Screening for Adverse Childhood Experiences in Children: A Systematic Review.

CONTEXT: Adverse childhood experiences (ACEs) are associated with increased risk of poor mental health outcomes. Although there is interest in screening for ACEs for early identification and intervention, it is not known whether screening improves outcomes for children. OBJECTIVE: To systematically review whether screening for ACEs in children leads to an increase in (1) identification of ACEs, (2) referrals to services, (3) increased uptake of services, and (4) improved mental health outcomes for children and parents. DATA SOURCES: Ovid Medline, PsycINFO, CINAHL, and Center for Clinical and Translational Research electronic databases were searched between 2009 and 2021. STUDY SELECTION: Studies were included if researchers screened for current ACEs in children aged 0 to 12 years and they had a control comparison. DATA EXTRACTION: Information was extracted, including study characteristics, sample demographics, screening tool characteristics, referral rates to services, uptake rates, and mental health outcomes. RESULTS: A total of 5816 articles were screened, with 4 articles meeting inclusion criteria. Screening for ACEs increases identification of adversity and may increase referrals to services. There are limited data about whether this leads to an increase in referral uptake by families. There are no reported data addressing mental health outcomes. LIMITATIONS: There are few published control trials of moderate quality. CONCLUSIONS: There is limited evidence that screening for ACEs improves identification of childhood adversity and may improve referrals. If we are to realize the hypothesized benefits of ACEs screening on child and parent mental health, it is essential to understand the barriers for families taking up referrals.

Functional imaging correlates of childhood trauma: A qualitative review of past research and emerging trends.

Childhood trauma exposure is common and is associated with poor clinical outcomes in adolescence along with mental health and sociodemographic challenges in adulthood. While many strategies exist to investigate the biological imprint of childhood trauma exposure, functional neuroimaging is a robust and growing technology for non-invasive studies of brain activity following traumatic experience and the relationship of childhood trauma exposure with psychopathology, cognition, and behavior. In this review, we discuss three popular approaches for discerning functional neural correlates to early life trauma, including regional activation, bivariate functional connectivity, and network-based connectivity. The breadth of research in each method is discussed, followed by important limitations and considerations for future research. We close by considering emerging trends in functional neuroimaging research of childhood trauma, including the use of complex decision-making tasks to mimic clinically-relevant behaviors, data-driven techniques such as multivariate pattern analysis and whole-brain network topology, and the applications of real-time neurofeedback for treatment of trauma-related mental disorders. We aim for this review to provide a framework for understanding the relationship between atypical neural functioning and adverse outcomes following childhood trauma exposure, with a focus on improving consistency in research methods and translatability of research findings for clinical settings.

Does Rural Living in Early Life Increase the Risk for Reduced Cognitive Functioning in Later Life?

BACKGROUND: There is a robust consensus, most recently articulated in the 2020 Lancet Commission, that the roots of dementia can be traced to early life, and that the path to prevention may start there as well. Indeed, a growing body of research demonstrates that early life disadvantage may influence the risk for later life dementia and cognitive decline. A still understudied risk, however, is early life rural residence, a plausible pathway given related economic and educational disadvantages, as well as associations between later life rural living and lower levels of cognitive functioning. OBJECTIVE: We aim to examine whether living in rural environments during early life has long term implications for cognitive health in later life. METHODS: We employed the Wisconsin Longitudinal Study, which tracked 1 in every 3 high school graduates from the class of 1957, from infancy to ∼age 72. The data include a rich array of prospectively collected early life data, unique among existing studies, as well as later life measures of cognitive functioning. RESULTS: We found a robust relationship between early life rural residence, especially living on a farm, and long-term risk for reduced cognitive performance on recall and fluency tasks. Controls for adolescent cognitive functioning, APOEɛ2 and APOEɛ4, as well as childhood and adult factors, ranging from early life socioeconomic conditions to later life health and rural and farm residency, did not alter the findings. CONCLUSION: Rural living in early life is an independent risk for lower levels of cognitive functioning in later life.

