Identification of widespread Adverse Childhood Experiences in Adolescents may mitigate their long term impact: JAMA

Adverse childhood experiences (ACEs) are abuse, neglect, and family dysfunction experienced by a child. They have short-term and long-term adverse physical and mental health outcomes like substance abuse, chronic diseases, and obesity. cognitive, social, and emotional challenges are common among children experiencing ACEs and ultimately lead to risky health behaviors, such as early smoking and substance misuse. Previous research has shown the prevalence of abuse in adults. However, the prevalence of ACEs in children 18 years and younger is unknown. Hence, researchers conducted a study to estimate the average prevalence of ACEs, identify characteristics and contexts associated with higher or lower ACE exposure, and explore methodological factors that might influence these prevalence estimates.

A systematic review and meta-analysis were carried out by utilizing data from MEDLINE, PsycINFO, CINHAL, and Embase. Studies that reported the distribution of 0, 1, 2, 3, and 4 or more ACEs, included a population sample of children 18 years or younger at the time of ACEs collection, used the 8- or 10-ACEs questionnaire (plus or minus 2 items) that included both maltreatment and family dysfunction items, and published in English were taken up for the analysis. a standardized coding was used to extract Study and sample characteristics. Data from 65 studies, representing 490 423 children from 18 countries, were extracted and synthesized using a multicategory prevalence meta-analysis. Measuring the ACE was the primary outcome of the study.

Findings:

• The mean age of children across studies was 11.9 (SD, 4.3) years, the age range across samples was 0 to 18 years, and 50.5% were female.
• The study estimated that the mean prevalence rates of ACEs were 42.3% for no ACEs, 22.0% had 1 ACE, 12.7% had 2 ACEs, 8.1% experienced 3 ACEs, and 14.8% had 4 or more ACEs.
• The prevalence of 4 or more ACEs was higher among adolescents vs children (prevalence ratio, 1.16), children in residential care (1.26), with a history of juvenile offending (1.29), and Indigenous peoples (1.63), as well as in studies where file review was the primary assessment method (1.29).
• Additionally, the prevalence of no ACEs was lower in questionnaire-based studies where children vs parents were informants (0.85).

Thus, the study concluded that ACEs are widespread among children, especially among adolescents for experiencing 4 or more ACEs leading to disease burden and early mortality. The researchers emphasized the need for trauma-informed care and culturally sensitive interventions to avoid ACEs and mitigate their long-term impact. The authors also stressed the immediate attention that has to be given to such issues and developing supportive programs to address childhood adversity.

• In this study, adverse childhood experiences (ACEs), which include abuse, neglect, and family dysfunction, were prevalent among children with notable disparities across participant demographic characteristics and contexts.
• As principal antecedent threats to child and adolescent well-being that can affect later life prospects, ACEs represent a pressing global social issue.
• Effective early identification and prevention strategies, including targeted co-designed community interventions, can reduce the prevalence of ACEs and mitigate their severe effects, thereby minimizing the harmful health consequences of childhood adversity in future generations

Further reading: Madigan S, Thiemann R, Deneault A, et al. Prevalence of Adverse Childhood Experiences in Child Population Samples: A Systematic Review and Meta-Analysis. JAMA Pediatr. Published online November 11, 2024. doi:10.1001/jamapediatrics.2024.4385