), (3) high discrimination and neighborhood violence exposure (7.6%), and (4) high-risk ACEs (5.6%). The "high-risk ACEs" and the "high discrimination and neighborhood violence exposure" class showed a higher likelihood of behavioral problems and depression, and anxiety and depression respectively. These findings provide some insight into the ACE patterns that are more likely to be associated with mental health problems among adolescents with ADHD.

Adverse Childhood Experiences and ADHD Symptoms Among French College Students

To examine the relationship between adverse childhood experiences (ACEs) and Attention-deficit Hyperactivity Disorder (ADHD) among college students. We investigated the association between ACEs and ADHD symptoms among French college students enrolled in the i-Share cohort using multivariate logistic regression models. The sample comprised of 1062 participants with a mean age of 20.3 (SD = 2.3) of which 30.6% had no ACEs exposure, 29.6% had 1 ACE, 19.2% had 2 ACEs, and 20.6% had ≥ 3 ACEs. After controlling for potential confounders, every increase in ACE exposure heightened the risk of ADHD symptoms with the respective adjusted Odds Ratios and 95% confidence intervals: 1 ACE: 2.1 (0.7-6.3) / 2 ACEs: 4.5 (2.6-12.8)/ ≥ 3 ACEs: 5.2 (1.8-14.8). Estimates for ADHD symptoms were higher with sexual abuse, emotional and physical neglect, and bullying. Findings suggest that ACEs heighten the risk for developing ADHD symptoms among college students and bear important implications for prevention and clinical practice.

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

BACKGROUND

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

OBJECTIVE

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

PARTICIPANTS AND SETTING

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Longitudinal Patterns of Multidimensional Violence Exposure and Adolescent Early Sexual Initiation

Early sexual intercourse is associated with sexually transmitted infections, pregnancy, and depressive symptoms, and delay of intercourse allows adolescents opportunities to practice relationship skills (Coker et al., 1994; Harden, 2012; Kugler et al., 2017; Spriggs & Halpern, 2008). Thus, understanding predictors of early sexual intercourse is crucial. Prior research has suggested that violence exposure is associated with early initiation of sexual intercourse in adolescence (Abajobir et al., 2018; Orihuela et al., 2020). However, most studies have looked only at a single type of violence exposure. In addition, little research has examined longitudinal patterns of violence exposure in order to determine whether there are particular periods when the violence exposure may have the strongest impact on sexual behavior. Guided by life history and cumulative disadvantage theories, we use longitudinal latent class analysis and data from the Future of Families and Child Well-being Study (N = 3,396; 51.1% female, 48.9% male) to examine how longitudinal patterns of multiple types of violence exposures across ages 3 to 15 are associated with early sexual initiation in adolescence. Findings suggest that experiencing persistent physical and emotional abuse across childhood was associated with the greatest prevalence of early sexual initiation. Early exposure to violence was not consistently associated with greater likelihood of sexual initiation; instead, early abuse was more strongly associated with sexual initiation for boys, while late childhood abuse was more strongly associated for girls. These findings suggest that gender-sensitive programs are highly needed to address unique risk factors for boys' and girls' sexual behaviors.

Early Adverse Childhood Experiences and Positive Functioning during Adolescence

Adverse childhood experiences (ACEs) have been shown to have consequences for adolescent development, yet little is known about the association between ACEs and positive functioning. Positive functioning evaluates engagement, perseverance, optimism, connectedness, and happiness, which are intimately related to pro-social behavior. As skills associated with sociability in adolescence often carry on into adulthood, understanding the developmental origins in inequalities in pro-social behavior, as measured by positive functioning, is key to ensuring equitable life chances across the life course. Subsequently, the Fragile Families and Child Wellbeing Study (FFCWS; n = 3444) was used to examine how early exposure to cumulative ACEs, plus the timing and duration of those ACEs may be associated with positive functioning development in adolescence. The sample consisted of urban-born youth (49% female) with the mean age of 15. Racial/ethnic breakdown of the sample is 18% non-Hispanic White, 49% non-Hispanic Black, 25% Hispanic, and 8% "Other". Overall, estimates suggest that roughly 88% of these youth experienced at least one ACE by age five. The findings indicate that cumulation, timing, and duration of early ACEs are related to overall adolescent positive functioning and four out of the five domains (perseverance, optimism, connectedness, and happiness), even after controlling for more recent ACEs. This study highlights the critical impact of very early ACEs on youth positive functioning, which may confer further physical, mental, and social disadvantages into adulthood. Positive functioning can serve as a protective factor against some of the negative consequences of adversity, and ensuring that all families receive proper supports may limit the lifelong effects of adversity, and most importantly, prevent ACEs from occurring in the first place.

Adverse Childhood Experiences Are Associated With Seizures in Children: A Cross-sectional Analysis

Background and Objective

To assess the relationship between adverse childhood experiences (ACE/ACEs) and epilepsy.

Methods

We performed a cross-sectional retrospective cohort analysis using population-based data from the 2018 and 2019 National Survey of Children's Health to examine caregiver-reported ACE exposures and their relationship to caregiver-reported physician diagnoses of epilepsy or seizure disorder in children. ACEs elicited in the survey included questions about experience of violence, household dysfunction, and food and housing insecurity. Adjusting for age, race, and income level, we used logistic regression to test the relationships between cumulative ACE score and current seizure disorder or epilepsy diagnosis and to examine which specific ACEs were individually associated with current seizure disorder or epilepsy diagnosis.

Results

The study population consisted of 59,963 participants; 52.2% were female, and 47.8% were male. Participant ages ranged from 0 to 17 years. A current diagnosis of epilepsy or seizure disorder was reported in 377 (0.63%) participants, and 22,749 (37.9%) participants had one or more ACE exposures. As the number of ACEs increased, odds of current epilepsy or seizure disorder diagnosis increased by 1.14 (95% confidence interval 1.07-1.22). Five ACE exposures demonstrated a high association with a current diagnosis of epilepsy or seizure disorder: food/housing insecurity, witnessing domestic violence, household mental illness, neighborhood violence, and parent/guardian incarceration.

Discussion

Multiple ACE exposures were individually associated with reporting a diagnosis of epilepsy or seizure disorder. An increase in cumulative ACE exposures increased odds of having current diagnosis of epilepsy or seizure disorder.

Early Life Stress, Hormones, and Neurodevelopmental Disorders

BACKGROUND

Early life stress (ELS) describes a broad spectrum of adverse and stressful prenatal events, namely, prenatal maternal stress (PMS), or early postnatal events, which can have detrimental long-term influences on the physiology, cognition, and behavior of an individual. There is abundant evidence indicating that ELS exerts its lasting effects on the physical and mental health of the individual, likely acting through a number of mediating mechanisms, including the disruption of developmental programming of the fetus. Neurodevelopmental disorders (NDDs), for example, attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), are a group of conditions that typically manifest during infancy, childhood, or adolescence and are characterized by developmental deficits in various domains.

