Systematic Review of Pediatric Health Outcomes Associated with Adverse Childhood Experiences (aces)*

Purpose When children are exposed to Adverse Childhood Experiences (ACEs), their biological stress response is chronically triggered, altering brain architecture and causing long-term harm to their developing bodies. Left unaddressed, this toxic stress response can have serious long-term health effects on children as well as impact educational, social, and economic outcomes. Early detection, therefore, has powerful potential to improve the health and wellbeing of children. Identification and diagnosis are currently limited, however, by gaps in understanding of the clinical response to ACEs in children. A systematic review of pediatric health outcomes associated with ACEs was conducted to help develop a clinical risk profile of children affected by toxic stress. Methods PubMed, PsychINFO, and CINAHL were searched for full text studies investigating adverse childhood experiences published in English between January 2001 and December 2015. The terms “early life”, “adolescent”, “child”, “infant”, “youth”, “childhood”, “prenatal”, “in utero” were used in conjunction with “divorce”, “parental incarceration,” “parental depression,” “abuse,” “neglect,” “adversity,” “maltreatment,” “toxic stress,” “allostatic load,” and “adverse childhood experience.” Abstracts were reviewed to identify articles investigating the relationship between exposure to ACEs and biological or health outcomes. Articles were excluded if they were not in English, if the study was on animals, if the article was a case report/series, if exposure was not an ACE, if the abstract was not available, if the exposure was in utero only, if the study only had mental or behavioral health outcomes, if the study did not have relevant biological or health outcomes, if the study investigated the direct effect of the ACEs (e.g., abusive head trauma), if the study investigated the indirect effect of the ACE (e.g., ACEs moderating the effect of genetic predisposition to mental health outcome), if the study was qualitative, or if the article was a review. Results Of 19,230 non-duplicated articles, 1216 articles were identified that investigated the relationship between ACE exposure and biological or health outcomes. Of these, 393 had outcomes in children. Biological changes in children were primarily neurological (e.g., gray matter volume) and hormonal (e.g., cortisol). Clinical outcomes were primarily neurologic (e.g., executive function). Conclusion Children affected by ACEs manifest alterations in biology and health in distinct ways. A standardized pediatric risk profile would allow for more precise diagnosis and effective treatment of children affected by ACEs.