Cited by 594Child Abuse and TraumaChild Welfare and AdoptionChild Abuse and Related Trauma

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The impact of adverse childhood experiences on an urban pediatric population

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Burke, Nadine J., Hellman, Julia L., Scott, Brandon G., Weems, Carl F., Carrion, Victor G.·2011·Child Abuse & Neglect

DOI 10.1016/j.chiabu.2011.02.006PMC PMC3119733

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Abstract

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.

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Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
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“Providers of pediatric health care have been motivated and inspired by the research on childhood adversity, which has shown that in the early stages of life, critical neurodevelopmental pathways can be disrupted through exposure to adverse childhood experiences (ACEs) and resultant toxic stress.(1,2) Early detection o…”
Background
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Srivastav, A., Davis, R. E., Strompolis, M., Crouch, E. L., Thrasher, J. F., & Spencer, M. (2019) · Journal of Child & Adolescent Substance Abuse · doi:10.1080/1067828x.2020.1774027 · Cited by 5
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From Bench to Bedside
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“Burke Harris [125–127] described how toxic stress, the chronic stress of poverty, and childhood adversity can harm children particularly in urban areas with fragmented and inadequate services.”
Background
Utilizing KAP in Schools: An Evaluation of Educators’ and Staff Knowledge, Attitudes, and Practices Related to Trauma
Heck, O. C., Ormiston, H., & Husmann, P. R. (2023) · Journal of Child and Adolescent Trauma · doi:10.1007/s40653-023-00536-y · Cited by 4
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Background
Experiences of Trauma and DNA Methylation Profiles among African American Mothers and Children
Barcelona, V., Huang, Y.-F., Caceres, B. A., Newhall, K. P., Hui, Q., Cerdeña, J., Crusto, C. A., Sun, Y. V., & Taylor, J. Y. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23168951 · Cited by 4
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BackgroundInfluential
Sex differences in the association of adverse childhood experiences on past 30-day opioid misuse among Florida justice-involved children
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“Research on the potential impacts of ACEs on education is gathering pace but is currently lagging behind research on the physical and mental impacts (e.g. Burke et al., 2011; Zarse et al., 2019).”
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Austin, A. E., Gottfredson, N. C., Halpern, C. T., Zolotor, A. J., Marshall, S. W., Parrish, J. W., & Shanahan, M. E. (2020) · Child Development · doi:10.1111/cdev.13356 · Cited by 7
“Similar to a cumulative risk approach (Burke et al., 2011; Kerker et al., 2015; Larson et al., 2008; Marie-Mitchell & O’Connor, 2013), this result suggests that exposure to accumulating adversities during early childhood increases the likelihood of poor developmental outcomes.”
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“Burke et al. (2011) found that increased ACEs are associated with increased risk of learning/behavior problems and obesity among youth.”
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Fahrenkamp, A. J., & Sato, A. F. (2017) · Children s Health Care · doi:10.1080/02739615.2017.1383910 · Cited by 5
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Background
Racial/Ethnic Differences in the Effects of Adverse Childhood Experiences on Substance Misuse among Justice-Involved Children
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“Note. n= 24,944. decreased likelihood of SU due to culturally based perceptions on addiction and SU that align with race, such as SU being interpreted as socially acceptable (Burke et al., 2011; Mason et al., 2014; Moreno et al., 2009; Wells et al., 2001).”
Background
Getting Help: Findings from Two World Cafés with Youth who Experience Homelessness
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“, 2010), obesity (Burke et al., 2011), homelessness (Lee et al.”