SUMMARY

The scope of the current mini-review is to provide an up-to-date summary of the findings regarding the association of ELS and NDDs and the possible hormonal mechanisms through which PMS exerts its impact on neurodevelopment. We focus on the available evidence regarding children and adolescents diagnosed with ADHD or ASD. ELS exposure during developmental vulnerability windows may increase the risk for either subclinical neuropsychological alterations or clinical conditions, such as NDDs. In fact, a large body of evidence underlies the association of ELS exposure and increased risk for NDDs in the offspring.

KEY MESSAGES

The majority of data suggest that ELS, including PMS, may be associated with ADHD and ASD in the offspring, although there is no consensus regarding the critical developmental periods. Carefully controlled prospective studies are needed to determine the possible causal processes and mechanisms underlying the association of ELS and NDDs.

Adverse Childhood Experiences and Adolescent Delinquency: A Theoretically Informed Investigation of Mediators during Middle Childhood

OBJECTIVE

The purposes of this study are twofold. First, we explore the associations between cumulative ACEs at ages 5 and 7 and delinquency at age 14 in a national sample of youth in the United Kingdom (UK). Second, we explore the role of five theoretically relevant mediators in explaining this relationship.

METHODS

Analyses were based on data from the UK Millennium Cohort Study-a prospective, longitudinal birth-cohort study of more than 18,000 individuals in the United Kingdom.

RESULTS

The results indicate that early ACEs are significantly associated with adolescent delinquency, with effects becoming significantly larger as ACEs accumulate. Findings also reveal that child property delinquency, substance use, low self-control, unstructured socializing, and parent-child attachment at age 11 all significantly mediate the relationship between early ACEs and delinquency in adolescence, with early delinquency and low self-control emerging as the most robust mediators.

CONCLUSIONS

Findings point to a need for early ACEs screening and a Trauma-Informed Health Care (TIC) approach in early delinquency prevention efforts. Early intervention efforts that bolster child self-control and curtail early-onset problem behaviors may also disrupt pathways from ACEs to adolescent delinquency.

Biological Burden of Adverse Childhood Experiences in Children

OBJECTIVE

This study aimed to examine relationships between adverse childhood experiences (ACEs) and related life events and allostatic load (AL)-"wear and tear" from chronic stress-in a pediatric population.

METHODS

Children were screened with the PEdiatric ACEs and Related Life Event Screener (PEARLS) tool, a 17-item questionnaire capturing experiences of abuse, neglect, household challenges, and related life events. Biological data were available for 207 participants, and AL was operationalized using clinical or empirical cutoff points across 4 physiological systems (i.e., cardiac, metabolic, inflammatory, neurologic). Covariate-adjusted multivariable regression models were used to examine associations between AL with adversity and health.

RESULTS

Children (mean age = 6.5 years, range = 1-11 years) had an average AL score of 1.9 (standard deviation = 1.7), and a U-shaped relationship was observed with child's age. Continuous PEARLS and original ACE scores were not associated with AL. However, children with a reported PEARLS score of 1 to 2 or original ACEs score of 1 to 3 had 1.5 (incidence rate ratio [IRR] = 1.50, 95% confidence interval [CI] = 1.09-2.08) and 1.4 (IRR = 1.41, 95% CI = 1.08-1.84) times greater AL, respectively, compared with participants with none reported. In secondary analyses, caregiver mental illness was associated with higher child AL (adjusted IRR = 1.27, 95% CI = 1.01-1.58). AL was also associated with poorer perceived child general health (adjusted β = -0.87, 95% CI = -1.58 to -0.15) and greater odds of child obesity (adjusted odds ratio = 1.51, 95% CI = 1.23-1.89).

CONCLUSIONS

Measuring AL in a pediatric population requires careful consideration of age. Higher AL was associated with a greater number of reported adversities and worse child health.

Eye Movement Desensitization and Reprocessing (EMDR) as a Possible Evidence-Based Rehabilitation Treatment Option for a Patient with ADHD and History of Adverse Childhood Experiences: A Case Report Study

BACKGROUND

Children with Attention Deficit Hyperactivity Disorder (ADHD) having a history of adverse childhood experiences (ACEs) could be very difficult to treat with standard psychotherapeutic approaches. Some children diagnosed with ADHD may have Post-Traumatic Stress Disorder (PTSD) or have had experienced a significant traumatic event. Trauma and PTSD could exacerbate ADHD core symptoms and be a risk factor of poor outcome response.

OBJECTIVE

to report for the first time the history of a patient with ADHD and ACE successfully treated with an EMDR approach.

CONCLUSION

EMDR could be a promising treatment for ADHD children with a history of traumatic experiences in addition to pharmacological treatments.

Association of adverse childhood experiences and depression among medical students: the role of family functioning and insomnia

Background

Few studies have explored the mechanisms linking adverse childhood experiences (ACEs) to depression in medical students. This study aimed to investigate the relationship between ACEs and depression through the serial mediation effect of family functioning and insomnia.

Methods

A cross-sectional survey was conducted with 368 medical students from university in Chengdu in 2021. The participants were asked to complete four self-report questionnaires, including ACEs scale, the family APGAR index, the ISI and PHQ-9. Singe and serial mediation analyses were conducted using structural equation modeling by Mplus 8.3.

Results

ACEs had a significant direct effect on depression (β = 0.438, p < 0.001) and through three significantly indirect pathways: (1) through family functioning (β = 0.026, 95% CI: 0.007-0.060), accounting for 5.9% of the total effect; (2) through insomnia (β = 0.103, 95% CI: 0.011-0.187), accounting for 23.5% of the total effect; and (3) through the serial mediators involving in family functioning and insomnia (β = 0.038, 95% CI: 0.015-0.078), accounting for 8.7% of the total effect. The total indirect effect was 38.1%.

Limitations

This cross-sectional study prevented us from establishing causality.

Conclusion

This study highlights the role of family functioning and insomnia as serial mediators of the relationship between ACEs and depression. Findings help to elucidate the mechanism that underlines the pathway between ACEs and depression in medical students. These findings may indicate developing measures to strengthen family functioning and improve insomnia aiming to reduce depression in medical students with ACEs.

A Systematic Review of Longitudinal Studies Investigating the Association Between Early Life Maternal Depression and Offspring ADHD

OBJECTIVE

The systematic review sought to understand the relationship between maternal depression and later ADHD in children.

METHOD

Three databases were used to identify the studies (Medline, Web of Science and PsychInfo) resulting in 1,223 studies being screened and 14 articles being included in the review.

