, et al
Adverse childhood experiences and child health in early adolescence
JAMA Pediatr.
; doi: 2013.22

Researchers from multiple institutions examined the relationship between adverse childhood experiences (ACEs) and the development of health problems in early adolescence. Study authors used data from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) consortium, collected at 5 mostly urban, geographically diverse study sites. Data for the current study were abstracted from interviews with LONGSCAN participants (caregivers and/or children, depending on the child’s age) at 4, 6, 8, 12, and 14 years of age. Each interview included questions regarding health and experiences within the previous 6 to 12 months. For time-varying demographics, such as parental marital status and family income, information from the most recent data point (at child age 14) was used. Data for categories of maltreatment were collected at least every 2 years via review of child protective services (CPS) reports. ACEs were classified into 4 categories of maltreatment (physical abuse, sexual abuse, psychological abuse, and neglect) and 4 measures of household dysfunction (caregiver’s substance abuse, caregiver’s depressive symptoms, caregiver being treated violently, and criminal behavior in the household). The investigators examined the relationship between the number of ACEs and health outcomes, after accounting for other influential variables, and the effect of age on this relationship.

There were 933 adolescents included in the study; 57% of the participants were African American, and 40% were from families with incomes less than $20,000. Over 90% of the participants had at least 1 ACE, with over 50% having ≥3 ACEs. The most common childhood exposures were neglect and caregiver depression (57% respectively). Children with 1 ACE had increased odds of having any health problem (OR = 3.09; 95% CI, 1.22–7.84) than those with no history of an ACE. After controlling for potentially confounding variables, children with 2 or ≥3 ACEs were significantly more likely to have somatic concerns than those without a previous ACE (ORs = 8.91 and 9.25, respectively). When evaluating health outcomes by age, the most consistent associations were found in adolescents with an ACE within the past 2 years. Within this age group, adolescents with 2 or ≥3 ACEs were significantly more likely to be classified as having poor health, somatic concerns, and any health problem than were adolescents with fewer ACEs.

The authors conclude that recent ACEs may predict poor health, somatic concerns, and any health problem, especially in adolescents with recent ACEs.

Dr Anderst has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

This study adds to a growing body of research showing the relationship between ACEs and health outcomes.1–3  Additionally, the age breakdown (0–6, >6–12, and 13–14 years) and relationship of ACEs allowed for an assessment of proximity of ACEs to effects on health status.


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