Adverse childhood experiences and life opportunities: Shifting the narrative

Metzler, Marilyn; Merrick, Melissa T.; Klevens, Joanne; Ports, Katie A.; Ford, Derek C.

doi:10.1016/j.childyouth.2016.10.021

Cited by 513 publications

(372 citation statements)

References 58 publications

(69 reference statements)

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“…Finally, whilst the model outlined here has focused on psychological mechanisms, the social context in which difficulties occur and the immense value of social and societal interventions is acknowledged. The social consequences of victimization, in terms of ongoing experiences of inequality and discrimination, are well documented and can of course significantly impede people’s potential to move on in their lives (Gilbert et al, 2010; Metzler et al, 2016). Addressing these consequences (including broader societal attitudes and responses to victimization) is essential and could, indirectly, have a beneficial impact on the posttraumatic stress processes outlined in the model.…”

Section: Discussionmentioning

confidence: 99%

Pathways from Trauma to Psychotic Experiences: A Theoretically Informed Model of Posttraumatic Stress in Psychosis

2017

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In recent years, empirical data and theoretical accounts relating to the relationship between childhood victimization and psychotic experiences have accumulated. Much of this work has focused on co-occurring Posttraumatic Stress Disorder or putative causal mechanisms in isolation from each other. The complexity of posttraumatic stress reactions experienced in psychosis remains poorly understood. This paper therefore attempts to synthesize the current evidence base into a theoretically informed, multifactorial model of posttraumatic stress in psychosis. Three trauma-related vulnerability factors are proposed to give rise to intrusions and to affect how people appraise and cope with them. First, understandable attempts to survive trauma become habitual ways of regulating emotion, manifesting in cognitive-affective, behavioral and interpersonal responses. Second, event memories, consisting of perceptual and episodic representations, are impacted by emotion experienced during trauma. Third, personal semantic memory, specifically appraisals of the self and others, are shaped by event memories. It is proposed these vulnerability factors have the potential to lead to two types of intrusions. The first type is anomalous experiences arising from emotion regulation and/or the generation of novel images derived from trauma memory. The second type is trauma memory intrusions reflecting, to varying degrees, the retrieval of perceptual, episodic and personal semantic representations. It is speculated trauma memory intrusions may be experienced on a continuum from contextualized to fragmented, depending on memory encoding and retrieval. Personal semantic memory will then impact on how intrusions are appraised, with habitual emotion regulation strategies influencing people’s coping responses to these. Three vignettes are outlined to illustrate how the model accounts for different pathways between victimization and psychosis, and implications for therapy are considered. The model is the first to propose how emotion regulation and autobiographical memory may lead to a range of intrusive experiences in psychosis, and therefore attempts to explain the different phenomenological associations observed between trauma and intrusions. However, it includes a number of novel hypotheses that require empirical testing, which may lead to further refinement. It is anticipated the model will assist research and practice, in the hope of supporting people to manage the impact of victimization on their lives.

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Section: Discussionmentioning

confidence: 99%

Pathways from Trauma to Psychotic Experiences: A Theoretically Informed Model of Posttraumatic Stress in Psychosis

2017

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“…Typically, ACE studies utilize a cumulative index that combines both child abuse and child neglect ACEs (i.e., physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect) with ACEs related to household challenges (i.e., exposure to mother being treated violently, parental divorce or separation, parental incarceration, a household member with substance abuse problems, and a household member with mental illness; Brown et al, 2009; Felitti et al, 1998; Gilbert et al, 2015; Metzler, Merrick, Klevens, Ford, & Ports, 2017). This summary index – frequently referred to as an ACE score – is computed for each participant and measures the total number of ACEs experienced within the first 18 years of life.…”

mentioning

confidence: 99%

“…ACE studies have revealed that ACEs are common, with approximately two-thirds of individuals experiencing at least one ACE (Felitti et al, 1998; Gilbert et al, 2015). Not only are ACEs common, but they are also associated with future violence and victimization, health risk behaviors, chronic health conditions, mental illness, decreased life potential, and premature death (Brown et al, 2009; Felitti et al, 1998; Gilbert et al, 2015; Metzler et al, 2017) in a dose-response pattern – as an individual’s ACE score or exposure to childhood adversity increases, their risk for experiencing poorer adult outcomes also increases.…”