RESULTS

The majority of studies (N = 11) reported a significant relationship between maternal depression (across both prenatal and postnatal periods) and ADHD symptoms in children. This relationship remained significant when temperament, or past ADHD symptoms were controlled for. Several methodological issues were identified including; overreliance on maternal report and parental ADHD not being accounted for in most studies.

CONCLUSION

The review adds to the literature regarding the temporal relationship between maternal depression and the development of ADHD in children, and thus supports the case for improving access to mental health services for mothers as a preventative strategy in the development of child psychopathology.

All in the Family? A Systematic Review and Meta-analysis of Parenting and Family Environment as Risk Factors for Attention-Deficit/Hyperactivity Disorder (ADHD) in Children

Parenting and family environment have significant impact on child development, including development of executive function, attention, and self-regulation, and may affect the risk of developmental disorders including attention-deficit/hyperactivity disorder (ADHD). This paper examines the relationship of parenting and family environment factors with ADHD. A systematic review of the literature was conducted in 2014 and identified 52 longitudinal studies. A follow-up search in 2021 identified 7 additional articles, for a total of 59 studies that examined the association of parenting factors with ADHD outcomes: ADHD overall (diagnosis or symptoms), ADHD diagnosis specifically, or presence of the specific ADHD symptoms of inattention and hyperactivity/impulsivity. For parenting factors that were present in three or more studies, pooled effect sizes were calculated separately for dichotomous or continuous ADHD outcomes, accounting for each study's conditional variance. Factors with sufficient information for analysis were parenting interaction quality (sensitivity/warmth, intrusiveness/reactivity, and negativity/harsh discipline), maltreatment (general maltreatment and physical abuse), parental relationship status (divorce, single parenting), parental incarceration, and child media exposure. All factors showed a significant direct association with ADHD outcomes, except sensitivity/warmth which had an inverse association. Parenting factors predicted diagnosis and overall symptoms as well as inattentive and hyperactive symptoms when measured, but multiple factors showed significant heterogeneity across studies. These findings support the possibility that parenting and family environment influences ADHD symptoms and may affect a child's likelihood of being diagnosed with ADHD. Prevention strategies that support parents, such as decreasing parenting challenges and increasing access to parent training in behavior management, may improve children's long-term developmental health.

Adverse childhood experiences and traumatic brain injury among adolescents: findings from the 2016-2018 National Survey of Children's Health

Exposure to adverse childhood experiences (ACEs) is a significant public health issue for youth. However, traumatic brain injury (TBI) has been almost entirely overlooked in the ACEs and health outcomes literature, which has largely focused on the significant mental and behavioral health impact of ACEs. The goal the current study is to examine the association between ACEs and TBI among a nationally representative sample of adolescents in the United States and the extent to which ADHD and conduct problems inform this association. To assess this relationship, we use a sample of 42,204 adolescents (ages 12-17 years) in the United States whose caregivers were surveyed during the three most recent cohorts (2016-2018) of the National Survey of Children's Health (NSCH). The results revealed a dose-response relationship between ACEs and TBI, even after accounting for an array of confounding variables. Findings also indicated that associations were of a greater magnitude among youth who are not sports-involved. Supplemental mediation analyses showed that ADHD and conduct problems attenuated associations between ACE exposure and TBI, but only in the absence of youth sports involvement. Given that both ACEs and TBI carry long-term consequences for health and well-being, the findings from this study draw attention to the need for early intervention and prevention programming (e.g. home visiting) that can reduce the prevalence of ACEs and a history of TBI among adolescents.

ADHD in the DSM-5-TR: What has changed and what has not

In this article, we critically review the changes made to the DSM-5 Text Revision published in 2022 regarding the diagnostic entity of Attention Deficit/Hyperactivity Disorder (ADHD). We structure our critique around three points. The first discusses the acknowledgment of ADHD as a neurodevelopmental disorder. The second examines the definition of ADHD provided in the updated edition of the manual. The third scrutinizes the changes in the diagnostic criteria for ADHD and assesses whether these changes make the diagnosis more accurate. We conclude that DSM's latest edition does not escape the logical and scientific pitfalls of its predecessor. DSM-5-TR keeps the faith in the neo-Kraepelinian paradigm by explicitly and implicitly cultivating the essentialist medical scientific metaphor of disorder, creating the illusion that it represents scientific progress that validates ADHD as a neurodevelopmental disorder.

Early adverse childhood experiences and exclusionary discipline in high school

The use of school suspension and expulsion is a widespread phenomenon in American schools (Wallace et al., 2009; Owens and McLanahan, 2020). Yet, much of what we know about these exclusionary practices provide little insight into the personal biographies of the students themselves-specifically their histories of childhood trauma. Using measures of adverse childhood experiences (ACEs), we examine the link between early ACEs (up to age 5) and school suspension/expulsion using the Fragile Families and Child Wellbeing Study (1998-2010) (FFCWS). We find that a child with a cumulative ACE score are almost four times more likely to have been suspended or expelled. Importantly, this negative link persists even when accounting for factors known to be associated with ACEs and school discipline. This work offers new theoretical insight into how we understand discipline in school contexts and suggests the importance of trauma-informed interventions in the American education system.

The Intersection and Dynamics between COVID-19, Health Disparities, and Adverse Childhood Experiences: "Intersection/Dynamics between COVID-19, Health Disparities, and ACEs"

The coronavirus disease 2019 (COVID-19) pandemic is shining a spotlight on health disparities that have long been overlooked in our society. The intersection between Adverse Childhood Experiences (ACEs), longstanding health disparities, and COVID-19 cannot be ignored. The accumulation of traumatic events throughout the childhood and adolescent years can cause toxic stress in the absence of supportive adults. This repetitive activation of the stress response system can be a catalyst to long-term, negative effects on both the body and brain. A major factor to appreciate is that ACEs do not affect all populations equally. ACEs disproportionately affect groups that have been historically oppressed. The current COVID-19 pandemic highlights this point when observing both case rates and fatality rates of the virus and has the potential to create a new series of long-term health conditions that will disproportionately affect marginalized communities. A foundational first and critical step of adopting a trauma-informed approach will help lead to system change, advance equity, and create a setting of mutuality and empowerment for our patients.

Adverse Childhood Experiences and Teen Behavior Outcomes: The Role of Disability

OBJECTIVE

To examine associations between adverse childhood experiences (ACEs) and teen behavior outcomes and whether the presence of disability moderates this relationship.

METHODS

We conducted a secondary analysis of population-based data from the Fragile Families & Child Wellbeing Study urban birth cohort. Disability status included physical/developmental/behavioral conditions (ages 1-5) using mother-reported child health conditions and cognitive disability (age 9), measured by the Peabody Picture Vocabulary Test (PPVT), an assessment of receptive vocabulary. We investigated whether either disability type moderates the relationship between ACEs occurring between ages 5 to 9 and behavior outcomes at age 15, specifically, standardized scales of caregiver-reported externalizing and youth-reported internalizing and delinquent behaviors. Associations were examined using multivariate linear regression models, including interaction effects of ACEs with low PPVT score and disability conditions to assess for potential moderation.

