Program evaluation of a school-based mental health and wellness curriculum featuring yoga and mindfulness.

BACKGROUND: Interest in the effectiveness of mindfulness-based interventions such as yoga in primary schools has grown. Evidence shows promise, as youth who engage in yoga to promote mindfulness show improved coping skills, increased socio-emotional competence and prosocial skills, academic performance, attention span, and ability to deal with stress. OBJECTIVE: This study reports the results of a program evaluation of a universal health and wellness curriculum, Pure Power, designed to teach youth yoga techniques, mindfulness, and emotion regulation. METHODS: A non-randomized comparison design examined outcomes among participants from schools that completed the intervention with highest fidelity of implementation (n = 461) and from students in matched comparison schools (n = 420). Standard measures of coping, emotion regulation and emotion dysregulation, spelling, and math achievement were collected. RESULTS: Analyses suggest the youth in the intervention schools demonstrated relative improvement on measures of emotion regulation, spelling, and math. CONCLUSIONS: Challenges in implementation in real-life settings are vital to identify. The data provide some real-world evidence for the effectiveness of a universal health and wellness curriculum on emotion regulation and positive academic outcomes. Training school staff to deliver the intervention may foster implementation. Future research should test the effectiveness of who delivers the intervention; for example, teacher-delivered groups vs. other wellness personnel.

Impact of anxiety and depression on academic achievement among underserved school children: evidence of suppressor effects.

Anxiety and depression symptoms may leave children at risk for lower academic scores, though this unique linkage to academic achievement in underserved youth is less well established. This study aimed to examine how anxiety and depression are uniquely related to spelling and math achievement beyond attention and hyperactivity deficits in children in underserved schools. Children aged 8 to 11 (n = 1085, 47.3% female) from historically underserved groups (Hispanic 75.3%, American Indian 6.4%, Black 4.9%, and White 1.5%) from 13 schools across two public school districts in California participated in the assessment of emotional and behavioral health symptoms that included a spelling and math assessment. While there was no relationship between anxiety or hyperactivity on spelling and math scores, depression and attention problems were significantly negatively related to spelling and math scores. However, when entered simultaneously, evidence of suppressor effects emerged. Anxiety and hyperactivity both became positively predictive of math. Similarly, anxiety became positively predictive of spelling. Subsample analyses showed that these suppressor effects were only in females. The associations among anxiety, depression, attention, and hyperactivity with spelling and math achievement are complex, and when controlling for depression and attention, anxiety levels and hyperactivity may be motivating some level of achievement in these areas.

Cortical activation predicts posttraumatic improvement in youth treated with TF-CBT or CCT.

BACKGROUND: Identifying neural activation patterns that predict youths' treatment response may aid in the development of imaging-based assessment of emotion dysregulation following trauma and foster tailored intervention. Changes in cortical hemodynamic activity measured with functional near-infrared spectroscopy (fNIRS) may provide a time and cost-effective option for such work. We examined youths' PTSD symptom change following treatment and tested if previously identified activation patterns would predict treatment response. METHODS: Youth (N = 73, mean age = 12.97, SD = 3.09 years) were randomly assigned to trauma-focused cognitive behavioral therapy (TF-CBT), cue-centered therapy (CCT), or treatment as usual (TAU). Parents and youth reported on youth's PTSD symptoms at pre-intervention, post-intervention, and follow-up. Neuroimaging data (N = 31) assessed at pre-intervention were obtained while youth engaged in an emotion expression task. Treatment response slopes were calculated for youth's PTSD symptoms. RESULTS: Overall, PTSD symptoms decreased from pre-intervention through follow-up across conditions, with some evidence of relative benefit of TF-CBT and CCT over TAU but significant individual variation in treatment response. Cortical activation patterns were correlated with PTSD symptom improvement slopes (r = 0.53). In particular, cortical responses to fearful and neutral facial stimuli in six fNIRS channels in the bilateral dlPFC were important predictors of PTSD symptom improvement. CONCLUSIONS: The use of fNIRS provides a method of monitoring and assessing cortical activation patterns in a relatively inexpensive and portable manner. Associations between functional activation and youths' PTSD symptoms improvement may be a promising avenue for understanding emotion dysregulation in clinical populations.

Functional near-infrared spectroscopy brain imaging predicts symptom severity in youth exposed to traumatic stress.

