1. Home
  2. adverse childhood experience

adverse childhood experience

Adolescent Opioid Misuse Attributable to Adverse Childhood Experiences

Author/s: 
Swedo, E.A., Sumner, S.A., Fijter, S., Werhan, L., Norris, K., Beauregard, J.L., Montgomery, M.P., Rose, E.B., Hillis, S. D., Massetti, G.M.

Objectives

To estimate the proportion of opioid misuse attributable to adverse childhood experiences (ACEs) among adolescents.

Study design

A cross-sectional survey was administered to 10,546 7th‒12th grade students in northeastern Ohio in Spring 2018. Study measures included self-reported lifetime exposure to 10 ACEs and past 30 day use of nonmedical prescription opioid or heroin. Using generalized estimating equations, we evaluated associations between recent opioid misuse, individual ACEs, and cumulative number of ACEs. We calculated population attributable fractions (PAF) to determine the proportion of adolescents’ recent opioid misuse attributable to ACEs.

Results

Nearly one in 50 adolescents reported opioid misuse within 30 days (1.9%); ∼60% of youth experienced ≥1 ACE; 10.2% experienced ≥5 ACEs. Cumulative ACE exposure demonstrated a significant graded relationship with opioid misuse. Compared with youth with zero ACEs, youth with 1 ACE (adjusted odds ratio [AOR]: 1.9, 95% confidence interval [CI]: 0.9‒3.9), 2 ACEs (AOR: 3.8, CI: 1.9‒7.9), 3 ACEs (AOR: 3.7, CI: 2.2‒6.5), 4 ACEs (AOR: 5.8, CI: 3.1‒11.2), and ≥5 ACEs (AOR: 15.3, CI: 8.8‒26.6) had higher odds of recent opioid misuse. The population attributable fraction of recent opioid misuse associated with experiencing ≥1 ACE was 71.6% (CI: 59.8–83.5).

Conclusions

There was a significant graded relationship between number of ACEs and recent opioid misuse among adolescents. Over 70% of recent adolescent opioid misuse in our study population was attributable to ACEs. Efforts to decrease opioid misuse could include programmatic, policy, and clinical practice interventions to prevent and mitigate the negative effects of ACEs.

Keywords 
adverse childhood experience

A Systematic Review of Trials to Improve Child Outcomes Associated With Adverse Childhood Experiences

Author/s: 
Marie-Mitchell, Ariane, Kostolansky, Rashel

Context

The purpose of this systematic literature review was to summarize current evidence from RCTs for the efficacy of interventions involving pediatric health care to prevent poor outcomes associated with adverse childhood experiences measured in childhood (C-ACEs).

Evidence acquisition

On January 18, 2018, investigators searched PubMed, PsycInfo, SocIndex, Web of Science, Cochrane, and reference lists for English language RCTs involving pediatric health care and published between January 1, 1990, and December 31, 2017. Studies were included if they were (1) an RCT, (2) on a pediatric population, and (3) recruited or screened based on exposure to C-ACEs. Investigators extracted data about the study sample and recruitment strategy, C-ACEs, intervention and control conditions, intermediate and child outcomes, and significant associations reported.

Evidence synthesis

A total of 22 articles describing results of 20 RCTs were included. Parent mental illness/depression was the most common C-ACE measured, followed by parent alcohol or drug abuse, and domestic violence. Most interventions combined parenting education, social service referrals, and social support for families of children aged 0–5years. Five of six studies that directly involved pediatric primary care practices improved outcomes, including three trials that involved screening for C-ACEs. Eight of 15 studies that measured child health outcomes, and 15 of 17 studies that assessed the parent–child relationship, demonstrated improvement.

Conclusions

Multicomponent interventions that utilize professionals to provide parenting education, mental health counseling, social service referrals, or social support can reduce the impact of C-ACEs on child behavioral/mental health problems and improve the parent–child relationship for children aged 0–5years.

Keywords 
adverse childhood experience child child abuse psychology of violence physical abuse

Adverse Childhood Experience (ACE) Questionnaire and Resource Packet

What is the role of healthcare providers?
The healthcare system is a natural place to respond to ACEs and promote resilience in children,
youth and families. Guidelines for well childcare are extensive in the early years – 13 visits in
the first three years of lifei --, which is a crucial period of child development. Health systems,
and in particular pediatric providers, are in a unique position to identify issues for both children
and their families that contribute to either promoting or inhibiting healthy development. The
American Association of Pediatrics (AAP) issued a policy statement in 2012 that encourages,
among other things, pediatricians to take a more proactive role in educating patients and
families about the impact of toxic stress and in advocating for the development of interventions
that mitigate its impact. ii

What is trauma-informed care?
Trauma-informed care encompasses three levels of focus from a systems level: addressing
policy and procedures, creating approaches for organizing and delivering services and providing
specific programs or interventions for families.

The federal agency Substance Abuse and Mental Health Services Administration (SAMHSA) has
outlined six principles for trauma informed care: (1) creating a culture of physical and
psychological safety for staff and the people they serve; (2) building and maintaining
trustworthiness and transparency among staff, clients and others involved with the
organization; (3) utilizing peer support to promote healing and recovery; (4) leveling the power
differences between staff and clients and among staff to foster collaboration and mutuality; (5)
cultivating a culture of empowerment, voice and choice that recognizes individual strengths,
resilience and an ability to heal from past trauma; and (6) recognizing and responding to the
cultural, historical and gender roots of trauma.

Keywords 
ACE children child adverse childhood experience patient health questionnaire
Subscribe to adverse childhood experience