Maternal Adverse Childhood Experience and Depression in Relation with Brain Network Development and Behaviors in Children: A Longitudinal Study.

Maternal childhood maltreatment and depression increase risks for the psychopathology of the offspring. This study employed a longitudinal dataset of mother-child dyads to investigate the developmental trajectories of brain functional networks and behaviors of children in relation with maternal childhood adverse experience and depression. Maternal childhood trauma was retrospectively assessed via childhood trauma questionnaire, whereas maternal depressive symptoms were prospectively evaluated during pregnancy and after delivery (n = 518). Child brain scans were acquired at age of 4.5, 6, and 7.5 years (n = 163) and behavioral problems were measured at 7.5 years using the Child Behavior Checklist. We found the functional connectivity of the language network with the sensorimotor, frontal, and attentional networks as a function of maternal adverse experience that interacted with sex and age. Girls exposed to mothers with depressive symptoms or childhood abuse showed the increased development of the functional connectivity of the language network with the visual networks, which was associated with social problems. Girls exposed to mothers with depressive symptoms showed the slower growth of the functional connectivity of the language network with the sensorimotor networks. Our findings, in a community sample, suggest the language network organization as neuroendophenotypes for maternal childhood trauma and depression.

Consistent evidence of indirect effects of impulsive delay discounting and negative urgency between childhood adversity and adult substance use in two samples.

RATIONALE: Exposure to adverse life experiences (ACEs) is robustly associated with problematic alcohol and other drug use. In addition, both ACEs and substance use have been independently associated with impulsivity. OBJECTIVE: To examine whether impulsivity is implicated in the link between ACE and adult substance use in two samples. METHODS: The primary sample was a cohort of community adults (N = 1431) who completed a one-time in-person assessment. A second sample was crowdsourced using Amazon Mechanical Turk (N = 3021). All participants were assessed for ACEs using the Adverse Childhood Experience Questionnaire and for current alcohol and other drug use. Given its multidimensional nature, impulsivity was assessed using the UPPS-P measure of impulsive personality traits, Go/NoGo (GNG) task (in-person community adult sample only), and delay discounting (Monetary Choice Questionnaire [MCQ] in the community adults and Effective Delay-50 [ED50] in the crowdsourced sample. Structural equation modeling was used to examine the hypothesized indirect effects for the measures of impulsivity between ACEs and substance use. RESULTS: In the community adults, significant indirect effects were observed from ACEs to substance use via UPPS-Negative Urgency (ß = 0.07, SE = 0.02, 95% CI [0.04, 0.10]), and the MCQ (ß = 0.02 SE = .01, 95% CI [0.01, 0.03]). In the crowdsourced sample, significant indirect effects were observed from ACEs to substance use via UPPS-Negative Urgency (ß = 0.05, SE = .01, 95% CI [0.04, 0.07]), UPPS-Premeditation (ß = 0.04, SE = .01, 95% CI [0.02, 0.05), and the ED50 (ß = 0.02, SE = .01; 95% CI [0.01, 0.03]). CONCLUSION: These findings provide consistent evidence that decrements in regulation of negative emotions and overvaluation of immediate rewards indirectly link ACE and substance use. These robust cross-sectional findings support the need for elucidating the underlying neural substrates implicated and for longitudinal evaluations.

The Association Between Adverse Childhood Experiences and Child Telomere Length: Examining Self-Regulation as a Behavioral Mediator.

Childhood adversity is linked to shortened telomere length (TL), but behavioral indicators of telomere attrition remain unclear. This study examined the association between adverse childhood experiences (ACEs) and child TL, and if ACEs were indirectly associated with TL through children's self-regulatory abilities (i.e., effortful control and self-control). Hypotheses were tested using national data from teachers, parents, and their children (N = 2,527; Mage  = 9.35, SD = .36 years). More ACEs were uniquely associated with short TL, and low self-control mediated the association between more ACEs and short TL. While longitudinal studies are needed to strengthen claims of causation, this study identifies a pathway from ACEs to TL that should be explored further.