Functional near-infrared spectroscopy (fNIRS) is a non-invasive neuroimaging technique with the potential to enable the assessment of posttraumatic stress disorder (PTSD) brain biomarkers in an affordable and portable manner. Consistent with biological models of PTSD, functional magnetic resonance imaging (fMRI) and fNIRS studies of adults with trauma exposure and PTSD symptoms suggest increased activation in the dorsolateral prefrontal cortex (dlPFC) and ventrolateral PFC (vlPFC) in response to negative emotion stimuli. We tested this theory with fNIRS assessment among youth exposed to traumatic stress and experiencing PTSD symptoms (PTSS). A portable fNIRS system collected hemodynamic responses from (N = 57) youth with PTSS when engaging in a classic emotion expression task that included fearful and neutral faces stimuli. The General Linear Model was applied to identify cortical activations associated with the facial stimuli. Subsequently, a prediction model was established via a Support Vector Regression to determine whether PTSS severity could be predicted based on fNIRS-derived cortical response measures and individual demographic information. Results were consistent with findings from adult fMRI and fNIRS studies of PTSS showing increased activation in the dlPFC and vlPFC in response to negative emotion stimuli. Subsequent prediction analysis revealed ten features (i.e., cortical responses from eight frontocortical fNIRS channels, age and sex) strongly correlated with PTSS severity (r = 0.65, p < .001). Our findings suggest the potential utility of fNIRS as a portable tool for the detection of putative PTSS brain biomarkers.

Longitudinal Trajectories of Hair Cortisol: Hypothalamic-Pituitary-Adrenal Axis Dysfunction in Early Childhood.

The objective of this study was to examine if longitudinal trajectories of hair cortisol concentrations (HCC) measured at two or three yearly time points can identify 1-3 year old children at risk for altered hypothalamic-pituitary-adrenal (HPA)-axis function due to early life stress (ELS). HCC was measured (N = 575) in 265 children using a validated enzyme-linked immunosorbent assay. Hair was sampled in Clinic Visits (CV) centered at years 1, 2, and 3 (n = 45); 1 and 2 (n = 98); 1 and 3 (n = 27); 2 and 3 (n = 95). Log-transformed HCC values were partitioned using latent class mixed models (LCMM) to minimize the Bayesian Information Criterion. Multivariable linear mixed effects models for ln-HCC as a function of fixed effects for age in months and random effects for participants (to account for repeated measures) were generated to identify the factors associated with class membership. Children in Class 1 (n = 69; 9% Black) evidenced declining ln-HCC across early childhood, whereas Class 2 members (n = 196; 43% Black) showed mixed trajectories. LCMM with only Class 2 members revealed Class 2A (n = 17, 82% Black) with sustained high ln-HCC and Class 2B (n = 179, 40% Blacks) with mixed ln-HCC profiles. Another LCMM limited to only Class 2B members revealed Class 2B1 (n = 65, 57% Black) with declining ln-HCC values (at higher ranges than Class 1), and Class 2B2 (n = 113, 30% Black) with sustained high ln-HCC values. Class 1 may represent hair cortisol trajectories associated with adaptive HPA-axis profiles, whereas 2A, 2B1, and 2B2 may represent allostatic load with dysregulated profiles of HPA-axis function in response to varying exposures to ELS. Sequential longitudinal hair cortisol measurements revealed the allostatic load associated with ELS and the potential for developing maladaptive or dysregulated HPA-axis function in early childhood.

Translating the neuroscience of adverse childhood experiences to inform policy and foster population-level resilience.

Imaging methods have elucidated several neurobiological correlates of traumatic and adverse experiences in childhood. This knowledge base may foster the development of programs and policies that aim to build resilience and adaptation in children and youth facing adversity. Translation of this research requires both effective and accurate communication of the science. This review begins with a discussion of integrating the language used to describe and identify childhood adversity and their outcomes to clarify the translation of neurodevelopmental findings. An integrative term, Traumatic and Adverse Childhood Experiences (TRACEs+) is proposed, alongside a revised adverse childhood experiences (ACEs) pyramid that emphasizes that a diversity of adverse experiences may lead to a common outcome and that a diversity of outcomes may result from a common adverse experience. This term facilitates linkages between the ACEs literature and the emerging neurodevelopmental knowledge surrounding the effect of traumatic adverse childhood experiences on youth in terms of the knowns and unknowns about neural connectivity in youth samples. How neuroscience findings may lead directly or indirectly to specific techniques or targets for intervention and the reciprocal nature of these relationships is addressed. Potential implications of the neuroscience for policy and intervention at multiple levels are illustrated using existing policy programs that may be informed by (and inform) neuroscience. The need for transdisciplinary models to continue to move the science to action closes the article. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The social ecology of childhood and early life adversity.