RESULTS

Of the 3038 children included, 15% had a cognitive disability and 24% had a disabling health condition. The presence of 2 or more ACEs (compared to none) is associated with more externalizing (by 0.34 standard deviations [SD]), internalizing (0.18 SD), and delinquent (0.18 SD) behaviors. Cognitive disability exacerbates this association for externalizing behaviors and delinquent behaviors while other disabling health conditions do not.

CONCLUSIONS

ACEs were associated with more behavior problems among urban youth. Cognitive disability, but not other disabling health conditions, compounded this association for externalizing and delinquent behaviors, indicating these children may be particularly vulnerable to the effects of trauma and adversity. Targeted assessment and resources for youth with cognitive disability are critical.

Examining the Relationship Between Adverse Childhood Experiences and ADHD Diagnosis and Severity

OBJECTIVE

Although prior research has examined the prevalence of ACEs among children with attention deficit-hyperactivity disorder (ADHD), little is known about the household and family settings of children with ADHD. Our study utilizes a recent nationally representative dataset to examine the association between adverse childhood experiences (ACEs), child and household characteristics, and ADHD diagnosis and severity.

METHODS

Using the 2017-2018 National Survey of Children's Health (NSCH), our sample consisted of children three years of age or older, as this is the youngest age at which the NSCH begins to ask caregivers if a child has been diagnosed with ADHD (n = 42,068). Multivariable logistic regression was used to examine the association between ACE type, score, and ADHD and ADHD severity, controlling for child and household characteristics.

RESULTS

Children exposed to four or more ACEs had higher odds of ADHD (aOR 2.16; 95% CI 1.72-2.71) and moderate to severe ADHD (aOR 1.89; 95% CI 1.31-2.72) than children exposed to fewer than four ACEs. Other child characteristics positively associated with ADHD included age and public insurance; other Non-Hispanic races compared to Non-Hispanic White had lower odds of ADHD. Of children reported with ADHD, public insurance was also associated with caregiver-reported moderate to severe ADHD.

CONCLUSIONS

Children with ADHD have a higher prevalence of ACEs, making this study important for understanding the relationship between ACEs and ADHD at the population level.

Associations of adverse childhood experiences with adolescent total sleep time, social jetlag, and insomnia symptoms

STUDY OBJECTIVE

Adverse childhood experiences (ACEs) are associated with sleep problems in adulthood, but less research has focused on ACEs and sleep during adolescence. The goal of the present study was to explore associations between ACEs reported at ages 5 and 9 years, and sleep (ie, total sleep time (TST), social jetlag, and insomnia symptoms) at age 15.

METHODS

Participants comprised 817 families from the Fragile Families and Child Wellbeing Study, a nationally representative sample of children born to unwed parents. Number of ACEs was constructed from primary-caregiver reports at ages 5 and 9, and sleep measures (ie, TST, social jetlag, and insomnia symptoms) were derived from adolescent-reported sleep behaviors at age 15.

RESULTS

Adjusting for sex and race/ethnicity, ACEs at age 9 were associated with longer weekend TST (B = 0.16, 95% CI = 0.04, 0.28), more social jetlag (B = 0.17, 95% CI = 0.07, 0.27), and higher odds of trouble falling asleep ≥3 times per week (Odds Ratio = 1.24, 95% CI = 1.01, 1.53). In females only, ACEs were associated with greater school night TST (B = 0.12, 95% CI = 0.01, 0.23). Results were similar after further adjustment for symptoms of anxiety and depression. Associations among ACEs, social jetlag, and insomnia symptoms appeared strongest among Non-Hispanic Black adolescents.

CONCLUSION

ACEs appear to be related to multiple aspects of sleep in adolescence. Additional research is needed to confirm these associations and examine the extent to which sleep disturbances associated with ACEs account for later health outcomes.

Adverse Childhood Experiences Predict Common Neurodevelopmental and Behavioral Health Conditions among U.S. Children

OBJECTIVE

Adverse childhood experiences (ACEs) can have a significant but variable effect on childhood neurodevelopment. The purpose of this study was to quantify and compare the associations between "household challenge" ACEs and common childhood neurodevelopmental and behavioral health conditions, using nationally representative U.S.

DATA

METHOD

This study used data from the 2016-2019 National Survey of Children's Health, a nationwide, population-based, cross-sectional survey. Seven household challenge ACEs (not including child maltreatment) were reported by parents/guardians: parental death, incarceration, divorce/separation, family violence, mental illness, substance abuse, and poverty. Logistic regression with sample weights was used to estimate the odds ratio (OR) for 15 parent-reported neurodevelopmental and behavioral health conditions, by the number of reported ACEs. A dose-response relationship was examined by applying tests of orthogonal polynomial contrasts to fitted logistic regression models.

RESULTS

Down syndrome, Tourette syndrome and cerebral palsy were not associated with household challenge ACEs, whereas behavior/conduct problems, depression, and substance abuse were strongly associated, with adjusted ORs ranging from 6.36 (95% confidence interval (CI) 5.53, 7.32) to 9.19 (95% CI 7.79, 10.84). Other neurodevelopmental conditions not traditionally associated with childhood adversity showed moderate yet robust associations with ACEs, including autism (adjusted OR 2.15, 95% CI 1.64, 2.81), learning disability (adjusted OR 3.26, 95% CI 2.80, 3.80), and attention deficit hyperactivity disorder (adjusted OR 3.95, 95% CI 3.44, 4.53). The ORs increased with the number of ACEs, showing significant positive linear trends.

CONCLUSION

We found significant dose-dependent or cumulative associations between ACEs and multiple neurodevelopmental and behavioral conditions.

Effects of Adversities during Childhood on Anxiety Symptoms in Children and Adolescents: Comparison of Typically Developing Children and Attention-Deficit/ Hyperactivity Disorder Group

Objectives

Childhood adversity is a risk factor for anxiety symptoms, but it affects anxiety symptoms in attention-deficit/hyperactivity disorder (ADHD). The current study aimed to examine the association between childhood adversity and anxiety symptoms in participants with and without ADHD.

Methods

Data were obtained from a school-based epidemiological study of 1017 randomly selected children and adolescents. The ADHD and non-ADHD groups were divided using the Diagnostic Interview Schedule for Children Predictive Scale (DPS). The DPS was also used to assess comorbidities such as anxiety and mood disorders. The childhood adversities were assessed using the Early Trauma Inventory Self Report-Short Form, and the anxiety symptoms were assessed using the Screen for Child Anxiety Related Disorders. Linear and logistic regression models were used to investigate the association between childhood adversity and anxiety in the ADHD and non-ADHD groups with adjustments for age and sex.