Adverse childhood experiences and asthma: trajectories in a national cohort.

OBJECTIVE: Research has linked early adverse childhood experiences (ACEs) with asthma development; however, existing studies have generally relied on parent report of exposure and outcome. We aimed to examine the association of early life ACEs with empirically determined trajectories of childhood asthma risk, using independent register information on both exposures and outcome. METHODS: Based on nationwide registries, we established a study cohort of 466 556 children born in Denmark (1997-2004). We obtained information on ACEs during the first 2 years of life (bereavement, parental chronic somatic and/or mental illness) and childhood asthma diagnosis or medication use from birth through age 10 years from the Danish National Patient and Prescription Registries, respectively. We identified asthma phenotypes using group-based trajectory modelling. We then used multinomial logistic regression to examine the association between early ACEs and asthma phenotypes. RESULTS: We identified four asthma phenotypes: non-asthmatic, early-onset transient, early-onset persistent and late-onset asthma. Girls with early-onset transient asthma (OR 1.13, 95% CI 1.04 to 1.24), early-onset persistent asthma (1.27, 95% CI 1.08 to 1.48) or late-onset asthma (OR 1.28, 95% CI 1.11 to 1.48) vs no asthma were more likely to have early life ACE exposure compared with girls without ACE exposure. Results were similar for boys who also had experienced early life ACEs with ORs of 1.16 (95% CI 1.08 to 1.25), 1.34 (95% CI 1.20 to 1.51) and 1.11 (95% CI 0.98 to 1.25), respectively. CONCLUSION: In a nationwide-population study, we identified three childhood onset asthma phenotypes and found that ACEs early in life were associated with increased odds for each of these asthma phenotypes among both girls and boys.

Childhood trauma is associated with elevated anhedonia and altered core reward circuitry in major depression patients and controls.

Childhood trauma (CT) is a well-established risk factor for major depressive disorder (MDD). However, the underlying mechanism linking CT and MDD remains not fully understood. The present study tested the hypothesis that CT have effects on specific types of anhedonia in depression via reward system. To do so, we evaluated different aspects of anhedonia and resting-state functional connectivity (FC) in reward system among 66 patients with MDD (44 with moderate-to-severe and 22 with no or low CT), and 57 healthy controls (HC; 23 with moderate-to-severe and 34 with no or low CT). Results showed that MDD patients with moderate-to-severe CT suffered more severe state anhedonic depression than patients with no or low level of CT. Individuals with moderate-to-severe CT, irrespective of MDD diagnosis, had elevated physical, social and anticipatory but not consummatory trait anhedonia, and demonstrated decreased left nucleus accumbens (NAcc)-right orbital frontal cortex (OFC) and left ventral caudate-left OFC connectivity compared to those with no or low exposure. Left NAcc-right OFC connectivity mediated relationship between CT and state anhedonia in MDD. The total altered ventral striatum (VS)-OFC connectivity mediated links between CT and physical trait anhedonia in HC. These findings highlight specific types of anhedonia and the core reward system as targets of CT. Blunted hedonic responses via decreased coupling within core reward system may be involved in the mechanism of depression following CT. Implications for clinical interventions are also discussed.

Differences in the prevalence of childhood adversity by geography in the 2017-18 National Survey of Children's Health.