An increasing prevalence of early childhood adversity has reached epidemic proportions, creating a public health crisis. Rather than focusing only on adverse childhood experiences (ACEs) as the main lens for understanding early childhood experiences, detailed assessments of a child's social ecology are required to assess "early life adversity." These should also include the role of positive experiences, social relationships, and resilience-promoting factors. Comprehensive assessments of a child's physical and social ecology not only require parent/caregiver surveys and clinical observations, but also include measurements of the child's physiology using biomarkers. We identify cortisol as a stress biomarker and posit that hair cortisol concentrations represent a summative and chronological record of children's exposure to adverse experiences and other contextual stressors. Future research should use a social-ecological approach to investigate the robust interactions among adverse conditions, protective factors, genetic and epigenetic influences, environmental exposures, and social policy, within the context of a child's developmental stages. These contribute to their physical health, psychiatric conditions, cognitive/executive, social, and psychological functions, lifestyle choices, and socioeconomic outcomes. Such studies must inform preventive measures, therapeutic interventions, advocacy efforts, social policy changes, and public awareness campaigns to address early life adversities and their enduring effects on human potential. IMPACT: Current research does not support the practice of using ACEs as the main lens for understanding early childhood experiences. The social ecology of early childhood provides a contextual framework for evaluating the long-term health consequences of early life adversity. Comprehensive assessments reinforced with physiological measures and/or selected biomarkers, such as hair cortisol concentrations to assess early life stress, may provide critical insights into the relationships between early adversity, stress axis regulation, and subsequent health outcomes.

Anxiety and Stress Alter Decision-Making Dynamics and Causal Amygdala-Dorsolateral Prefrontal Cortex Circuits During Emotion Regulation in Children.

BACKGROUND: Anxiety and stress reactivity are risk factors for the development of affective disorders. However, the behavioral and neurocircuit mechanisms that potentiate maladaptive emotion regulation are poorly understood. Neuroimaging studies have implicated the amygdala and dorsolateral prefrontal cortex (DLPFC) in emotion regulation, but how anxiety and stress alter their context-specific causal circuit interactions is not known. Here, we use computational modeling to inform affective pathophysiology, etiology, and neurocircuit targets for early intervention. METHODS: Forty-five children (10-11 years of age; 25 boys) reappraised aversive stimuli during functional magnetic resonance imaging scanning. Clinical measures of anxiety and stress were acquired for each child. Drift-diffusion modeling of behavioral data and causal circuit analysis of functional magnetic resonance imaging data, with a National Institute of Mental Health Research Domain Criteria approach, were used to characterize latent behavioral and neurocircuit decision-making dynamics driving emotion regulation. RESULTS: Children successfully reappraised negative responses to aversive stimuli. Drift-diffusion modeling revealed that emotion regulation was characterized by increased initial bias toward positive reactivity during viewing of aversive stimuli and increased drift rate, which captured evidence accumulation during emotion evaluation. Crucially, anxiety and stress reactivity impaired latent behavioral dynamics associated with reappraisal and decision making. Anxiety and stress increased dynamic casual influences from the right amygdala to DLPFC. In contrast, DLPFC, but not amygdala, reactivity was correlated with evidence accumulation and decision making during emotion reappraisal. CONCLUSIONS: Our findings provide new insights into how anxiety and stress in children impact decision making and amygdala-DLPFC signaling during emotion regulation, and uncover latent behavioral and neurocircuit mechanisms of early risk for psychopathology.

The Network Structure of Posttraumatic Stress Symptoms in Children and Adolescents Exposed to Disasters.

