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ACEs: Evidence, Gaps, Evaluation and Future Priorities

Published online by Cambridge University Press:  11 April 2019

Andrew Steptoe*
Affiliation:
Department of Behavioural Science and Health, University College London E-mail: a.steptoe@ucl.ac.uk
Theresa Marteau
Affiliation:
Department of Public Health and Primary Care, University of Cambridge E-mail: Tm388@cam.ac.uk
Peter Fonagy
Affiliation:
Division of Psychology and Language Sciences, University College London E-mail: p.fonagy@ucl.ac.uk
Kathryn Abel
Affiliation:
Division of Psychology and Mental Health, University of Manchester E-mail: Kathryn.M.Abel@manchester.ac.uk

Abstract

There is strong evidence linking adverse childhood experiences (ACEs) and poor outcomes in adulthood both in terms of mental and physical health. Gaps in both the evidence base and research priorities still exist. These include understanding how to identify and assess risk in children who have experienced ACEs, and also the development and, importantly, the evaluation of interventions. Outstanding gaps include whether there are sensitive periods during childhood, the role of resilience/protective factors, the causal relationships, biological mechanisms and relative risk of ACEs for particular negative outcomes. ACEs affect individual children differently and chronic exposure appears to increase the risk of poor outcomes in adulthood, meaning interventions should also be tailored to the individual children, families and communities. Generally, there needs to be better evaluation of interventions and dissemination of this information to ensure that their use is evidence based. More input from affected communities, clinicians, funding bodies and Government departments is required to identify research priorities and ensure gaps in the evidence base are addressed.

Type
Themed Section: Adverse Childhood Experiences (ACES) – Implications and Challenges
Copyright
© Cambridge University Press 2019 

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References

Anda, R. F., Butchart, A., Fellitti, V. J. and Brown, D. W. (2010) ‘Building a framework for global surveillance of the public health implications of adverse childhood experiences’, American Journal of Preventive Medicine, 39, 1, 93–8.CrossRefGoogle ScholarPubMed
Bellis, M. A., Hughes, K., Leckenby, N., Hardcastle, K. A., Perkins, C. and Lowey, H. (2014) ‘Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: a national survey’, Journal of Public Health, 37, 3, 445–54.CrossRefGoogle ScholarPubMed
Bethell, C. D., Carle, A., Hudziak, J., Gombojav, N., Powers, K., Wade, R. and Braveman, P. (2017a) ‘Methods to assess adverse childhood experiences of children and families: toward approaches to promote child well-being in policy and practice’, Academic Pediatrics, 17, 7S, S51–69.CrossRefGoogle ScholarPubMed
Bethell, C. D., Solloway, M. R., Guinosso, S., Hassink, S., Srivastav, A., Ford, D. and Simpson, L. A. (2017b) ‘Prioritising possibilities for child and family health: an agenda to address adverse childhood experiences and foster the social and emotional roots of well-being in paediatrics’, Academic Pediatrics, 17, 7S, S36–50.CrossRefGoogle Scholar
Bransford, C. L. and Blizard, R. A. (2016) ‘Viewing psychopathology through a trauma lens’, Social Work Mental Health, 15, 1, 8098.CrossRefGoogle Scholar
