Original Investigation | Journal Club

Adverse Childhood Experiences and Child Health in Early Adolescence

Emalee G. Flaherty, MD1,2; Richard Thompson, PhD3; Howard Dubowitz, MD4; Elizabeth M. Harvey, MPH5; Diana J. English, PhD6; Laura J. Proctor, PhD7; Desmond K. Runyan, MD, DrPH8
[+] Author Affiliations
1Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
2Northwestern University Feinberg School of Medicine, Chicago, Illinois
3Department of Research, Juvenile Protective Association, Chicago, Illinois
4Department of Pediatrics, University of Maryland, Baltimore
5Department of Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill
6School of Social Work, University of Washington, Seattle
7Judge Baker Children’s Center, Harvard Medical School, Boston, Massachusetts
8Department of Pediatrics and CH Kempe Center, University of Colorado School of Medicine, Aurora
JAMA Pediatr. 2013;167(7):622-629. doi:10.1001/jamapediatrics.2013.22.
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Importance  Child maltreatment and other adverse childhood experiences, especially when recent and ongoing, affect adolescent health. Efforts to intervene and prevent adverse childhood exposures should begin early in life but continue throughout childhood and adolescence.

Objectives  To examine the relationship between previous adverse childhood experiences and somatic concerns and health problems in early adolescence, as well as the role of the timing of adverse exposures.

Design  Prospective analysis of the Longitudinal Studies of Child Abuse and Neglect interview and questionnaire data when target children were 4, 6, 8, 12, and 14 years old.

Setting  Children with reported or at risk for maltreatment in the South, East, Midwest, Northwest, and Southwest United States Longitudinal Studies of Child Abuse and Neglect sites.

Participants  A total of 933 children who completed an interview at age 14 years, including health outcomes.

Exposures  Eight categories of adversity (psychological maltreatment, physical abuse, sexual abuse, neglect, caregiver’s substance use/alcohol abuse, caregiver’s depressive symptoms, caregiver treated violently, and criminal behavior in the household) experienced during the first 6 years of life, the second 6 years of life, the most recent 2 years, and overall adversity.

Main Outcomes and Measures  Child health problems including poor health, illness requiring a doctor, somatic concerns, and any health problem at age 14 years.

Results  More than 90% of the youth had experienced an adverse childhood event by age 14 years. There was a graded relationship between adverse childhood exposures and any health problem, while 2 and 3 or more adverse exposures were associated with somatic concerns. Recent adversity appeared to uniquely predict poor health, somatic concerns, and any health problem.

Conclusions and Relevance  Childhood adversities, particularly recent adversities, already show an impact on health outcomes by early adolescence. Increased efforts to prevent and mitigate these experiences may improve the health outcome for adolescents and adults.

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