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Background
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Landis, H. (2020) · doi:10.1080/01609513.2020.1811014 · Cited by 3
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Background
The Role of a Temperament Intervention in Kindergarten Children’s Standardized Academic Achievement
Collins, A., O’Connor, E. E., & McClowry, S. (2017) · Journal of Education and Training Studies · doi:10.11114/jets.v5i2.2138 · Cited by 6
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Background
Child Maltreatment—The Role of the School Nurse
(2013) · NASN School Nurse · doi:10.1177/1942602x13478381 · Cited by 3
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Self-citation
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“…long-lasting effects on cognitive and social development, behavioral functioning, emotional regulation, and academic engagement and performance (Burke et al., 2011; McLaughlin et al., 2013; Perfect et al., 2016; Porche et al., 2016), along with harmful physical and mental health outcomes…”
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“A child’s stress responses may lead to increases in disruptive behaviours in the classroom (e.g., withdrawal, violence, impulsivity; Burke et al., 2011).”
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“There is also evidence regarding this study on the relationships between ACEs and childhood obesity (Burke et al. 2011), and some researchers revealed from a large sample of US adolescents that ACEs are related to an increased risk of obesity, but not underweight (Davis et al. 2019).”
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“…(12 among 27 articles) used different versions of the Childhood Trauma Questionnaire-Short Form (CTQ-SF: 28 items) (Baron & Forde, 2020; N. J. Burke et al., 2011; Chang et al., 2021; Chen, 2020; Choi et al., 2017; DeLisi et al., 2018; Estrada et al., 2021; X. Guo et al., 2022; Peng et al.,…”
Method
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“Young people face a wide array of behavioral health risks, such as mental illness, substance abuse, traumatic events, bullying, criminal justice involvement, and suicide/self-harm (Burke et al., 2011; Hawton et al., 2012; Merikangas & McClair, 2012; Steel et al., 2014).”
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“43 As stated previously, trauma can affect all areas of development.”
Background
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“…of infections Wyman et al., 2007; Lanier et al. 2010 Developmental and learning delays and difficulties Enlow et al., 2012; Strathearn et al., 2001; Burke et al., 2011 Dental problems Bright et al., 2015 Asthma Wing et al., 2015; Kozyrskyj et al., 2008; Lange et al., Karmel & Gardner (1996);…”
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“Adverse Childhood Experiences Questionnaire (ACE-Q; [7]): The ACE-Q is a screener used to measure childhood exposure to ACEs since birth.”
Method
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Derck, J., Livingston, J., Zhang, A.-Q., Phipps, A., Maddock, R., Gilmore, G., & October, T. (2023) · Journal of Child and Adolescent Trauma · doi:10.1007/s40653-023-00555-9 · Cited by 2
“ACE scores in this sample were lower in PICU patients compared to ACE scores reported for non-PICU children nationally (Burke et al., 2011; Data Resource Center for Child and Adolescent Health, 2019) and there was not an association between severity of illness or resource utilization for patients…”
BackgroundResultInfluential
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Adverse Childhood Experiences Predict Preference for Male Facial Masculinity in Gay Men in China
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“Various early life conditions and experiences in childhood could lead to stress, such as abuse and neglect, parental absence, household dysfunction, low socioeconomic status (SES), and malnutrition (Felitti et al., 1998; Burke et al., 2011; Ellis et al., 2009; Felitti et al., 1998; Mell et al., 2018; Simpson et al., 2…”
Background
The effects of disability status and perceived neighbourhood cohesion and safety on adverse childhood experiences among college students
Son, E., Lee, H., Cho, H., Choi, Y. J., & Seon, J. (2021) · Health & Social Care in the Community · doi:10.1111/hsc.13656 · Cited by 3
Behavior Checker® Staff Training for Positive Parenting in Primary Care: Changes in the Knowledge, Attitudes, and Confidence
Moon, D., Lauer, S. J., & Unell, B. C. (2021) · Journal of Child and Family Studies · doi:10.1007/s10826-021-01917-3 · Cited by 2
Evaluation of a Simulation-Based Training Program on Childhood Trauma with Occupational Therapy Students
Miller‐Cribbs, J., Bragg, J. E., Isaacson, M., Nay, E. D. E., Howell, D., Rodriguez, K., Wen, F. K., Jelley, M., & Coon, K. A. (2021) · Journal of Occupational Therapy Education · doi:10.26681/jote.2021.050209 · Cited by 4
“9 https://encompass.eku.edu/jote/vol5/iss2/9 & Alvira-Hammond, 2016; Bethell et al., 2014; Boynton-Jarrett et al., 2008; Bright et al., 2015; Burke et al., 2011; Duke et al., 2010; Fagan & Novak, 2018; Flaherty et al., 2013; Flouri & Kallis, 2011; Hamburger et al., 2008; Hillis et al., 2004; Hunt…”
Playing through the unimaginable: Play therapy for traumatic loss.