OBJECTIVE: To evaluate current theoretical assumptions about the nature of pediatric posttraumatic stress disorder (PTSD) by examining the network structure of PTSD in a sample of youth exposed to disasters and testing for age differences. Network analysis provides the opportunity to identify "central" symptoms that might hold an outsized influence over others and are important targets for research and treatment. The authors hypothesized that particular symptoms would exhibit greater influence over others. They further hypothesized marked differences in symptom networks across children and adolescents. METHOD: Participants were 786 youth 8 to 13 years old (children) and 14 to 18 years old (adolescents) exposed to Hurricanes Katrina and Gustav who were assessed for PTSD symptoms using the University of California-Los Angeles PTSD Reaction Index for Children. Network models were computed and constructed using the R-package qgraph, which estimates associations between symptoms and forms graphic network models. RESULTS: Consistent with the hypotheses, the symptom network demonstrated meaningful variability across age, particularly in the strength of associations, and the relative importance of individual symptoms to the network as a whole. Results further demonstrated that symptoms cluster together in a manner that adds a unique perspective to current model conceptualizations. CONCLUSION: Network analysis is a potentially important additional conceptualization of psychopathology with related data analytic techniques. Results suggest that PTSD can be characterized as a web of interactions between symptoms. This work illuminates differences in the PTSD symptom network across development, such as the link between numbness of negative affect and amnesia in children, but not in teens, and how the critical symptoms within that network differ across childhood and adolescence. Network analysis could allow the re-envisioning of the nature of this complex disorder with new avenues for research and clinical practice.

The moderating effects of sex on insula subdivision structure in youth with posttraumatic stress symptoms.

BACKGROUND: The insula is involved in interoceptive processing, emotion awareness, and attention to salient stimuli. Research suggests that these functions are specific-albeit overlapping-within insula subdivisions. Additional studies also imply that sexual dimorphism and different rates of development occur within these subdivisions in youth. The purpose of this study was to examine potential insula subdivision structure differences in youth with PTSD symptoms as compared to controls and test sex as a moderator of these differences. METHODS: Insula structure (volume, surface area, and thickness) was measured with structural magnetic resonance imaging (sMRI) and calculated using Freesurfer software. We compared insula structure across age- and sex-matched boys and girls with (30 with and 29 without) PTSD symptoms while also controlling for age and whole brain measurements. RESULTS: Differences were specific to the insula's anterior circular sulcus. Within this subregion, boys with PTSD symptoms demonstrated larger volume and surface area than control boys, while girls with PTSD symptoms demonstrated smaller volume and surface area than control girls. DISCUSSION: Findings indicate a potential neurobiological explanation for sex differences in youth with PTSD symptoms.

Post-traumatic stress and age variation in amygdala volumes among youth exposed to trauma.

Theoretically, normal developmental variation in amygdala volumes may be altered under conditions of severe stress. The purpose of this article was to examine whether posttraumatic stress moderates the association between age and amygdala volumes in youth exposed to traumatic events who are experiencing symptoms of post-traumatic stress disorder (PTSD). Volumetric imaging was conducted on two groups of youth aged 9-17 years: 28 with exposure to trauma and PTSD symptoms (boys = 15, girls = 13) and 26 matched (age, IQ) comparison youth (Controls; boys = 12, girls = 14). There was a significant group by age interaction in predicting right amygdala volumes. A positive association between age and right amygdala volumes was observed, but only in PTSD youth. These associations with age remained when controlling for IQ, total brain volumes and sex. Moreover, older youth with PTSD symptoms had relatively larger right amygdala volumes than controls. Findings provide evidence that severe stress may influence age-related variation in amygdala volumes. Results further highlight the importance of utilizing age as an interactive variable in pediatric neuroimaging research, in so far as age may act as an important moderator of group differences.

Child abuse, disruptive behavior disorders, depression, and salivary cortisol levels among institutionalized and community-residing boys in Mongolia.

INTRODUCTION: Hypothalamic-pituitary-adrenal (HPA) axis activity is related to childhood disruptive behavior disorders and to exposure to abuse and neglect. This study explores the relationship of diurnal salivary cortisol levels with oppositional defiant disorder (ODD) and caregiver attitudes toward physical punishment among boys in Mongolia. METHODS: Salivary cortisol was collected in the home or institution 4 times daily for 4 days from 46 boys, aged 4-10 years, in Ulaanbaatar, Mongolia. Caregivers rated child disruptive behavior symptoms, attitudes toward physical punishment, and community violence exposures. Mixed effects models were used to estimate the association of psychopathology and caregiver attitudes with salivary cortisol levels. RESULTS: Boys meeting criteria for ODD displayed consistently lower diurnal salivary cortisol levels compared to boys without ODD diagnoses. Controlling for ODD diagnosis, boys with depression showed higher cortisol levels throughout the day. No other diagnosis was associated with cortisol levels. Psychiatric diagnosis accounted for 17% of between individual variations in cortisol levels unexplained by the covariates. In a separate model, caregivers' beliefs regarding physical punishment accounted for 11% of between individual differences: boys with caregivers who stated physical punishment was necessary for discipline displayed hypocortisolism. Institutionalization did not associate with cortisol levels. DISCUSSION: Salivary cortisol data from a non-Western naturalistic setting support an association of reduced basal HPA activity with disruptive behavior disorders and caregiver attitudes toward discipline. These findings suggest HPA functioning may be a reflection of or mediate disruptive behavior disorders in children across ethnic and cultural settings.