BACKGROUND: Previous efforts to examine differences in adverse childhood experiences (ACEs) exposure by geography have yielded mixed results, and have not distinguished between urban, suburban, and rural areas. Additionally, few studies to date have considered the potentially moderating role of geography on the relationship between ACEs and health outcomes. OBJECTIVE: To examine differences in exposure to ACEs by geography, and determine whether geography moderates the relationship between ACE exposure and health outcomes (overall health, asthma, attention deficit hyperactivity disorder (ADHD), and special health care needs). PARTICIPANTS AND SETTING: The cross-sectional 2017-18 National Survey of Children's Health (NSCH). METHODS: Distributions of individual and cumulative ACEs by geography (urban, suburban, rural) were compared using chi-squared tests. Logistic regression was used to determine the association between geography and exposure to 4 + ACEs, and to explore whether the relationship between ACEs and health outcomes varied by geography, adjusting for sociodemographic covariates. RESULTS: Adjusting for covariates, rural residency was associated with 1.29 times increased odds of exposure to 4 + ACEs (95 % CI: 1.00, 1.66) compared to suburban residency. Statistically significant evidence for an interaction between geography and ACE exposure on overall health was not observed, but urban status was observed to increase the association between ACEs and asthma. CONCLUSIONS: This analysis demonstrates a higher ACE burden in rural compared to suburban children. These findings underscore the importance of ACE screening and suggest investment of healthcare resources in the historically underserved rural population.

Adverse childhood experiences and early life inflammation in the Avon longitudinal study of parents and children.

BACKGROUND: Adverse childhood experiences (ACEs) have been associated with poorer health across the life course. Previous studies have used cumulative risk scores (ACE scores) or individual ACEs but these two approaches have important shortcomings. ACE scores assume that each adversity is equally important for the outcome of interest and the single adversity approach assumes that ACEs do not co-occur. Latent class analysis (LCA) is an alternative approach to operationalising ACEs data, identifying groups of people co-reporting similar ACEs. Here we apply these three approaches for ACEs operationalisation with inflammation in childhood with the aim of identifying particular ACEs or ACE combinations that are particularly associated with higher inflammation in early life. METHODS: Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) we compare ACE scores, single adversities and LCA-derived ACE clusters in their relationships with Interleukin-6 at age 9 (n = 4935) and C-Reactive Protein (CRP) at age 9 (n = 4887). ACEs included were parental separation/divorce, parental alcohol problems, parental mental health problems, parental offending, inter-parental violence, parental drug misuse, and physical, emotional and sexual abuse. RESULTS: Two thirds of the sample reported at least one ACE. Mother's mental health problems was the most frequently reported ACE (32.3 %). LCA identified four ACE classes - 'Low ACEs' (81.1 %), 'Maternal mental health problems' (10.3 %), 'Maternal mental health problems and physical abuse' (6.3 %) and 'Parental conflict, mental health problems and emotional abuse' (2.4 %). Parental separation/divorce was associated with higher IL-6. Parental alcohol problems, paternal mental health problems, parental convictions and emotional abuse were associated with lower levels of IL-6. Associations for paternal mental health problems and emotional abuse were only observed for boys. ACE score and LCA-derived ACE classes were not associated with differences in IL-6. Girls in the 'Maternal mental health problems' cluster had lower CRP levels. CONCLUSIONS: Specific adversities and adversity combinations are important for differences in childhood inflammation. Some associations were only observed for girls or boys.

Methylation of oxytocin related genes and early life trauma together shape the N170 response to human faces.

Childhood trauma fundamentally shapes social cognition and basic processing of social cues, which frequently cascade into adverse behavioral outcomes. Recent studies indicate that epigenetic changes in oxytocin functioning might contribute to these long-term effects, although a deeper understanding of the underlying mechanisms is still lacking. The electroencephalographic N170 response to faces might capture a neural response at the core of these interactive effects of oxytocin gene methylation and childhood adversity, given that this response is considered to reflect fundamental face processing, to be susceptible to oxytocin administration and also to be a biomarker of various psychiatric disorders. We assessed the N170 response to neutral faces in relation to participant's (81, women) recalled childhood trauma, methylation of their oxytocin structural (OXTg) and oxytocin receptor (OXTRg) genes, and endogenous levels of cortisol and testosterone. Additionally, we investigated the interactive effect of OXTg methylation and CTQ across three face sets of varying maturity. Methylation of OXTg relates to a weakened N170 response towards adults, children and infants. Moreover, methylation of both OXTRg and OXTg shaped the directionality of adversity effects, predicting a weakened N170 response in those with high methylation and hyper-vigilance with participants with low methylation. Our results are the first to relate OXT(R)g methylation to the N170 response. They shed light on biological processes linking childhood adversity and epigenetic marks to altered behavior and potentially psychopathologies.