Turner, R. (2020) · International Journal of Play Therapy · doi:10.1037/pla0000116 · Cited by 2
The Tragedy of Wasted Funds and Broken Dreams: An Economic Analysis of Childhood Exposure to Crime and ViolencePreprint
Gilad, M., & Gutman, A. (2019) · SSRN Electronic Journal · doi:10.2139/ssrn.3458626 · Cited by 2
Steps towards a comprehensive approach to maternal and child mental health.
Weis, J., & Renshon, D. (2019) · Lancet Public Health · doi:10.1016/s2468-2667(19)30087-8 · Cited by 2
What’s the Punchline?: Promoting Child and Teacher Resilience Through Pediatrician–Teacher Partnerships
Selvaraj, K. (2018) · Pediatrics · doi:10.1542/peds.2017-3538 · Cited by 2
Surveillance and screening
Glascoe, F. P., & Sturner, R. (2017) · CRC Press eBooks · doi:10.1201/9781315375748-4 · Cited by 1
The relations of child adiposity with parent-to-child and parent-to-parent hostility
Lorber, M. F., White-Ajmani, M., Dixon, D., Slep, A. M. S., & Heyman, R. (2017) · Psychology and Health · doi:10.1080/08870446.2017.1336238 · Cited by 2
Parental Report of Gender Differences in Sexual Functioning Among Adolescents With Down Syndrome: A Jordanian Experience
Amr, M., Zaki, N., Raddad, D., Zayed, Z., Deba, M., Hassan, M., & Hasan, N. (2016) · doi:10.14302/issn.2474-9273.jbtm-15-792 · Cited by 2
Teacher/Child Relationships and Child Temperament in Early Achievement
Collins, A., & O'Connor, E. E. (2016) · Journal of Educational and Developmental Psychology · doi:10.5539/jedp.v6n1p173 · Cited by 2
“…living (including financial difficulty, chronic community violence, failing schools) can experience an impaired ability to learn new academic concepts and develop a positive school perception (Burke et al., 2011; Chartier, Walker, & Naimark, 2010; Evans & Schamberg, 2009; Noguera, 2008, 2003).”
Background
Adverse Family Experiences, Child Mental Health, and Educational Outcomes for a National Sample of Students
Porche, M. V. M., Costello, D. M., & Rosen‐Reynoso, M. (2016) · School Mental Health · doi:10.1007/s12310-016-9174-3 · Cited by 159
“Experience of multiple adversities has been shown to increase the risk of behavioral problems in an urban pediatric population (Burke et al., 2011).”
BackgroundInfluential
Cumulative Adverse Childhood Experiences and Multiple Neurodevelopmental Disorders in Children and Adolescents: A Population‐Based Study
Lin, J., Scott, J. G., Eapen, V., Kallapiran, K., O’Shea, P., Haslam, D. M., Edirippulige, S., & Davidson, P. M. (2026) · Stress and Health · doi:10.1002/smi.70202 · Cited by 1
“…are consistent with and build upon prior research demonstrating the bidirectional relationship between ACEs and individual NDDs such as ADHD (Jimenez et al. 2017), ASD (Dodds 2021), LD (Burke et al. 2011), as well as the relationship between the number of ACEs and specific NDDs (Zarei et al. 2021).”