Brown, D. W., Anda, R. F., Tiemeier, H., Felitti, V. J., Edwards, V. J., Croft, J. B. and Giles, W. H. (2009) ‘Adverse childhood experiences and the risk of premature mortality’, American Journal of Preventive Medicine, 37, 5, 389–96.CrossRefGoogle ScholarPubMed
Brunzell, T., Stokes, H. and Waters, L. (2016) ‘Trauma-informed positive education: using positive psychology to strengthen vulnerable students’, Contemporary School of Psychology, 20, 1, 6383.CrossRefGoogle Scholar
Bryson, S. A., Gauvin, E., Jamieson, A., Rathgeber, M., Faulkner-Gibson, L., Bell, S., Davidson, J., Russel, J. and Burke, S. (2017) ‘What are the strategies for implementing trauma-informed care in youth inpatient psychiatric and residential treatment settings? A realist systematic review’, International Journal of Mental Health Systems, 11, 36, doi: 10.1186/s13033-017-0137-3.CrossRefGoogle ScholarPubMed
Burnette, C. E. and Figley, C. R. (2017) ‘Historical oppression, resilience and transcendence: can a holistic framework help explain violence experiences by indigenous people?’, Social Work, 62, 1, 3744.CrossRefGoogle Scholar
Cicchetti, D. and Toth, S. L. (2005) ‘Child maltreatment’, Annual Review of Clinical Psychology, 1, 409–38, doi: 10.1146/annurev.clinpsy.1.102803.144029.CrossRefGoogle ScholarPubMed
Danese, A. and McEwen, B. S. (2012) ‘Adverse childhood experiences, allostasis, allostatic load, and age-related disease’, Physiology and Behavior, 106, 1, 2939.CrossRefGoogle ScholarPubMed
Davies, B. R. and Allen, N. B. (2017) ‘Trauma and homelessness in youth: psychopathology and intervention’, Clinical Psychology Review, 54, 1728.CrossRefGoogle ScholarPubMed
Department for Education (2012) Evaluation of the NAPP’s Training Offer in Evidence Based Parenting Programmes, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/183457/DFE-RR186.pdf [accessed 13.02.2019].Google Scholar
Department of Health (2003) Women’s Mental Health, Into the Mainstream: Implementation Guidance, London: Department of Health.Google Scholar
Diamond, A. (2013) ‘Executive functions’, Annual Review of Psychology, 64, 135–68.CrossRefGoogle ScholarPubMed
Dvir, Y., Denietolis, B. and Frazier, J. A. (2013) ‘Childhood trauma and psychosis’, Child and Adolescent Psychiatry Clinics of North America, 22, 4, 629–41.CrossRefGoogle ScholarPubMed
Exley, D., Norman, A. and Hyland, M. (2015) ‘Adverse childhood experience and asthma onset: a systematic review’, European Respiratory Review, 24, 136, 299305.CrossRefGoogle ScholarPubMed
Figley, C. R. and Burnette, C. E. (2017) ‘Building bridges: connecting systemic trauma and family resilience in the study and treatment of diverse traumatized families’, Traumatology, 23, 1, 95101.CrossRefGoogle Scholar
Finkelhor, D. (2017) ‘Screening for adverse childhood experiences (ACEs): cautions and suggestions’, Child Abuse and Neglect, 85, 174–9.CrossRefGoogle ScholarPubMed
Geoffroy, M-C., Gunnell, D. and Power, C. (2014) ‘Prenatal and childhood antecedents of suicide: 50-year follow-up of the 1958 British Birth Cohort Study’, Psychological Medicine, 44, 1245–56.CrossRefGoogle ScholarPubMed
Golding, N. and Duggal, A. (2011) Commissioning Services for Women and Children Who Have Experienced Violence or Abuse– A Guide for Health Commissioners, London: Department of Health.Google Scholar
Gomez, S. H., Tse, J., Wang, Y., Turner, B., Millner, A. J., Nock, M.K. and Dunn, E. C. (2017) ‘Are there sensitive periods when child maltreatment substantially elevates suicide risk? Results from a nationally representative sample of adolescents’, Depression and Anxiety, 34, 8, 734–41.CrossRefGoogle ScholarPubMed