The history of multiple adverse childhood experiences in patients with schizophrenia is associated with more severe symptomatology and suicidal behavior with gender-specific characteristics.

The current study aims to compare the prevalence of adverse childhood experiences (ACEs) between patients with schizophrenia and non-psychiatric control group, and to analyze the association of having suffered multiple ACEs with clinical symptoms of schizophrenia and suicidal behavior. A multicenter, cross-sectional study was conducted across three facilities in Buenos Aires, Argentina. One-hundred patients with schizophrenia and 50 healthy subjects were assessed with the Adverse Childhood Experiences questionnaire (ACE-Q), the Positive and Negative Syndrome Scale (PANSS), and the Columbia-Suicide Severity Rating Scale (C-SSRS). We observed that the prevalence of at least one ACE in schizophrenic patients was almost double in comparison with the non-psychiatric control group. Multiple ACEs were associated with persistent auditory hallucinations and lower negative symptoms in both sexes. Higher frequency of death ideation and a higher number of suicide attempts were reported among women. The strength of this study is the possibility of comparing the presence of ACEs between schizophrenic patients and non-psychiatric control using the same questionnaire in an under-reported sample of low socio-economic patients assisted in public hospitals. A limitation is that the history of ACEs relied on the retrospective assessment of childhood experiences, and adults could over-report ACEs because of recall bias.

Trends in Adverse Childhood Experiences (ACEs) in the United States.

BACKGROUND: It is important for those called upon to discuss major social determinants of health such as adverse childhood experiences (ACEs) to have accurate knowledge about generational trends in their prevalence. OBJECTIVE: To review available trend data on major forms of ACEs. METHODS: A search of academic data bases was conducted by combining the term "trend" with a variety of terms referring to childhood adversities. RESULTS: Available trend data on ACEs from the 20th century show multi-decade declines in parental death, parental illness, sibling death, and poverty, but multi-decade increases in parental divorce, parental drug abuse and parental incarceration. More recent trend data on ACEs for the first fifteen to eighteen years of the 21st century show declines in parental illness, sibling death, exposure to domestic violence, childhood poverty, parental divorce, serious childhood illness, physical abuse, sexual abuse, physical and emotional bullying and exposure to community violence. Two 21st century ACE increases were for parental alcohol and drug abuse. Overall, there appear to have been more historical and recent improvements in ACEs than deteriorations. But the US still lags conspicuously behind other developed countries on many of these indicators. CONCLUSION: Awareness of improvements, as well as persistent challenges, are important to motivate policy makers and practitioners and to prompt them to recognize the feasibility of success in the prevention of ACEs.

DNA methylation of IL-4 gene and the association with childhood trauma in panic disorder.

Increasing evidence suggests that aberrations in the immune-inflammatory pathways contribute to the pathophysiology of panic disorder (PD). We aimed to investigate whether an aberrant DNA methylation of the inflammation-related genes in the development of PD, including CCL3, CRP, CSF2, CXCL8, IFNG, IL12B, IL1A, IL-4, IL-6, TNF. Then, the effect of childhood trauma(CT) on methylation levels of  inflammation-related genes and the severity of PD was also investigated. We compared the methylation levels of the inflammation-related genes between 113 patients with PD and 130 matched healthy controls using MethylTarget approach. In addition, the Hamilton Anxiety Rating Scale (HAMA), Panic Disorder Severity Scale (PDSS) and Childhood Trauma Questionnaire-28 item Short Form (CTQ-28) were respectively assessed to all subjects. The result found that the methylation levels of IL-4 gene was significantly higher in PD patients than controls. ROC results found that the IL-4 gene had a sensitivity of 52.3% and a specificity of 74.6%. The methylation levels of IL-4 gene was significantly positively related to the severity of panic and anxiety. Finally, the hypermethylation of CSF2, CXCL8 and IL-4 genes was significantly associated with higher CT.