Assessing Traumatic and Adverse Childhood Experiences: A Conceptual and Empirical Comparison of Approaches in Justice System Involved Individuals
Weems, C. F., & Zarling, A. (2026) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-026-10297-1 · Cited by 1
Self-citation
Trauma Informed Care Training: A Theory-Driven Qualitative Evaluation and Recommendations for Improvement
Lorenz, H., Chan, C., & Anderson, C. (2026) · Clinical Child Psychology and Psychiatry · doi:10.1177/13591045261428726 · Cited by 1
“…training, behavior change model Childhood trauma and adversity can have a signi ﬁ cant psychosocial impact across the lifespan (Brown et al., 2009; Burke et al., 2011; Kiesel et al., 2016) and is associated with elevated risk of psychopathology, risk events (including self-harm, suicide and…”
The Association of Childhood Adversity and Post-Traumatic Stress Symptoms with Cognition in Older Adults: A Cross-Sectional Study
Ruisch, J. E., Quaedflieg, C. W. E. M., van Alphen, S. P. J., Schulkens, J. E. M., Daamen, M. A. M. J., Schruers, K. R. J., & Sobczak, S. (2026) · Clinical Gerontologist · doi:10.1080/07317115.2026.2631041 · Cited by 1
“…aspects of psychological and physical domains, such as more ACEs leading to more behavioral problems in children (Burke et al., 2011; Liming & Grube, 2018) and the presence of chronic health conditions in adults (Anda et al., 2008; Burke et al., 2011; Felitti et al., 1998; Liming & Grube, 2018).”
Forum: Addressing Childhood Trauma and Maltreatment Through the Lens of the ICF.
Kokotek, L. E., Westby, C., & Washington, K. (2026) · Language, Speech & Hearing Services in Schools · doi:10.1044/2025_lshss-24-00125 · Cited by 1
Culturally Responsive Social-Emotional Learning in STEM for Underserved Students with Behavioral Challenges
Ilusanmi, A. M.-R., Somoye, O. I., & Adeyemo, O. O. (2025) · American Journal of Education and Technology · doi:10.54536/ajet.v4i4.4730 · Cited by 1
Measuring adverse childhood experiences in youth: metric development using a statewide youth survey
Shah, A., Gorman, H., Nurius, P. S., & Simckes, M. S. (2025) · Children and Youth Services Review · doi:10.1016/j.childyouth.2025.108620 · Cited by 1
The Relationship Between Adverse Childhood Experiences, Mental Health, and School Outcomes in Adolescents
Denicola, G., Gubi, A. A., Wert, I. J., Giordano, K., & Garro, A. (2025) · Psychology in the Schools · doi:10.1002/pits.23498 · Cited by 1
“Through a retrospective pediatric chart review, Burke et al. (2011) found that roughly 51% of participants with four or more ACES exhibited learning problems, as measured by pediatrician reports of low academic achievement.”
Implementing an Adverse Childhood Experiences Screening Tool With Migrant Children: A Quality Improvement Project Using the PEARLS Screening Tool.
Fevry, N. J., Convoy, S., Teague, M. S., Taldon, T., & Waldrop, J. (2024) · Journal of Pediatric Health Care · doi:10.1016/j.pedhc.2024.08.014 · Cited by 1
Drivers to implementing a whole-system approach to enquiring about adverse childhood experiences: A mixed methods evaluation from a single county in England.
