Sample Review

Adverse childhood exposures and reported child health at age 12. Emalee G Flaherty, Richard Thompson, Alan J Litrownik et al. Acad Pediatr 2009; 9:150-156. (from Chicago IL, San Diego CA and Baltimore MD)

Adverse childhood experiences and adult health. Vincent J Felitti. Acad Pediatr 2009;9:131-132. (from San Diego CA)

Review from Winter 2009 issue

This study used LONGSCAN data to examine the impact of childhood adverse childhood experiences (ACES) on health outcomes at age 12. The LONGSCAN (Longitudinal Studies of Child Abuse and Neglect) consortium included 1,354 children recruited at five sites around the country. Children were recruited because they had been maltreated or were at high risk of experiencing maltreatment. In this study, subjects were included if interview data had been collected when the children were either age 4 or 6, and ages 8 and 12. These criteria resulted in a sample of 805 children. 

Information about eight categories of ACES, including psychological maltreatment, physical abuse, sexual abuse, neglect, caregiver’s substance/alcohol use, caregivers being treated
violently, caregiver’s depressive symptoms, and criminal behavior in the household, were collected when the children were either 4 or 6 and at age 8. Health outcomes were determined when the children were age 12 years and were based on data from children, with the children self-rating their health or somatic complaints using the Youth Self-Report measure. Outcomes were also determined based on information collected from the caregiver, using data obtained from hospitalizations, or somatic complaints from the Child Behavior Checklist.

Only 10% of the children had experienced no ACES; 20% had experienced at least five. Not surprisingly, there were significant relationships between having at least five ACES and poor health outcomes. These associations were stronger for ACES during the period of ages 8 to 12 compared to ACES during the period of ages 4 to 6.

In the accompanying commentary, Felitti notes that the most important finding in the article is that ACES are “surprisingly common” even in the earliest years. He also notes that ACES are generally unrecognized but that they can be identified in childhood.

When he addresses how ACES lead to poor health in adulthood, Felitti posits two pathways. First, disease might come about as a delayed consequence of various coping devices, such as smoking, drug use, or over eating. Second, disease can come about when chronic stress in childhood leads to hypercortisolemia and proinflammatory cytokines, which in turn result in disease.

Felitti ends by highlighting the importance of prevention that focuses on improved parenting.

    Reviewed by John M. Leventhal, M.D.

Reviewer’s Note:
The link between childhood ACES and health at age 12 is not surprising. The strongest associations were for ACES noted between ages 8 and 12. I was surprised that the associations were much weaker and sometimes non-existent for ACES during the earlier years.

It is important to note that the generalizability of these results is limited by the sample. Since many of the children in the LONGSCAN sample had experienced maltreatment and all the others were at high risk of maltreatment, the prevalence of ACES noted in this study was very high, substantially higher than in the sample of adults studied by Felitti in the San Diego Kaiser HMO. Thus, the results of this study cannot be generalized to all U.S. children or even to underserved children.