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Cited by 353Child Abuse and TraumaChild Welfare and AdoptionChild Abuse and Related Trauma

Adverse Childhood Experiences and Child Health in Early Adolescence

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Flaherty, Emalee G., Thompson, Richard, Dubowitz, Howard, Harvey, Elizabeth M., English, Diana J., Proctor, Laura J., Runyan, Desmond K.·2013·JAMA Pediatrics
DOI 10.1001/jamapediatrics.2013.22PMC PMC3732117
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Abstract

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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  • Adverse childhood experiences predict poorer long-term outcomes across health and social domains.

    “Epidemiological studies have demonstrated that adverse childhood experiences, namely exposures such as neglect, abuse, caregiver mental illness, and family or community violence, predict poorer long-term outcomes across health and social domains.”

    From Biological embedding of childhood adversity: from physiological mechanisms to clinical implications (2017) · cites this paper as [5]

    The Results and Discussion (page not available) link adverse childhood experiences to poorer physical health at age 14, particularly when adversity was recent. The Introduction also describes links to adolescent mental health and behavior, but this study does not establish long-term outcomes across both health and social domains. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Early adversity is associated with higher risk of type 2 diabetes, obesity, ischemic heart disease, cancers, depression, addictions, premature mortality, unemployment, and lower educational attainment.

    “Outcomes associated with early adversity include higher risk of type 2 diabetes, obesity, ischemic heart disease, cancers, depression, addictions, and premature mortality, as well as social outcomes including unemployment and lower educational attainment [1–8].”

    From Biological embedding of childhood adversity: from physiological mechanisms to clinical implications (2017) · cites this paper as [5]

    The Introduction (page unavailable) reports associations of adverse childhood experiences with ischemic heart disease, cancer, alcohol and drug abuse, depressed mood, and weight problems. It does not substantiate the more specific claims about type 2 diabetes or obesity, or address premature mortality, unemployment, or lower educational attainment. The study’s own Results concern general health problems in young adolescents, not those adult and social outcomes. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Adverse psychosocial exposures in early life are associated with increased lifetime risk of adverse outcomes including diabetes, heart disease, cancers, and psychiatric illnesses.

    “Adverse psychosocial exposures in early life, namely experiences such as child maltreatment, caregiver stress or depression, and domestic or community violence, have been associated in epidemiological studies with increased lifetime risk of adverse outcomes, including diabetes, heart disease, cancers, and psychiatric illnesses.”

    From Biological embedding of childhood adversity: from physiological mechanisms to clinical implications (2017) · cites this paper as [5]

    The Introduction reports that adverse childhood experiences are linked to adolescent mental-health problems and cites studies associating them with adult ischemic heart disease and cancer. It does not report an association with diabetes. The paper’s own results concern health at age 14, not lifetime disease risk. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • ELA-induced changes may mediate epidemiological links to key diseases, including obesity, dyslipidemia, type 2 diabetes, atherosclerosis, asthma, thromboembolic events, cancer onset and progression, addictions, psychopathology, and adverse social outcomes.

    “In full, ELA-induced changes may mediate epidemiological links to key diseases, including, among others, obesity, dyslipidemia, type 2 diabetes, atherosclerosis, asthma, thromboembolic events (myocardial infarction, stroke), cancer onset and progression, as well as addictions, psychopathology, and adverse social outcomes [1–6, 18].”

    From Biological embedding of childhood adversity: from physiological mechanisms to clinical implications (2017) · cites this paper as [5]

    The Introduction reports epidemiological links between childhood adversity and ischemic heart disease, cancer, and alcohol and drug abuse. The Discussion proposes stress-related neurobiological changes as a possible explanation for adverse health outcomes. Our copy does not establish the full list of specific diseases and outcomes in the citing sentence, or show that those changes mediate each link. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • An aggregative approach to conceptualize early life adversity is supported by observed dose-response effects linking cumulative early adversity to later outcomes and by the allostatic load paradigm.

    “Such an approach facilitates the synthesis of complex evidence for application, and is supported by observed dose–response effects linking cumulative early adversity to later outcomes [1, 3, 5], and by the “allostatic load” paradigm exploring pathogenic effects of cumulative all-cause stress [15].”

    From Biological embedding of childhood adversity: from physiological mechanisms to clinical implications (2017) · cites this paper as [5]

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1 of the 60 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. [40]Straus MA Measuring intrafamily conflict and violence: The conflict tactics scale Journal of Marriage and the Family 1979 41 75 88
  2. [56]Shonkoff JP Boyce WT McEwen BS Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities JAMA 2009 301 21 2252 2259 19491187

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Authors
Flaherty, E. G., Thompson, R., Dubowitz, H., Harvey, E. M., English, D. J., Proctor, L. J., & Runyan, D. K.
Affiliations
  • Northwestern University (US)
  • Juvenile Protective Association (US)
  • University of Maryland, Baltimore (US)
  • University of North Carolina at Chapel Hill (US)
  • University of Washington (US)
  • Harvard University (US)
  • University of Colorado Anschutz (US)
ORCID
Venue
JAMA Pediatrics
Publisher
American Medical Association (AMA)
Published
2013-07-01
Volume
167
Issue
7
Pages
622
ISSN
  • 1072-4710 (ISSN-L)
  • 2168-6203
DOI
10.1001/jamapediatrics.2013.22
PMC
PMC3732117
OpenAlex
W2110442242
Cited by
353
References
60
Citations by year
2026: 12 · 2025: 23 · 2024: 28 · 2023: 35 · 2022: 39 · 2021: 54 · 2020: 36 · 2019: 30 · 2018: 29 · 2017: 23 · 2016: 18 · 2015: 15 · 2014: 5 · 2013: 5
FWCI
15.95
Type
journal article
Language
en
Open access
Locations
  • Archives of Pediatrics and Adolescent Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Drug Abuse (R01DA031189, K01DA021674)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Social Sciences › Safety Research › Child Welfare and Adoption
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Child Abuse and Related Trauma
Keywords
adverse childhood experiences, child abuse, early adolescence, adolescent health, somatic symptoms, physical abuse, sexual abuse, neglect, caregiver depression, domestic violence, child abuse prevention
MeSH terms
Adolescent, Child, Child Abuse, Child, Preschool, Female, Health Status, Humans, Longitudinal Studies, Male, Prospective Studies, Risk Factors, Time Factors, United States, Child of Impaired Parents, Caregivers

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