Quigg, Z., Harrison, R., Harris, J., Butler, N., Bates, R., & Timpson, H. (2024) · International Journal of Child Abuse & Neglect · doi:10.1016/j.chiabu.2024.106983 · Cited by 1
Interventions for children who have experienced physical abuse: A systematic review narrative synthesis
Pearson, K., Stephens-Lewis, D., & Schenke, K. (2024) · Children and youth services review · doi:10.1016/j.childyouth.2024.107684 · Cited by 1
Persistent environmental lead exposures disrupting black children’s neurodevelopment and quality of life trajectories: an under-recognized ACE in the hole
Neuwirth, L. S., & Bell, J. (2024) · Journal for Multicultural Education · doi:10.1108/jme-11-2022-0160 · Cited by 1
Assessing the association between safety perceptions and communication about sex and drugs among Black adolescents exposed to adversity
Smith, B. D., Spencer, B. H., Nur-Singletary, Z., Adane, N., Moser, N., & Powell, T. W. (2024) · Journal of Traumatic Stress · doi:10.1002/jts.23044 · Cited by 1
Pain of the past and present: an identity conscious exploration of the prevalence and scope of educator primary and secondary trauma
Olive, J. L., Gilbert, C., Wronowski, M. L., & Peddle, A. (2023) · Teachers and Teaching: theory and practice · doi:10.1080/13540602.2023.2291069 · Cited by 1
“As a result of this work, educators now have a better understanding of trauma’s impact on students’ cognitive and social development (Burke et al., 2011; van der Kolk, 2005), behaviour (Dong et al., 2005; Hunt et al., 2017), and academic performance (Duplechain et al., 2008; Larson et al., 2017).”
Associations between telomere length, glucocorticoid receptor gene DNA methylation, volume of stress-related brain structures, and academic performance in middle-school-age children
Burenkova, O. V., Naumova, O. Y., Church, J. A., Juranek, J. J., Fletcher, J. M., & Grigorenko, E. L. (2023) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2023.100223 · Cited by 1
Helping Today’s Teachers be More Trauma-Effective: Results from a Needs Assessment and a Proposed Collaborative School Counseling
Woodliff, T. A., & Coll, K. M. (2023) · Journal of Trauma Studies in Education · doi:10.32674/jtse.v2i1.3658
“This pilot group helps challenge the perception of trauma-informed practices as extraneous labor for teachers, instead highlighting such practices as valuable in decreasing problematic behaviors and increasing test scores (Barfield et al., 2012; Burke et al., 2011).”
Screening for Adverse Childhood Experiences (ACEs) before age 3: Evidence for the Family Map Inventory
Whiteside-Mansell, L., McKelvey, L., Lewis, K. N., & Peters, R. M. (2022) · HS Dialog: The Research to Practice Journal for the Early Childhood Field · doi:10.55370/hsdialog.v25i2.1353 · Cited by 1
Sibling Conflict and ADHD: Initial Efficacy of the Adapted “Siblings Are Special” Program
Rosenthal, E., Franklin‐Gillette, S., Feinberg, M. E., & DuPaul, G. J. (2022) · The ADHD Report · doi:10.1521/adhd.2022.30.4.1
The Consumer Recovery Movement in the United States
Carpio, M. G., Chee, N., Swarna, M., & Clauss‐Ehlers, C. S. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108678971.017
Preschool Social Participation, the Impact of Early Life Stress and Parental Health
Doove, B. M., Schiffelers, B. A. A. H., Lukkien, C., van Os, J., FERON, F. J. M., & Drukker, M. (2021) · Child Care in Practice · doi:10.1080/13575279.2021.1901655 · Cited by 3
“While ELS is common (Bonanno&Mancini, 2008; Burke et al., 2011; Committee onPsychosocial aspects of Child and FamilyHealth andTask Force onMentalHealth, 2009; Neigh et al., 2009), it is important to know the prevalence and incidence of various types of ELS, rather than limiting attention to one…”
Background
Foundational Concepts
Thai, C. (2020) · You CAN Stop Stupid · doi:10.1007/978-3-319-00984-1_3 · Cited by 1
Childhood adversity and physical health among Asian Indian emerging adults in the United States: Exploring disease-specific vulnerabilities and the role of anger.