Association between different types of childhood trauma and parental bonding with antisocial traits in adulthood: A systematic review.

BACKGROUND: ASPD describes individuals with a pervasive pattern of disregard for the rights of others that begins in childhood and continues into adulthood. The relationship between parental bonding, trauma, and ASPD is well established, however, it remains unclear what types of trauma or which patterns of bonding are more associated with ASPD. OBJECTIVES: Review the literature regarding what types of trauma and bonding characteristics were related to antisocial personality traits. METHOD: Systematic searches of PubMed, Embase, Web of Science, and Scielo for studies about the relationship between antisocial personality traits and the Childhood Trauma Questionnaire (CTQ) and/or the Parental Bonding Instrument (PBI). RESULTS: 357 abstracts were selected, and 18 studies met the inclusion criteria. Regarding CTQ, the most consistent finding was the association between physical abuse and neglect to antisocial traits. Sexual abuse was the variable least related to antisocial traits. Regarding PBI, the most consistent finding was the inverse relationship between maternal and paternal care and antisocial traits. Concerning overprotection, the data is less consistent. Also, there was a considerable heterogenity between studies. CONCLUSIONS: The literature little explores how these variables interact with each other. Thus, more studies are important to aidpolitical,educational, and public health programs to create preventive initiatives for ASPD.

The Interaction of Adverse Childhood Experiences and Resiliency on the Outcome of Depression Among Children and Youth, 8-17 year olds.

BACKGROUND: Adverse childhood experiences (ACEs) are common among children. Little is known on how resilience factors and positive childhood experiences (PCEs) may moderate the relationship between ACEs and childhood depression. OBJECTIVE: Our study fills this gap by providing recent, nationally representative estimates of ACE and PCE exposure for ages 8-17 and examines the associations between ACE exposure and PCEs on the outcome of depression. PARTICIPANTS AND SETTING: Data were drawn from the nationally representative 2016-2017 National Survey of Children's Health (NSCH) and included a total sample of 40,302 children and adolescents. METHODS: Chi square analysis and multivariate logistic regressions were performed to assess associations of depression with 9 ACE and 6 PCE exposures. Additive and multiplicative interactions were examined between ACE exposure and PCEs (resiliency measures) on depression. Survey sampling weights and SAS survey procedures were used. RESULTS: Our study found that 4% of children had current depression and those with an ACE count greater than four had increased odds (aOR: 2.29; CI: 1.74-3.02). Multivariate regressions demonstrated associations between depression and low resiliency as well as significant interactions between ACE exposure and three PCEs. Children who were exposed to greater than four ACEs and did not exhibit resilience had 8.75 higher odds of depression (CI: 5.23-14.65) compared to those with less than four ACEs and some resilience. CONCLUSIONS: These findings illustrate the need for the promotion of PCEs and the building of resiliency for combatting depression and reducing the impact of trauma in children and adolescents.

Adverse childhood experiences and sexual health outcomes and risk behaviors among a nationwide sample of men who have sex with men.

BACKGROUND: Adverse Childhood Experiences (ACEs) are associated with a wide range of increased risk behaviors and health consequences, they have not been extensively described in all subpopulations. OBJECTIVE: The specific objectives of the study were to describe the prevalence of predefined ACEs among a nationwide sample of men who have sex with men (MSM) and determine associated HIV or sexually transmitted infection (STI) related health outcomes, testing practices, and risk behaviors. PARTICIPANTS AND SETTING: Eligible participants were MSM aged 18 years or older who reported male-male sex in the past 12 months. METHODS: Data were obtained from the 2015 cycle of the American Men's Internet Survey, these data were collected between September 2015 and April 2016, and contained questions related to 8 ACE exposure categories. During analyses conducted between September 2017 and April 2018, multiple log-binomial models were fit to assess associations. RESULTS: Among 2590 participants, 79.7 % reported exposure to one or more ACE category. Participants exposed to any ACE were more likely to report STI testing (adjusted prevalence ratio [aPR]: 1.07; 95 % confidence interval [95 %-CI]: 1.00, 1.15), illicit substance use (aPR: 1.23, 95 %-CI: 1.05, 1.46), and condomless anal intercourse with another man (aPR: 1.13, 95 %-CI: 1.03, 1.21). CONCLUSIONS: There is a high overall ACE burden among MSM nationally, with potential influences on key HIV/STI behaviors in later life. ACE exposure should be routinely assessed, prevention is ideal but appropriate measures such as trauma informed care should also be considered for adult MSM accessing HIV and STI-related services.

