Adverse Childhood Experiences (ACEs)

Adverse Childhood Experiences and Adolescent Violence 
(Summary/Overview/Commentary on the Study)

“Adverse Childhood Experiences and Adolescent Violence.” Brown University Child & Adolescent Behavior Letter 26, no. 6 (June 2010): 3.

Original Citation: Duke N, Pettingell S, McMorris B, et al.: Adolescent violence perpetration: Associations with multiple types of adverse childhood experiences. Pediatrics 2010; 125(4):778–786. E-mail: duke0028@umn.edu.

TAKEAWAYS AND SUMMARY:

In their recently published study Naomi N. Duke and colleagues evaluated the relationship between six adverse childhood experiences (AEs), and risk for a spectrum of violence perpetration in adolescence, including interpersonal violence and self-directed violence. (3) 

Violence-related behavior was defined by several behavioral constructs: delinquent behavior, bullying, physical fighting, dating violence, weapon-carrying on school property, and self-directed violence (self-mutilation, suicidal ideation, and suicide attempt). (3) 

Twenty-nine percent of the youth reported exposure to at least one childhood AE, most commonly alcohol abuse by a household member that caused problems (14.5%). The next most common AEs were physical abuse within the family (11.6%), physical abuse against the individual (10.4%), and drug use that caused problems (10.1 %). Girls and older teens were more likely to report all types of AEs. (3) 

At 44.8%, bullying was the most commonly reported violence-perpetration behavior (defined as past-month teasing another student in a hurtful way or exclusion of another student from activities). This was followed by physical fighting (past-year hit or beat up another person; 23.2%), suicidal ideation (any history of contemplating suicide; 22.4%), and self harm (any history of hurting self on purpose (cutting, burns, bruises; 17.3%). For adolescent girls, the risk of violence perpetration increased 1.7- to 5-fold (p<0.001) with any childhood AE, regardless of its nature. For boys, the risk of violence perpetration increased 1.7- to 44-fold (p<0.001) by any childhood AE. As the adverse-childhood event score (1–6) increased, so too did the likelihood of adolescent violence. When adolescents who reported 4 or more childhood AEs were compared to adolescents who reported no exposure to AEs, the likelihood of female violence perpetration increased 2- to 7-fold (bullying and suicide attempts, respectively), and male perpetration increased 2.7- to 10-fold (bullying and suicide attempts, respectively). (3) 

The authors note that the degrees of associated risk for violence outcomes differed among girls and boys. Duke and colleagues point out that although boys were less likely to report abuse or household dysfunction, a history of physical or sexual abuse was “a notably powerful” risk factor for dating violence perpetration, weapon-carrying, and self-directed violence. For girls, the risk of violence perpetration was increased from 38% to 88% for each increase in the adverse-events score. For boys, the increase in risk was from 35% to 144% with each increase in the adverse-events score. “These findings are particularly sobering,” write the authors, “given what is known about the interrelatedness of child abuse and household dysfunction.” (3)

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Adverse Childhood Experiences and Adult Health

Felitti, Vincent J. “Adverse Childhood Experiences and Adult Health.” Academic Pediatrics 9, no. 3 (June 2009): 131–32.

 

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Adverse Childhood Experiences and Mental Health in Young Adults: A Longitudinal Survey

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Adverse Childhood Experiences and Sexual Risk Behaviors in Women: A Retrospective Cohort Study

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Adverse Childhood Experiences: Translating Knowledge into Identification of Children at Risk for Poor Outcomes

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Assessment for and Response to Adverse Childhood Experiences

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Association Between Adverse Childhood Experiences and Diagnosis of Cancer

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Community Violence Exposure, Adverse Childhood Experiences, and Posttraumatic Distress Among Urban Development Workers

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Do Adverse Childhood Experiences Increase the Risk of Postdeployment Posttraumatic Stress Disorder in US Marines?

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Gender Differences in the Association of Adult Hopelessness with Adverse Childhood Experiences

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It's OK to Ask About Past Abuse

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Population Attributable Fractions of Psychiatric Disorders and Suicide Ideation and Attempts Associated with Adverse Childhood Experiences

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Predictability of Physical and Psychological Violence by Early Adverse Childhood Experiences

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Risk Factors for Unfavorable Pregnancy Outcome in Women with Adverse Childhood Experiences

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Setting the Stage for Chronic Health Problems: Cumulative Childhood Adversity Among Homeless Adults with Mental Illness in Vancouver, British Columbia

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Suicidal Ideation, Parent-Child Relationships, and Adverse Childhood Experiences: A Cross-Validation Study Using a Graphical Markov Model

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The Enduring Effects of Abuse and Related Adverse Experiences in Childhood: A Convergence of Evidence from Neurobiology and Epidemiology (Summary/Overview/Commentary on the Study)

Reading, Richard. “The Enduring Effects of Abuse and Related Adverse Experiences in Childhood: A Convergence of Evidence from Neurobiology and Epidemiology.” Child: Care, Health & Development 32, no. 2 (March 2006): 253–56.

Actual publication is from European Archives of Psychiatry and Clinical Neuroscience, ePub, November 29, 2005.

MAJOR TAKEAWAYS:

Based upon logistic regression analysis, the risk of every outcome in the affective, somatic, substance abuse, memory, sexual, and aggression related domains increased in a graded fashion as the ACE score increased (P < 0.001). The mean number of comorbid outcomes tripled across the range of the ACE score. The graded relationship of the ACE score to 18 different outcomes in multiple domains theoretically parallels the cumulative exposure of the developing brain to the stress response with resulting impairment in multiple brain structures and functions. (253)

There are a number of implications. First, the prevention of childhood adversity is vital for long-term mental health and well-being. This is difficult and challenging, but we already know this. However, the finding that the effects of childhood adversity are cumulative offers the prospect that even small reductions in that amount of adversity suffered by individual children may have an important long-term benefit. In public health terms, this could have a significant effect on population with mental health morbidity. (254)

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The Relationship of Adverse Childhood Experiences to a History of Premature Death of Family Members

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The Role of Beliefs, Attitudes and Adverse Childhood Experiences in Predicting Men's Reactions Towards Their Spouses Violence

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