Santoro, A. F., Suchday, S., Robbins, R. N., Benkhoukha, A., & Zemon, V. M. (2020) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000942 · Cited by 15
“…A uthor M anuscript the studies that examine ACEs by ethnicity tend to group all Asian participants into a single, heterogenous group (e.g., Burke et al., 2011; Mersky et al., 2013; Schilling et al., 2007), possibly obscuring meaningful differences across distinct Asian subpopulations,…”
It takes a village: Reflections on a randomized controlled trial to teach mindfulness skills to teens in foster and kinship care
Jee, S. H., Swanson, D. P., Sugarman, L. I., & Couderc, J. (2019) · Developmental Child Welfare · doi:10.1177/2516103218810938 · Cited by 2
Adverse Childhood Experiences: A New Framework for Infant Mental Health
Hays-Grudo, J., Ratliff, E. L., & Morris, A. S. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-809324-5.23592-x · Cited by 2
L'impact des violences sur le développement somatique et psychique
Roussey, M., & Dayan, J. (2020) · Elsevier eBooks · doi:10.1016/b978-2-294-76474-5.00003-7
Play-Based Bereavement Centers for Children and Families
Turner, R. (2019) · Advances in Psychology, Mental Health, and Behavioral Studies · doi:10.4018/978-1-5225-8226-7.ch010 · Cited by 1
Addressing Childhood Trauma in School Settings: A Framework for Evidence-Based Practice
Chafouleas, S. M., Koriakin, T. A., Roundfield, K. D., & Overstreet, S. (2018) · School Mental Health · doi:10.1007/s12310-018-9256-5 · Cited by 113
Feasibility of Assessing Parental ACEs in Pediatric Primary Care: Implications for Practice-Based Implementation
Gillespie, R., & Folger, A. T. (2017) · Journal of Child and Adolescent Trauma · doi:10.1007/s40653-017-0138-z
Life History Evolution Forms the Foundation of the Adverse Childhood Experience Pyramid
Hertler, S. C., de Baca, T. C., Peñaherrera‐Aguirre, M., Fernandes, H. B. F., & Figueredo, A. J. (2021) · Evolutionary Psychological Science · doi:10.1007/s40806-021-00299-5 · Cited by 14
Organized and Unstructured Activity Participation Among Adolescents Involved with Child Protective Services in the United States
Kwak, Y., Lu, T. R., & Christ, S. L. (2017) · Child & Youth Care Forum · doi:10.1007/s10566-017-9392-3 · Cited by 9

Authors: Burke, N. J., Hellman, J. L., Scott, B. G., Weems, C. F., & Carrion, V. G.
Affiliations: California Pacific Medical Center (US)
LSU New Orleans (US)
ORCID: Scott, Brandon G.
Weems, Carl F.
Venue: Child Abuse & Neglect
Publisher: Elsevier BV
Published: 2011-06
Volume: 35
Issue: 6
Pages: 408-413
ISSN: 0145-2134 (ISSN-L)
DOI: 10.1016/j.chiabu.2011.02.006
PMC: PMC3119733
OpenAlex: W2079494095
Cited by: 594
References: 26
Citations by year: 2026: 16 · 2025: 34 · 2024: 40 · 2023: 44 · 2022: 71 · 2021: 106 · 2020: 58 · 2019: 57 · 2018: 38 · 2017: 35 · 2016: 36 · 2015: 21 · 2014: 10 · 2013: 17 · 2012: 10
FWCI: 12.78
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Child Abuse & Neglect (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health (K23MH063893, MH 63893)
Topics: Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Social Sciences › Sociology and Political Science › Child Welfare and Adoption
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Child Abuse and Related Trauma
Keywords: adverse childhood experiences, low-income youth, childhood obesity, body mass index, ACE score, ACE screening, primary prevention
MeSH terms: Adolescent, Child, Child Abuse, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Learning Disabilities, Male, Medical Records, Obesity, Parent-Child Relations, Poverty, Retrospective Studies, Risk Factors, San Francisco, Urban Population, Logistic Models, Young Adult

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The impact of adverse childhood experiences on an urban pediatric population

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