Adverse childhood experiences (ACEs) and transitions in stages of alcohol involvement among US adults: Progression and regression.

BACKGROUND: Adverse childhood experiences (ACEs) are associated with a number of medical comorbidities. However, there is a paucity of data on the role ACEs play in transitions in stages of alcohol involvement. OBJECTIVE: To examine the association between ACEs and transitions in alcohol problems progression and regression between No Problems, Moderate Problems and Severe Problems stages. PARTICIPANTS AND SETTING: Data from 14,363 male and 19,774 female participants in Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). METHODS: We used latent transition analysis (LTA) with propensity score adjustment to estimate the odds of transitioning across stages of alcohol involvement, between waves, based on the number of types of ACEs experienced. We hypothesized that ACEs would be associated with increased risk of progression and decreased risk of regression. RESULTS: ACEs were associated with progression to higher alcohol involvement stages, with greatest likelihood of progression from No Problems to Severe Problems for those reporting ≥3 ACEs (males: aOR = 4.78 [CI (1.84-12.44)]; females: aOR = 3.81 [CI (1.69-8.57)]). ACEs were also associated with decreased odds of regression to less problematic alcohol involvement stages, with some distinctive patterns of associations in males and in females. CONCLUSIONS: This study suggests that ACEs impact transitions in alcohol involvement in both males and females, affecting both progression and regression. The association is magnified for those with multiple types of ACE exposures. These results highlight the need for prevention, early identification and intervention to mitigate the risks associated with childhood maltreatment.

Frequencies and patterns of adverse childhood events in LGBTQ+ youth.

BACKGROUND: Trauma, specifically adverse childhood experiences (ACEs), predicts significant health and mental health disparities, yet there is a paucity of research with LGBTQ + youth. OBJECTIVE: This study explored ACE prevalence in a large sample of LGBTQ+ youth; examined ACE patterns within and across subgroups; and compared results with the general population. PARTICIPANTS AND SETTING: Participant (n = 3,508) ages ranged between 14-18 (x̄ = 16.02) and represented a range of sexual orientations: pansexual (33.9 %), bisexual (26.6 %), and queer (16.2 %), and gender identities: female (39.9 %), non-conforming (38 %), male (14.9 %), and transgender (16.6 %). METHODS: An online cross-sectional survey was conducted with LGBTQ+ youth ages 14-18 that self-identified as LGBTQ+ and resided in the US or Canada. Descriptive statistics generated the prevalence of ACEs, and ANOVAs and post-hoc tests were run for comparisons. RESULTS: Participants reported multiple ACEs (M = 3.14, SD = 2.44) with emotional neglect (58 %), emotional abuse (56 %), and living with a family member with mental illness (51 %) as the most prevalent. Notably, 43 % of participants experienced 4+ ACEs, considered to be a high level of trauma exposure. Compared to national samples, LGBTQ + youth demonstrated unique patterns of ACEs and were higher in 9 of 10 categories. Significantly high (all p < .001) ACEs were found in pansexual (t = 7.67), transgender and gender non-conforming (t = 5.19), American-Indian (t = 6.42), Latinx (t = 2.83) and rural youth (F = 12.12) while those with highly educated parents (F = 83.30, p < .001), lived with a parent (t = 6.02), and in Canada (t = 6.14) reported fewer ACEs. CONCLUSION: LGBTQ+ youth experience significant childhood trauma with potential impact on their mental health. This study identifies implications for trauma-informed practice and research.