Hambrick, E. P., Oppenheim-Weller, S., N’zi, A. M. and Taussig, H. N. (2016) ‘Mental health interventions for children in foster care: a systematic review’, Children and Youth Service Review, 70, 6577.CrossRefGoogle ScholarPubMed
Hardt, J. and Rutter, M. (2004) ‘Validity of adult retrospective reports of adverse childhood experiences: review of the evidence’, Journal of Child Psychology and Psychiatry, 45, 2, 260–73.CrossRefGoogle Scholar
Hatch, S. and Dohrenwend, B. (2007) ‘Distribution of traumatic and other stressful life events by race/ethnicity, gender, SES and age: a review of the research’, American Journal of Community Psychology, 40, 3–4, 313–32.CrossRefGoogle Scholar
Holman, D. M., Ports, K. A., Buchanan, N. D., Hawkins, N. A., Merrick, M. T., Metzler, M. and Trivers, K. F. (2016) ‘The association between adverse childhood experiences and risk of cancer in adulthood: a systematic review of the literature’, Pediatrics, 138, S1, S81–91.CrossRefGoogle ScholarPubMed
Huang, H., Yan, P., Shan, Z., Chen, S., Li, M., Luo, C., Gao, H., Hao, L. and Liu, L. (2015) ‘Adverse childhood experiences and risk of type 2 diabetes: a systematic review and meta-analysis’, Metabolism, 64, 11, 1408–18.CrossRefGoogle ScholarPubMed
Huffhines, L., Noser, A. and Patton, S. R. (2016) ‘The link between adverse childhood experiences and diabetes’, Current Diabetes Reports, 16, 6, 54, doi: 10.1007/s11892-016-0740-8.CrossRefGoogle ScholarPubMed
Humphreys, K. L. and Zeanah, C. H. (2015) ‘Deviations from the expectable environment in early childhood and emerging psychopathology’, Neuropsychopharmacology, 40, 1, 154–70.CrossRefGoogle ScholarPubMed
Juffer, F., Bakermans-Kranenburg, M. J. and van IJzendoorn, M. H. (2005) ‘The importance of parenting in the development of disorganized attachment: evidence from a preventive intervention study in adoptive families’, Journal of Child Psychology and Psychiatry, 46, 3, 263–74.CrossRefGoogle ScholarPubMed
Jenkins, J., Madigan, S. and Arseneault, L. (2015) ‘Psychosocial adversity’, in Rutter, M., Bishop, D., Pine, D., Scott, S., Stevenson, J. S., Taylor, E., and Thapar, A. (eds.), Rutter’s Child and Adolescent Psychiatry, Oxford: Wiley-Blackwell, 330.CrossRefGoogle Scholar
Kalmakis, K. A. and Chandler, G. E. (2015) ‘Health consequences of adverse childhood experiences: a systematic review’, Journal of the American Association of Nurse Practitioner, 27, 8, 457–65.CrossRefGoogle ScholarPubMed
Kajeepeta, S., Gelaye, B., Jackson, C. L. and Williams, M. A. (2015) ‘Adverse childhood experiences are associated with adult sleep disorders: a systematic review’, Sleep Medicine, 16, 3, 320–30.CrossRefGoogle ScholarPubMed
Larkin, H., Shields, J. J. and Anda, R. F. (2012) ‘The health and social consequences of adverse childhood experiences across the lifespan: an introduction to prevention and intervention in the community’, Journal of Preventive Intervention in the Community, 40, 4, 263–70.CrossRefGoogle Scholar
Larkin, H., Felitti, V. J. and Anda, R. F. (2014) ‘Social work and adverse childhood experiences research: implications for practice and health policy’, Social Work and Public Health, 29, 1, 116.CrossRefGoogle ScholarPubMed
Lereya, S. T., Winsper, C., Heron, H., Lewis, G., Gunnell, D., Fisher, H. L. and Wolke, D. (2013) ‘Being bullied during childhood and the prospective pathways to self-harm in late adolescence’, Journal of the American Academy of Child and Adolescent Psychiatry, 52, 608–18.CrossRefGoogle ScholarPubMed