Results

This study found that the ADHD group did not show any significant association between anxiety symptoms and childhood adversities, whereas the non-ADHD group always showed a significant association. In a subgroup analysis of the non-ADHD group, the normal group without any psychiatric disorders assessed with DPS demonstrated a statistically significant association between childhood adversities and anxiety symptoms. These results were consistent with the association between childhood adversities and anxiety disorders assessed using DPS, as shown by logistic regression.

Conclusion

The association between anxiety symptoms and childhood adversities statistically disappears in ADHD; ADHD may mask or block the association. Further longitudinal research is necessary to investigate this relationship.

Adverse Childhood Experiences and Digital Media Use Among U.S. Children

INTRODUCTION

Increasing amounts of time using digital media (i.e., texting, social media, electronic gaming, and general smartphone and computer use) among children and adolescents is becoming a growing concern given its potentially deleterious effects on health. However, little is known about the social and developmental underpinnings of digital media use among children and youth. This study examines the link between adverse childhood experiences and digital media use among a recent, nationally representative sample of children and adolescents.

METHODS

Data pertaining to children/youth aged 6-17 years from the 2018 National Survey of Children's Health were analyzed in 2020 (N=21,954). The association between 9 distinct forms of childhood adversity and time spent on digital media among youth was assessed using multinomial logistic regression. The mediating roles of family-, parent-, and child-level factors were determined using the Karlson-Holm-Breen method.

RESULTS

Net of covariates, the relative risk of heavy digital media use was 3 times higher among youth experiencing ≥4 adverse childhood experiences than among those experiencing none. Both family resilience and connection as well as parenting stress emerged as significant mediators of the association between adverse childhood experiences and heavy digital media use, collectively accounting for approximately 39% of the association.

CONCLUSIONS

In an effort to mitigate heavy digital media use, providers and practitioners who consistently interact with youth should consider screening for adverse childhood experiences and referring high-risk youth and their families for various prevention and treatment programs poised to address these risk factors.

The impact of adverse childhood experiences on healthcare utilization in children

BACKGROUND

Adverse childhood experiences (ACEs) are related to long-term negative outcomes. The impact of these experiences on healthcare utilization in children has been understudied.

OBJECTIVE

To examine the impact of ACEs on children's healthcare utilization, medical diagnoses, and pharmacological treatment.

PARTICIPANTS AND SETTING

Children aged 6 months to 17 years who were screened for ACEs in the Behavioral Health Department or in primary care locations as part of an initial consultation visit and who had at least one subsequent healthcare visit during the study period were included in the study.

METHODS

Adverse childhood experiences were measured using the ACE screening questionnaire designed by Felitti et al. (1998). Data from the year following administration of the ACE screening tool were retrospectively extracted from the electronic health record.

RESULTS

Overall, 1,183 children met study inclusion criteria. Children with any reported ACEs were more likely to no show appointments (1-3 ACEs incidence rate ratio (IRR) [95 % confidence interval (CI)]: 1.40 [1.11-1.77]; 4+ ACEs IRR [95 % CI]: 1.41 [1.08-1.84]) and to use emergency services (1-3 ACEs IRR [95 % CI]: 1.24 [1.00-1.53]; 4+ ACEs: IRR [95 % CI]: 1.42 [1.11-1.81) than children with no ACEs. Those with 4+ ACEs used the telephone nurse advisor less frequently (1-3 ACEs IRR [95 % CI]: 0.67 [0.53-0.84]; 4+ ACEs IRR [95 % CI]: 0.69 [0.53-0.90]). Although ACE scores were associated with healthcare utilization, insurance status was more robustly associated with healthcare utilization than ACE score.

CONCLUSIONS

Healthcare systems may employ results from this study to adopt trauma-informed care initiatives. Ensuring that all patients have insurance may be a first step toward improving healthcare utilization.

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.

Exposure to Adverse Childhood Experiences (ACEs) and Stress among the Community-based Urban Pediatric Population in Korea

BACKGROUND

This study aimed to investigate the impact of exposure to adverse childhood experiences (ACEs) and stress among the community-based urban pediatric population in Korea.

METHODS

In 2017, the analysis was conducted on 3,937 children and adolescents in an urban area in Korea based on the impact of actual traumatic experience, addiction, and mental health. The respondents were excluded if they were missing data on the survey, resulting in a final sample size of 3,556. The collected data were analyzed by applying cross-sectional and correlation analyses.

RESULTS

Among the respondents in the study group (mean age = 13.77), 43.1% were boys (n = 1,532) and 56.9% were girls (n = 2,024). Overall, 23.5% (n = 835) reported at least one ACE and 1.8% (n = 63) reported experiencing four or more ACEs. Emotional abuse (13.2%) was the most commonly reported ACE, followed by abandonment (7.7%) and physical abuse (7.5%). Self-reported measures of stress were associated with the ACE scores.

CONCLUSION

This is the first study of self-reported ACEs from a community-based pediatric population in Korea. We found that the number of the students revealed more than one ACEs was similar to the data in the US community study with self-reporting among the community samples and exposure to adverse experiences is highly correlated with various stress responses.

Unseen Costs: The Direct and Indirect Impact of U.S. Immigration Policies on Child and Adolescent Health and Well-Being

Shifts in migration and border control policies may increase the likelihood of trauma exposure related to child-parent separation and result in costs to the health system and society. In the present study, we estimated direct and indirect costs per child as well as overall cohort costs of border control policies on migrant children and adolescents who were separated from their parents, detained, and placed in the custody of the United States following the implementation of the 2018 Zero Tolerance Policy. Economic modeling techniques, including a Markov process and Monte Carlo simulation, based on data from the National Child Traumatic Stress Network's Core Data Set (N = 458 migrant youth) and published studies were used to estimate economic costs associated with three immigration policies: No Detention, Family Detention, and Zero Tolerance. Clinical evaluation data on mental health symptoms and disorders were used to estimate the initial health state and risks associated with additional trauma exposure for each scenario. The total direct and indirect costs per child were conservatively estimated at $33,008, $33,790, and $34,544 after 5 years for No Detention, Family Detention, and Zero Tolerance, respectively. From a health system perspective, annual estimated spending increases ranged from $1.5 million to $14.9 million for Family Detention and $2.8 million to $29.3 million for Zero Tolerance compared to baseline spending under the No Detention scenario. Border control policies that increase the likelihood of child and adolescent trauma exposure are not only morally troubling but may also create additional economic concerns in the form of direct health care costs and indirect societal costs.

ADHD and Exposure to Maltreatment in Children and Youth: a Systematic Review of the Past 10 Years

PURPOSE OF THE REVIEW

The purpose of the current paper was to review and summarize the literature on ADHD and maltreatment over the past 10 years.