Developmental variation in amygdala volumes among children with posttraumatic stress.

This article examined associations between indices of maturation (age and Tanner stage) and amygdala volumes in 24 youth (aged 7-14) with posttraumatic stress disorder symptoms and a matched control group. Fifteen of the youth with exposure to trauma were also re-evaluated one year later. A positive association between maturation and right amygdala volumes was observed in the trauma group but not in controls. Associations with maturation remained when controlling for a number of possible covariates and over time. Developmentally younger youth (Tanner stage 1 and 2) showed increases and older (Tanner stage 3 and 4) decreases in right amygdala volumes.

A prospective study on the association between caregiver psychological symptomatology and symptom clusters of pediatric posttraumatic stress disorder.

This study investigated the influence of caregiver psychological symptoms on posttraumatic stress disorder (PTSD) symptoms in traumatized children. One-hundred eleven children and caretakers were assessed in this study. Children (N = 59) with a history of exposure to interpersonal violence were evaluated for reexperiencing, avoidance/numbing, and hyperarousal symptom clusters using the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). The 52 primary caregivers were evaluated using the Symptom Checklist-90-Revised (SCL-90-R) on 9 domains of psychological symptomatology: anxiety, depression, hostility, interpersonal sensitivity, obsessive-compulsive disorder, paranoid ideation, phobic anxiety, psychoticism, and somatization. At 14-month follow-up, 45 of the children were re-evaluated with the CAPS-CA. Caregiver psychological symptoms in the domains of anxiety, depression, interpersonal sensitivity, obsessive-compulsive disorder, and paranoid ideation were associated with less improvement in total pediatric PTSD symptoms. Analysis of PTSD symptoms by cluster showed that greater caregiver symptomatology in the domains of anxiety, depression, interpersonal sensitivity, and obsessive-compulsive disorder were associated with less improvement in the hyperarousal symptom cluster. These results suggest caregiver symptomatology may be specifically associated with hyperarousal symptoms in pediatric trauma.

Cue-centered treatment for youth exposed to interpersonal violence: a randomized controlled trial.

This study provides preliminary evidence of the feasibility and efficacy of the Stanford cue-centered treatment for reducing posttraumatic stress, depression, and anxiety in children chronically exposed to violence. Sixty-five youth aged 8­17 years were recruited from 13 schools. Participants were randomly assigned to cue-centered treatment or a waitlist control group. Assessments were conducted at 4 discrete time points. Self-report measures assessed youth symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression.Self-report ratings of caregiver anxiety and depression as well as caregiver report of child PTSD were also obtained. Therapists evaluated participants' overall symptom improvement across treatment sessions. Hierarchal linear modeling analyses showed that compared to the waitlist group, the cue-centered treatment group had greater reductions in PTSD symptoms both by caregiver and child report, as well as caregiver anxiety. Cue-centered treatment, a hybrid trauma intervention merging diverse theoretical approaches, demonstrated feasibility,adherence, and efficacy in treating youth with a history of interpersonal violence.

Can traumatic stress alter the brain? Understanding the implications of early trauma on brain development and learning.

BACKGROUND: Youth who experience traumatic stress and develop post-traumatic symptoms secrete higher levels of the glucocorticoid cortisol than youth with no trauma history. Animal research suggests that excess corticosterone secretion can lead to neurotoxicity in areas of the brain rich in glucocorticoid receptors such as the hippocampus and the prefrontal cortex (PFC). These two areas of the brain are involved in memory processing and executive function, both critical functions of learning. METHODS: In this article, we summarize findings presented at the National Summit for Stress and the Brain conducted at Johns Hopkins University's Department of Public Health in April 2011. The presentation highlighted structural and functional imaging findings in the hippocampus and PFC of youth with post-traumatic stress symptoms (PTSS). RESULTS: Youth with PTSS have higher levels of cortisol. Prebedtime cortisol levels predict decreases in hippocampal volume longitudinally. Cortisol levels are negatively correlated with volume in the PFC. Functional imaging studies demonstrate reduced hippocampal and PFC activities on tasks of memory and executive function in youth with PTSS when compared with control subjects. CONCLUSIONS: Effective interventions for youth with PTSS should target improved function of frontolimbic networks. Treatment outcome research using these potential markers can help develop more focused interventions that target the impaired learning of vulnerable youth experiencing traumatic stress.