Liu, H., Atrooz, F., Salvi, A. and Salim, S. (2017) ‘Behavioural and cognitive impact of early life stress: insights from an animal model’, Progress in Neuropsychopharmacology and Biological Psychiatry, 78, 88–9.CrossRefGoogle ScholarPubMed
Mars, B., Heron, J., Crane, C., Hawton, K., Kidger, J., Lewis, G., Macleod, J., Tilling, K. and Gunnell, D. (2014) ‘Differences in risk factors for self-harm with and without suicidal intent: findings from the ALSPAC cohort’, Journal of Affective Disorders, 168, 407–14.CrossRefGoogle ScholarPubMed
Mayer, L. M. and Thursby, E. (2012) ‘Adolescent parents and their children: a multifaceted approach to prevention of adverse childhood experiences’, Journal of Preventive Intervention in the Community, 40, 4, 304–12.CrossRefGoogle ScholarPubMed
McCrory, E. J., Gerin, M. I. and Viding, E. (2017) ‘Annual research review: childhood maltreatment, latent vulnerability and the shift to preventative psychiatry ‐ the contribution of functional brain imaging’, Journal of Child Psychology and Psychiatry, 58, 4, 338–57.CrossRefGoogle ScholarPubMed
McDonnell, C. J. and Garbers, S. V. (2017) ‘Adverse childhood experiences and obesity: systematic review of behavioural interventions for women’, Psychological Trauma, 16, 5, 1195.Google Scholar
McLaughlin, K. A. (2016) ‘Future directions in childhood adversity and youth psychology’, Journal of Clinical Child Adolescent Psychology, 45, 3, 361–82.CrossRefGoogle Scholar
Medical Research Council (2017) Strategy for Lifelong Mental Health Research, www.mrc.ac.uk/documents/pdf/strategy-for-lifelong-mental-health-research/ [accessed 13.02.2019].Google Scholar
Moffitt, T. E., Arseneault, L., Belsky, D., Dickson, N., Hancox, R. J., Harrington, H., Houts, R., Poulton, R., Roberts, B. W., Ross, S., Sears, M. R., Thomson, W. M. and Caspi, A. (2011) ‘A gradient of childhood self-control predicts health, wealth and public safety’, Proceedings of the National Academy of Sciences USA, 108, 7, 2693–8.CrossRefGoogle ScholarPubMed
Montalvo-Liendo, N., Fredland, N., McFarlane, J., Lui, F., Koci, A. F. and Nava, A. (2015) ‘The intersection of partner violence and adverse childhood experiences: implications for research and clinical practice’, Issues in Mental Health Nursing, 36, 12, 9891006.CrossRefGoogle ScholarPubMed
Nelson, S. M., Cunningham, N. R. and Kashikar-Zuck, S. (2017) ‘A conceptual framework for understanding the role of adverse childhood experiences in paediatric chronic pain’, Clinical Journal of Pain, 33, 3, 264–70.Google Scholar
National Institute for Health and Clinical Excellence (NICE) (2014) Psychosis and Schizophrenia in Adults: Prevention and Management, https://www.nice.org.uk/guidance/cg178 [accessed 13.02.2019].Google Scholar
Oral, R., Ramirez, M., Coohey, C., Nakada, S., Walz, A., Kuntz, A., Benoit, J. and Peek-Asa, C. (2016) ‘Adverse childhood experiences and trauma informed care: the future of health care’, Pediatric Research, 79, 1-2, 227–33.CrossRefGoogle ScholarPubMed
Read, J. (2010) ‘Can poverty drive you mad? ‘Schizophrenia’, socio-economic status and the case for primary prevention’, New Zealand Journal of Psychology, 39, 2, 719.Google Scholar
Read, J., Harper, D., Tucker, I. and Kennedy, A. (2018) ‘Do adult mental health services identify child abuse and neglect? A systematic review’, International Journal of Mental Health Nursing, 27, 1, 719.CrossRefGoogle ScholarPubMed
