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Monday, June 13, 2011

Adverse Childhood Events - More Evidence - Updated

In research conducted by Felitti and colleagues in the USA, data has shown that the more we are exposed to adverse childhood events (ACE), the greater a likelihood of later emotional and physical adverse outcomes. This research has been replicated in many other studies but it has significant implications for child protection. A new study by Burke et al., to be published in Child Abuse and Neglect, has added new understanding for youth in urban areas.

One of the more important conclusions is that physicians are not asking enough about the trauma exposures of youth. I suspect that this could be said of many professionals who come into contact with youth from troubled urban areas. Too often, it is easy to see the traumas from environments as something that is normal and that the youth come to see as just part of their life. This research helped to show that children do not just get used to their challenging neighbourhoods. Rather, they live in constant states of stress and trauma effects grow. As the authors note, if you don't ask about the impact then you are taking it as normal and that nothing can be done. Yet, we know that trauma can be treated.

Felitti's work was astounding because he and his colleagues found significant impact in a middle class population. The current study was done in a higher risk population and, not surprisingly, found greater adverse childhood effects. An important further finding was, "Another alarming finding in this study was the greater prevalence of learning/behavior problems among children who had experienced at least 4 ACEs as compared to those children without such ACEs (51.2% vs. 3%, respectively)." Thus, in children with higher number of ACEs we should also be looking at learning - is this a huge surprise - how do you learn when you are under chronic stress?

The authors go on to state in their conclusions, "Specifically, the alarming prevalence of aversive childhood experiences being endorsed in this urban population supports the dire need for the implementation of ACEs screening procedures across urban health-care settings. Furthermore, due to the association between ACES and both obesity and learning/behavior problems found in this study, the authors advocate for pediatricians and mental-health care providers be aware of the potential influence ACEs may have on preventative and intervention measures for these two more common childhood problems."

When one considers this research in context of child protection populations, such screening should be almost automatic.

Reference: Burke, N. J., et al. The impact of adverse childhood experiences on an urban pediatric population. Child Abuse & Neglect (2011), doi:10.1016/j.chiabu.2011.02.006

No sooner have I posted this than another study comes to my attention. Journal Watch Psychiatry (JWP) reviewed two new studies that help us to see that there are long term genetic and neuroanatomical impacts from ACEs. In their commentary on the research, JWP states, "Comment: These results bolster the negative impact of early childhood adverse experiences on genetic and neuroanatomical factors, and argue for primary and secondary prevention, especially given the relationship between telomere length and duration of institutional care. The findings are particularly relevant to practitioners caring for psychiatrically impaired parents, with regard to the need for providing adequate child care when the parents are unable to do so. For example, social services within adult psychiatric clinics able to attend to children's needs would be useful."

— Barbara Geller, MD


Drury SS et al. Telomere length and early severe social deprivation: Linking early adversity and cellular aging. Mol Psychiatry 2011 May 17; [e-pub ahead of print]. (
Gerritsen L et al. BDNF Val66Met genotype modulates the effect of childhood adversity on subgenual anterior cingulate cortex volume in healthy subjects. Mol Psychiatry 2011 May 17; [e-pub ahead of print]. (

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