Posttraumatic stress disorder: shifting toward a developmental framework.

This article reviews the current classification of posttraumatic stress disorder and its limitations when applied to youth. Distinctions are made between single-event and multiple-event traumas. Diagnosis, neurobiology, treatment development, and treatment outcomes are presented. A summary of current empirical interventions is provided. The authors present implications for future research and for clinical practice.

Building an Effective Medico-Legal Intervention Model in post-Earthquake Haiti / Construcción de un modelo de intervención médico-legal efectivo tras el terremoto en Haití

The earthquake that struck Haiti on January 12, 2010 left the country and its people devastated, with overwhelming losses, death, homelessness and increased violence and safety concerns. This study proposes an effective intervention model for facilitating humanitarian parole for survivors of the earthquake. A medico-legal team of psychiatrists and human rights and immigration evaluated traumatized individuals and families in Port-au-Prince in March 2010. With support from local NGOs, the legal team screened and prioritized the most severe cases, and the medical team assessed individuals with acute medical and psychiatric concerns. 124 cases were screened for humanitarian parole. Psychological, psychiatric and medical assessments were completed in 48 families (68 individuals) to identify orphans and vulnerable children, survivors of past violence who faced a risk of re-traumatization, and those at high-risk of psychological trauma. All cases needed shelter, clean water and food. Mental health impairment beyond loss and grief were identified in 89.7% of cases. Our findings suggest that a multi-disciplinary, community-based model is effective in identifying individuals and families that meet the conceptual criteria for Humanitarian Parole. The model is also effective in identifying the psychosocial and medical needs of survivors and assisting them in receiving essential health services

El terremoto que azotó Haití el 12 de Enero de 2010 dejó devastados al país y a su gente, con abrumadoras preocupaciones en torno a la pérdida, la muerte, el aumento de la violencia y la seguridad. Este estudio propone un modelo de intervención efectivo para proporcionar refugio humanitario en EE.UU. a los supervivientes del terremoto. Un equipo médico-legal de psiquiatras, personal de inmigración, y de derechos humanos, evaluó a los individuos traumatizados y a sus familias en Puerto Príncipe en Marzo de 2010. con el apoyo de ONGs locales, el equipo legal valoró y priorizó los casos más graves, y el equipo médico evaluó a los individuos con problemas médicos y psiquiátricos. Se seleccionaron 124 casos para proporcionarles refugio humanitario en EE.UU. Se completaron las valoraciones psicológica, psiquiátrica y médica en 48 familias (68 individuos), con el fin de identificar niños huérfanos y vulnerables, supervivientes de violencia pasada con riesgo de nueva traumatización, y persona de alto riesgo de trauma psicológico. Todos los casos necesitaban albergue, agua limpia y comida. Se identificó desajuste mental más allá del propio de la pérdida y el duelo en un 89,7% de los casos. Nuestros hallazgos sugieren que un modelo multidisciplinar, basado en la comunidad, es efectivo para identificar las necesidades psicológicas y médicas de los supervivientes y asistirles para recibir servicios sanitarios esenciales

The impact of adverse childhood experiences on an urban pediatric population.

OBJECTIVE: The goal of this study was to investigate the adverse childhood experiences (ACEs) in youth in a low-income, urban community. STUDY DESIGN: Data from a retrospective chart review of 701 subjects from the Bayview Child Health Center in San Francisco are presented. Medical chart documentation of ACEs as defined in previous studies were coded and each ACE criterion endorsed by a traumatic event received a score of 1 (range=0-9). This study reports on the prevalence of various ACE categories in this population, as well as the association between ACE score and two pediatric problems: learning/behavior problems and body mass index (BMI)≥85% (i.e., overweight or obese). RESULTS: The majority of subjects (67.2%, N=471) had experienced 1 or more categories of adverse childhood experiences (ACE≥1) and 12.0% (N=84) had experienced 4 or more ACEs (ACE≥4). Increased ACE scores correlated with increased risk of learning/behavior problems and obesity. CONCLUSIONS: There was a significant prevalence of endorsed ACE categories in this urban population. Exposure to 4 or greater ACE categories was associated with increased risk for learning/behavior problems, as well as obesity. PRACTICE IMPLICATIONS: Results from this study demonstrate the need both for screening of ACEs among youth in urban areas and for developing effective primary prevention and intervention models.