Reuben, A., Moffitt, T. E., Caspi, A., Belsky, D. W., Harrington, H., Schroeder, F., Hogan, S., Ramrakha, S., Poulton, R. and Danese, A. (2016) ‘Lest we forget: comparing retrospective and prospective assessments of adverse childhood experiences in the prediction of adult health’, Child Psychology and Psychiatry, 57, 10, 1103–12.CrossRefGoogle ScholarPubMed
Sachs-Ericsson, N. J., Rushing, N. C., Stanley, I. H. and Sheffler, J. (2016) ‘In my end is my beginning: developmental trajectories of adverse childhood experiences to late-life suicide’, Aging and Mental Health, 20, 2, 139–65.CrossRefGoogle Scholar
Sapienza, J. K. and Masten, A. S. (2011) ‘Understanding and promoting resilience in children and youth’, Current Opinion Psychiatry, 24, 4, 267–73.CrossRefGoogle ScholarPubMed
Scottish Government (2017) Scotland’s Mental Health Strategy (2017–2027), http://www.gov.scot/Resource/0051/00516047.pdf [accessed 13.02.2019].Google Scholar
Sheridan, M. A., Fox, N. A., Zeanah, C. H., McLaughlin, K. A. and Nelson, C. A. (2012) ‘Variation in neural development as a result of exposure to institutionalization early in childhood’, Proceedings of the National Academy of Sciences USA, 109, 12927–32.CrossRefGoogle ScholarPubMed
Soares, A. L., Howe, L. D., Matijasevich, A., Wehrmeister, F. C., Menezes, A. M. and Gonçalves, H. (2016) ‘Adverse childhood experiences: prevalence and related factors in adolescents of a Brazilian birth cohort’, Child Abuse and Neglect, 51, 2130.CrossRefGoogle ScholarPubMed
Somaini, L., Donnini, C., Manfredini, M., Raggi, M. A., Saracino, M. A., Gerra, M. L., Amore, M., Leonardi, C., Serpelloni, G. and Gerra, G. (2011) ‘Adverse childhood experiences, genetic polymorphisms and neurochemical correlates in experimentation with psychotropic drugs among adolescents’, Neuroscience Biobehavioral Reviews, 35, 8, 1771–8.CrossRefGoogle ScholarPubMed
Stringhini, S., Sabia, S., Shipley, M., Brunner, E., Nabi, H., Kivimaki, M. and Singh-Manoux, A. (2010) ‘Association of socioeconomic position with health behaviors and mortality’, JAMA, 303, 12, 1159–66.CrossRefGoogle ScholarPubMed
Sweeney, A., Clement, S., Filson, B. and Kennedy, A. (2016) ‘Trauma-informed mental healthcare in the UK: what is it and how can we further its development?’, Mental Health Review Journal, 21, 3, 174–92.CrossRefGoogle Scholar
Traub, F. and Boynton-Jarrett, R. (2017) ‘Modifiable resilience factors to childhood adversity for clinical pediatric practice’, Pediatrics, 139, 5, e20162569, doi: 10.1542/peds.2016-2569.CrossRefGoogle ScholarPubMed
Vaiserman, A. M. (2015) ‘Epigenetic programming by early-life stress: evidence from human populations’, Developmental Dynamics, 244, 3, 254–65.CrossRefGoogle ScholarPubMed
Waite, R., Gerrity, P. and Arango, R. (2010) ‘Assessment for and response to adverse childhood experiences’, Journal of Psychosocial Nursing and Mental Health Services, 48, 12, 5161.CrossRefGoogle ScholarPubMed
Wiest-Stevenson, C. and Lee, C. (2016) ‘Trauma-informed schools’, Journal of Evidence Informed Social Work, 13, 5, 498503.CrossRefGoogle ScholarPubMed
Weisz, J. R., Ng, M. Y. and Lau, N. (2015) ‘Psychological interventions: overview and critical issues for the field’, in Rutter, M., Bishop, D., Pine, D., Scott, S., Stevenson, J. S., Taylor, E., and Thapar, A. (eds.), Rutter’s Child and Adolescent Psychiatry, Oxford: Wiley-Blackwell, 461–82.CrossRefGoogle Scholar
Wilson, A., Hutchinson, M. and Hurley, J. (2017) ‘Literature review of trauma-informed care: implications for mental health nurses working in acute inpatient settings in Australia’, International Journal of Mental Health Nursing, 26, 4, 326–43.CrossRefGoogle ScholarPubMed