RECENT FINDINGS

The majority of research on ADHD and exposure to maltreatment focuses on the high rates of comorbidity, including international studies from Asia, South America, North America, and Europe. Longitudinal studies showed that early exposure to maltreatment is a risk factor for ADHD symptoms later in development; however, this finding was not consistent. There were some preliminary studies on the neurological and genetic mechanisms underlying the link between ADHD and exposure to maltreatment. Finally, ADHD and exposure to maltreatment were found to have an additive effect on clinically salient outcomes (e.g., aggression, suicide attempts). Results from the review have direct clinical and future implications, including the need to understand the effect of comorbid ADHD and exposure to maltreatment in treatment studies.

Adverse childhood experiences are associated with at-risk drinking, cannabis and illicit drug use in females but not males: an Emergency Department study

BACKGROUND

Adverse childhood experiences (ACEs) are associated with adult substance use in the general population. Given pervasive health disparities among underserved populations, understanding how ACEs are associated with substance use among urban Emergency Department (ED) patients could help inform design of effective screening, brief interventions, and referral to treatment.

OBJECTIVES

To estimate gender differences in prevalence of separate and cumulative ACEs among a sample of urban ED patients, and assess its association with at-risk drinking (4+/5+ drinks for females/males), cannabis, and illicit drug use. We hypothesized that the association between ACEs and each outcome would be stronger among females than males.

METHODS

Cross-sectional survey data were obtained from 1,037 married/partnered ED patients (53% female) at a public safety-net hospital. Gender-stratified logistic regression models were estimated for each substance use outcome.

RESULTS

One+ ACEs were reported by 53% of males and 60% of females. Females whose mother was a victim of domestic violence had greater odds of at-risk drinking compared to females who did not report this ACE (AOR = 1.72; 95% CI 1.03, 2.88). Females' cumulative ACEs were associated with cannabis use (OR = 2.26, 95% CI 1.06, 4.83) and illicit drug use (OR = 3.35; 95% CI 1.21, 9.30). Males' separate and cumulative ACEs were not associated with increased likelihood for any of the outcomes.

CONCLUSION

ACEs are associated with greater odds of substance use among female than male ED patients. The prevalence of ACE exposure in this urban ED sample underscores the importance of ED staff providing trauma-informed care.

Pediatrics adverse childhood experiences and related life events screener (PEARLS) and health in a safety-net practice

BACKGROUND

Adverse Childhood Experiences (ACEs) are associated with behavioral, mental, and clinical outcomes in children. Tools that are easy to incorporate into pediatric practice, effectively screen for adversities, and identify children at high risk for poor outcomes are lacking.

OBJECTIVE

To examine the relationship between caregiver-reported child ACEs and related life events with health outcomes.

PARTICIPANTS AND SETTING

Participants (0-11 years) were recruited from the University of California San Francisco Benioff's Children Hospital Oakland Primary Care Clinic. There were 367 participants randomized.

METHODS

Participants were randomized 1:1:1 to item-level (item response), aggregate-level (total number of exposures), or no screening for ACEs (control arm) with the PEdiatric ACEs and Related Life Event Screener (PEARLS). We assessed 10 ACE categories capturing abuse, neglect, and household challenges, as well as 7 additional categories. Multivariable regression models were conducted.

RESULTS

Participants reported a median of 2 (IQR 1-5) adversities with 76 % (n = 279) reporting at least one adversity; participants in the aggregate-level screening arm, on average, disclosed 1 additional adversity compared to item-level screening (p = 0.01). Higher PEARLS scores were associated with poorer perceived child general health (adjusted B = -0.94, 95 %CI: -1.26, -0.62) and Global Executive Functioning (adjusted B = 1.99, 95 %CI: 1.51, 2.46), and greater odds of stomachaches (aOR 1.14; 95 %CI: 1.04-1.25) and asthma (aOR 1.08; 95 %CI 1.00, 1.17). Associations did not differ by screening arm.

CONCLUSION

In a high-risk pediatric population, ACEs and other childhood adversities remain an independent predictor of poor health. Increased efforts to screen and address early-life adversity are necessary.

The Effect and Mechanism of Adverse Childhood Experience on Suicide Ideation in Young Cancer Patients During Coronavirus Disease 2019 (COVID-19) Pandemic

Background and Aim

Coronavirus disease 2019 (COVID-19) is currently prevalent worldwide. This research aimed to explore the effect of adverse childhood experience (ACE) on suicide ideation in young cancer patients during the COVID-19 pandemic. Self-reported questionnaires analyzed the mediating effects of sleep quality, anxiety symptoms, and inflammatory conditions between ACE and suicide ideation.

Materials and Methods

A total of 197 young cancer patients (age 18–40) completed questionnaires and a blood test. Correlation analysis and structural equation model were used to explore the relationships between ACE, sleep quality, anxiety symptom, serum C-reactive protein (CRP) levels and suicide ideation. The mediating roles of sleep quality, anxiety symptoms, and CRP levels on the influence of ACE on suicide ideation were explored.

Results

ACE was positively related to anxiety symptoms, CRP levels, and suicide ideation, and negatively related to sleep quality. Anxiety symptoms and CRP levels were positively related to suicide ideation, while sleep quality was negatively related to suicide ideation. Anxiety symptoms were positively related to CRP levels but negatively related to sleep quality. From these results, we found ACE affected suicide ideation directly and was mediated by roles sleep quality, anxiety symptom and CRP.

Conclusion

ACE not only directly affected suicide ideation but also affected suicide ideation through sleep quality, anxiety symptoms, and inflammatory conditions in young cancer patients during the COVID-19 pandemic. Therefore, targeted intervention and help for cancer patients from the perspective of ACE should be put into practice.

Synergistic adversities and behavioral problems in traumatized children and adolescents

OBJECTIVE

This study investigated synergy of commonly co-occurring pairs of childhood traumas/adversities to determine: 1) if synergistic pairings differ by gender and/or age grouping; and 2) if some traumas/adversities were more synergistically reactive.

METHODS

A sample of 10,355 clinic-referred youth (1.5-18 years) from the National Child Traumatic Stress Network Core Data Set was divided by gender and categorized into salient age groups (1.5-5 years, 6-12 years, and 13-18 years). Attributable Proportion (AP), a biomedically relevant metric, was calculated to assess additive synergy for behavior problems on the CBCL.

RESULTS

Overall, only four pairs of adversities were synergistic. Three involved sexual abuse with physical abuse, parental loss, and domestic violence. When the sample was analyzed by Gender X Age group, however, a more complicated picture emerges. Twelve of the twenty-one possible pairings (57 %) show additive synergy in one or more categories. The mean AP accounted for approximately 40 % of outcome variance. Males had more synergistic pairings (16) than females (7). The average synergistic effect was higher for males (42 % of variance) than females (36 % of variance). The vast majority of synergy occurs in the 6-12 and 13-18 age groups. Sexual abuse was the most synergistically reactive trauma, pairing most frequently (16) followed by physical abuse (10) or neglect (9).