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confidence: 99%

Unpacking the impact of adverse childhood experiences on adult mental health

Merrick

Ports

Ford

et al. 2017

Child Abuse & Neglect

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604

376

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Exposure to childhood adversity has an impact on adult mental health, increasing the risk for depression and suicide. Associations between Adverse Childhood Experiences (ACEs) and several adult mental and behavioral health outcomes are well documented in the literature, establishing the need for prevention. The current study analyzes the relationship between an expanded ACE score that includes being spanked as a child and adult mental health outcomes by examining each ACE separately to determine the contribution of each ACE. Data were drawn from Wave II of the CDC-Kaiser ACE Study, consisting of 7465 adult members of Kaiser Permanente in southern California. Dichotomous variables corresponding to each of the 11 ACE categories were created, with ACE score ranging from 0 to 11 corresponding to the total number of ACEs experienced. Multiple logistic regression modeling was used to examine the relationship between ACEs and adult mental health outcomes adjusting for sociodemographic covariates. Results indicated a graded dose-response relationship between the expanded ACE score and the likelihood of moderate to heavy drinking, drug use, depressed affect, and suicide attempts in adulthood. In the adjusted models, being spanked as a child was significantly associated with all self-reported mental health outcomes. Over 80% of the sample reported exposure to at least one ACE, signifying the potential to capture experiences not previously considered by traditional ACE indices. The findings highlight the importance of examining both cumulative ACE scores and individual ACEs on adult health outcomes to better understand key risk and protective factors for future prevention efforts.

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“…ACEs have been associated with health risk behaviors (e.g., risky sexual behaviors and substance abuse [27]), chronic health conditions (e.g., obesity and heart disease [27, 28]), future exposure to violence and injury (e.g., sexual victimization, intimate partner violence, and suicide [31–33]), mental health concerns (e.g., depression and anxiety [27, 34], brain development and physiological responses (e.g., under developed executive functioning and dysregulated stress response [35], and premature death [36]. Early adversity also impacts one’s life opportunities including educational attainment, income, and employment that can be protective for health and well-being [37–39]. Of additional concern is the documented intergenerational continuity of child abuse, neglect, and other early adversities [40], whereby children of parents exposed to violence are also at increased risk of victimization in childhood.…”

Section: Consequences Of Exposure To Violence: Adverse Childhood Expementioning

confidence: 99%

“…The impact of ACEs on health and well-being can also reverberate across generations. For example, ACEs are associated with lower adult socioeconomic outcomes (SES) [39], and children of parents who are undereducated, unemployed, and/or living in poverty are also at risk for low SES outcomes [41]. …”

Section: Consequences Of Exposure To Violence: Adverse Childhood Expementioning

confidence: 99%

Unaccompanied Children Migrating from Central America: Public Health Implications for Violence Prevention and Intervention

2017

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Purpose of Review Unaccompanied children (UC) migrating to the USA from the Central American countries of El Salvador, Guatemala, and Honduras are an underserved population at high risk for health, academic, and social problems. These children experience trauma, violence, and other risk factors that are shared among several types of interpersonal violence. Recent Findings The trauma and violence experienced by many unaccompanied children, and the subsequent implications for their healthy development into adulthood, indicate the critical need for a public health approach to prevention and intervention. Summary This paper provides an overview of the violence experienced by unaccompanied children along their migration journey, the implications of violence and trauma for the health and well-being of the children across their lifespan, prevention and intervention approaches for UC resettled in the USA, and suggestions for adapted interventions to best address the unique needs of this vulnerable population.

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Adverse childhood experiences and life opportunities: Shifting the narrative

Cited by 513 publications

References 58 publications

Pathways from Trauma to Psychotic Experiences: A Theoretically Informed Model of Posttraumatic Stress in Psychosis

Pathways from Trauma to Psychotic Experiences: A Theoretically Informed Model of Posttraumatic Stress in Psychosis

Unpacking the impact of adverse childhood experiences on adult mental health

Unaccompanied Children Migrating from Central America: Public Health Implications for Violence Prevention and Intervention

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