CONCLUSION

Sexual abuse was malignantly synergistic, frequently pairing with other adversities, followed by physical abuse, neglect, and domestic violence. The findings underscore that all ACEs are not equal in their contributions to commonly assessed outcomes. The findings also have considerable implications for prevention, intervention, and future research.

Closed-loop digital meditation for neurocognitive and behavioral development in adolescents with childhood neglect

Adverse childhood experiences are linked to poor attentive behaviors during adolescence, as well as increased risk for mental health disorders in adults. However, no study has yet tested targeted interventions to optimize neurocognitive processes in this population. Here, we investigated closed-loop digital interventions in a double-blind randomized controlled study in adolescents with childhood neglect, and evaluated the outcomes using multimodal assessments of neuroimaging, cognitive, behavioral, and academic evaluations. In the primary neuroimaging results, we demonstrate that a closed-loop digital meditation intervention can strengthen functional connectivity of the dorsal anterior cingulate cortex (dACC) in the cingulo-opercular network, which is critically developing during the adolescent period. Second, this intervention enhanced sustained attention and interference-resolution abilities, and also reduced behavioral hyperactivity at a 1-year follow-up. Superior academic performance was additionally observed in adolescents who underwent the digital meditation intervention. Finally, changes in dACC functional connectivity significantly correlated with improvements in sustained attention, hyperactivity, and academic performance. This first study demonstrates that closed-loop digital meditation practice can facilitate development of important aspects of neurocognition and real-life behaviors in adolescents with early childhood neglect.

Shared Reading at Age 1 Year and Later Vocabulary: A Gene-Environment Study

OBJECTIVE

To assess the extent to which associations between shared reading at age 1 years and child vocabulary at age 3 years differ based on the presence of sensitizing alleles in the dopaminergic and serotonergic neurotransmitter systems.

STUDY DESIGN

We conducted a secondary analysis of data from a national urban birth cohort using mother reports in conjunction with child assessments and salivary genetic data. Child vocabulary was assessed using the Peabody Picture Vocabulary Test. The primary exposure was mother-reported shared reading. We used data on gene variants that may affect the function of the dopaminergic and serotonergic systems. We examined associations between shared reading and Peabody Picture Vocabulary Test score using multiple linear regression. We then included interaction terms between shared reading and the presence of sensitizing alleles for each polymorphism to assess potential moderator effects adjusting for multiple comparisons.

RESULTS

Of the 1772 children included (56% black, 52% male), 31% of their mothers reported reading with their child daily. Daily shared reading was strongly associated with child Peabody Picture Vocabulary Test scores in unadjusted (B = 7.9; 95% CI, 4.3-11.4) and adjusted models (B = 5.3; 95% CI, 2.0-8.6). The association differed based on the presence of sensitizing alleles in the dopamine receptor 2 and serotonin transporter genes.

CONCLUSIONS

Among urban children, shared reading at age 1 years was associated with greater vocabulary at age 3 years. Although children with sensitizing alleles on the dopamine receptor 2 and serotonin transporter genes were at greater risk when not read to, they fared as well as children without these alleles when shared reading occurred.

Association of Adverse Childhood Experience and Attention Deficit Hyperactivity Disorder with depressive symptoms among men who have sex with men in China: moderated mediation effect of resilience

Background

Adverse childhood experience (ACE), attention deficit hyperactivity disorder (ADHD), and resilience can all contribute to depressive symptoms. However, little is known regarding the complex relationships between these factors and their joint effects on depressive symptoms. This study aimed to explore the underlying mechanism of ACE, ADHD, and resilience on depressive symptoms among men have sex with men (MSM) in China.

Methods

A total of 714 MSM were recruited from gay/bisexual men-serving venues in Wuhan, Changsha, and Nanchang of China. The data was collected using computer-assisted self-interview. The mediated and moderated mediation models were employed to explore the underlying mechanisms between ACE, ADHD, resilience, and depressive symptoms.

Results

Among 714 MSM, 51.4% reported at least one ACE and 13.0% reported three or more. ACE had a direct (β = 1.01, 95% CI: 0.45–1.57) effect on depressive symptoms. ADHD partially mediated the correlation between ACE and depressive symptoms (indirect effect: 0.55; 95% CI: 0.34–0.79). Additionally, the effect of ACE on depressive symptoms was moderated and buffered by resilience (β = −0.09, 95% CI: -0.15 - −0.03).

Conclusion

The findings suggested that, programs and policies that promote resilience and address ADHD might protect Chinese MSM exposed to ACE from depressive symptoms.

Prevalence of adverse childhood experiences (ACEs) among US children

OBJECTIVE

The purpose of this study was to estimate the prevalence of adverse childhood experiences (ACEs) among children in the United States and to examine the relationship between child and family characteristics and the likelihood of reported exposure to ACEs.

METHODS

Data were drawn from the nationally representative 2016 National Survey of Children's Health (NSCH). Parent-reported child ACE exposure was measured using counts of those reporting zero ACEs, one to three ACEs, and four or more ACEs.

RESULTS

The study sample included 45,287 children. The most prevalent types of ACE exposure experienced by children were economic hardship (22.5%) and parent or guardian divorce or separation (21.9%). Older children (34.7%), Non-Hispanic African American children (34.7%), children with special health care needs (SHCN; 36.3%), children living in poverty (37.2%), and children living in rural areas (30.5%) were more likely to be exposed to parental divorce or separation than their counterparts. Five cross-cutting factors emerged as important across outcomes: child's age, family structure, poverty, type of health insurance, and SHCN status.

CONCLUSIONS

We found high prevalence rates of economic hardship on a national level. Our findings of higher prevalence among rural children further suggest the importance of the intersection of place and ACEs. Therefore, the geographic component of ACEs must be considered by policymakers. The identification of predictive factors related to high ACE exposure can inform early interventions at the national level.

Adverse childhood experiences and the onset of chronic disease in young adulthood

This study examined the association of adverse childhood experiences (ACEs) with early-onset chronic conditions. We analyzed data from the 2011-2012 Behavioral Risk Factor Surveillance System (BRFSS), which included 86,968 respondents representing a nine-state adult population of 32 million. ACE questions included physical, emotional, and sexual abuse; substance use, mental illness or incarceration of a household member; domestic violence, and parental separation. Outcomes included chronic conditions (cardiovascular disease, chronic obstructive pulmonary disease, cancer, depression, diabetes, and prediabetes); overall health status; and days of poor mental or physical health in the past month. We estimated Poisson regression models of the likelihood of chronic conditions and poor health status comparing adults reporting ≥4 ACEs to respondents with no ACEs within three age strata: 18-34, 35-54 and ≥55 years. The prevalence of ≥4 ACEs was highest among youngest respondents (19%). There was a dose-response gradient between ACE scores and outcomes except for cancer in older adults. Among younger respondents, those reporting ≥4 ACEs had two to four times the risk for each chronic condition and poor health status compared to respondents reporting no ACEs. With few exceptions (depression, poor mental and physical health in the past month), incidence rate ratios were highest in young adults and successively decreased among older adults. This study is among the first to analyze patterns of association between ACEs and adult health disaggregated by age. Young adults with high ACE scores are at increased risk of early-onset chronic disease. Trauma-informed care and ACEs prevention are crucial public health priorities.

Associations between Adverse Childhood Experiences, Major Depressive Episode and Chronic Physical Health in Adolescents: Moderation of Race/Ethnicity

Adverse childhood experiences (ACE) are associated with health problems in adolescence. However, the moderating role of race/ethnicity is not well understood. The current study examines direct and indirect effects of ACE on major depressive episodes and chronic health outcomes, and the moderating role of race/ethnicity among adolescents who participated in the National Comorbidity Survey-Adolescent Supplement. Results show an association between ACE and both health outcomes. Race/ethnicity was associated with differential outcomes and indicated moderation. Results underscore the importance of examining associations between ACE and adolescent well-being by race/ethnicity. The need for trauma-informed and culturally responsive services for adolescents is discussed.

Risk and protective factors for the development of ADHD symptoms in children and adolescents: Results of the longitudinal BELLA study

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood worldwide, and causes significant impairments in overall functioning. In order to develop effective prevention and intervention programs, knowledge of the determinants that have an impact on the onset and development of ADHD symptoms is essential. So far, little is known about factors affecting ADHD symptoms in children and adolescents over time. Therefore, this study investigates potential psychosocial risk and protective factors for ADHD symptoms based on cross-sectional and longitudinal data of a German population-based study.

METHODS

Data on children and adolescents (n = 1,384 aged 11 to 17 years) were collected at three measurement points (baseline, 1-year and 2-year follow-ups) covering a period of two years. We used latent growth modelling to investigate effects of parental mental health problems (risk factor) and self-efficacy, family climate and social support (protective factors) on symptoms of ADHD based on cross-sectional as well as longitudinal data. Sociodemographic factors, pre- and postnatal factors, and comorbid symptoms of internalizing and externalizing mental health problems were considered as covariates.

RESULTS

At baseline, male gender, younger age, stronger aggressive behavior, and stronger parental mental health problems were related to more ADHD symptoms. Longitudinal analyses showed that female gender, migration status, increasing symptoms of generalized anxiety, increasing aggressive behavior and increasing parental mental health problems were associated with stronger increase of ADHD symptoms over time. However, improving family climate was related to decreasing ADHD symptoms over time. We further found moderator effects for social support.

CONCLUSION

The findings of the study provide important information concerning risk and protective factors in the context of ADHD. Hence, the results may be integrated into the planning and implementation of future prevention and early intervention strategies that target affected children and adolescents.

Adverse Childhood Experiences and Trauma-Informed Care in Rehabilitation Clinical Practice

Adverse childhood experiences (ACEs) contribute to physical, behavioral, and mental health issues throughout the lifespan and, because of their prevalence, constitute a significant public health issue. Practitioners in all health care disciplines need to be knowledgeable about ACEs and prepared to address them. ACEs can contribute to conditions that lead patients to seek rehabilitation care, and therefore a framework is needed that enables rehabilitation professionals to understand the effects of ACEs and how to discuss them with patients. This article summarizes ACE research and its clinical relevance, presents an overview of the related topic of trauma-informed care, and introduces rehabilitation professionals to practical tools for incorporating ACE- and trauma-informed care into clinical practice.

There is growing acknowledgement across all health care disciplines of the impact of ACEs. ACEs are understood as stressful, potentially traumatic events that may have lasting negative effects on health and well-being. Since the 1990s, when landmark research found striking associations between early life stress and adversity and a wide range of chronic physical, behavioral, and mental health issues, international attention to ACEs as a major public health issue has grown.1, 2 ACE-related research has identified strong correlations between chronic disease, stress, and prior experience. Eighty-six percent of health care dollars in the United States are spent on chronic diseases, and a population health strategy should include empowering, person-centered, low-risk, low-cost, self-management skill-building practices to help patients manage the stress response.³

Though a relevant consideration for all care provision, the biopsychosocial framework may be particularly important for understanding and working with chronic health conditions.4, 5, 6, 7 For example, chronic pain affects 116 million in the United States⁸ and may be a key force in driving patients to seek rehabilitation services. Patients need their providers to skillfully and comprehensively navigate the intersection of mental, emotional, and physical components of their healing process. Given the prevalence of ACEs and their potential contribution to chronic pain, among other conditions, rehabilitation professionals should be prepared to address ACEs in the clinical setting as a possible underlying contributor to the condition for which treatment is sought. This article provides an overview of ACEs research and the health effects that can result from ACEs and introduces a trauma-informed practical guide for rehabilitation professionals to use in clinical encounters.

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Adverse childhood experiences (ACEs) contribute to a broad spectrum of health challenges across the lifespan and constitute a significant public health issue.

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Rehabilitation professionals routinely work with individuals experiencing health challenges that may be linked to ACEs.

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Models of trauma-informed care and resilience-building approaches assist rehabilitation professionals in contributing to a solution to the prevalence of ACEs and chronic stress in the population.

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A novel schema is presented to assist rehabilitation professionals in navigating the topic of ACEs in clinical care.

Adverse experiences in infancy and toddlerhood: Relations to adaptive behavior and academic status in middle childhood

Findings from the Adverse Childhood Experiences (ACE) study articulated the negative effects of childhood trauma on long-term well-being. The purpose of the current study is to examine the associations between ACEs experienced in infancy and toddlerhood and adaptive behavior and academic status in middle childhood. We used data collected from a sample of low-income families during the impacts study of Early Head Start (EHS). Data were collected by trained interviewers demonstrating at least 85% reliability with protocols. Data come from 1469 socio-demographically diverse mothers and children collected at or near ages 1, 2, 3, and 11. At ages 1, 2, and 3, an EHS-ACEs index was created based on interview and observation items. The EHS-ACEs indices were averaged to represent exposure across infancy and toddlerhood. At age 11, parents were asked about school outcomes and completed the Child Behavior Checklist. Across development, children were exposed to zero (19%), one (31%), two (27%), and three or more ACEs (23%). Logistic regression analyses, controlling for EHS program assignment, and parent, school, and child characteristics, showed ACEs were significantly associated with parental report of the child: having an individualized educational program since starting school and in the current school year, having been retained a grade in school, and problems with externalizing and internalizing behavior, as well as attention. Findings suggest that ACEs influence children's behavioral and academic outcomes early in development.