Adverse childhood experiences: towards a clear conceptual meaning
Abstract
Aim: To report an analysis of the concept of adverse childhood experiences. Background: Adverse childhood experiences have been associated with negative physical and psychological health outcomes, but this phenomenon lacks the clear, consistent meaning necessary for use in nursing research, theory development and practice. Design: Concept clarification. Data Sources: The literature search was not limited a priori by date and included publications with abstracts in English from PubMed, CINAHL , Psych INFO and Social Abstracts. The search retrieved 128 articles published from 1970–2013. The search term ‘adverse childhood experiences’ was used, with similar terms permitted. A snowball approach was used to expand the search to relevant literature. Methods: The articles were read and analysed following Norris's five steps for concept clarification to refine, elucidate and operationally define the concept and the context in which it occurred. Results: Adverse childhood experiences were defined operationally as childhood events, varying in severity and often chronic, occurring in a child's family or social environment that cause harm or distress, thereby disrupting the child's physical or psychological health and development. Conclusion: This concept clarification should raise awareness and understanding of the diverse nature and shared characteristics of adverse childhood experiences that are believed to influence the health of individuals as they age. This clarified concept will help expand research on health consequences of adverse childhood experiences and interventions to improve health. We recommend promoting a model of primary care that pays attention to the social and familial influences on the health of individuals worldwide.
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Baldini, V., Gottardi, C., Di Stefano, R., Rindi, L. V., Pazzocco, G., Varallo, G., Purgato, M., De Ronchi, D., Barbui, C., & Ostuzzi, G. (2025) · European Psychiatry · doi:10.1192/j.eurpsy.2025.2452 · Cited by 41 · see citing works
“…experiences occurring during childhood, including various forms of abuse, neglect, bullying, physical and verbal violence, and sexual abuse [20], as reported by authors in each primary study through clinical interviews or as assessed with validated rating scales, such as the Child Trauma…”
Women’s experiences of their maternity care: a principle-based concept analysis
Beecher, C., Devane, D., White, M., Greene, R., & Dowling, M. (2020) · Women and Birth · doi:10.1016/j.wombi.2019.11.001 · Cited by 34 · see citing works
Coupland, H., Scheidwasser, N., Katsiferis, A., Davies, M., Flaxman, S., Hulvej Rod, N., Mishra, S., Bhatt, S., & Unwin, H. J. T. (2025) · BMC Public Health · doi:10.1186/s12889-025-22705-4 · Cited by 26 · see citing works
Domoff, S. E., Borgen, A. L., Wilke, N., & Hiles Howard, A. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18136725 · Cited by 22 · see citing works
Glossary of terms: A shared understanding of the common terms used to describe psychological trauma
Canadian Institute for Public Safety Research and Treatment (CIPSRT) (2019) · doi:10.37119/10294/9055 · Cited by 21 · see citing works
Kascakova, N., Furstova, J., Hasto, J., & Tavel, P. (2025) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2025.102982 · Cited by 8 · see citing works
- Authors
- Kalmakis, K. A., & Chandler, G. E.
- Affiliations
- University of Massachusetts Amherst (US)
- Venue
- Journal of Advanced Nursing
- Publisher
- Wiley
- Published
- 2013-12-11
- Volume
- 70
- Issue
- 7
- Pages
- 1489-1501
- ISSN
- 0309-2402 (ISSN-L)
- 1365-2648
- OpenAlex
- W1972616797
- Cited by
- 390
- References
- 102
- Citations by year
- 2026: 38 · 2025: 60 · 2024: 61 · 2023: 48 · 2022: 38 · 2021: 36 · 2020: 44 · 2019: 24 · 2018: 12 · 2017: 12 · 2016: 6 · 2015: 9 · 2014: 1 · 2013: 1
- FWCI
- 6.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Advanced Nursing (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Safety Research › Child Welfare and Adoption
- Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
- Keywords
- adverse childhood experiences, conceptual clarification, operational definitions, childhood trauma, child health outcomes, mental health, physical health, family environment, social determinants of health, primary care, nursing research
- MeSH terms
- Child, Psychology, Child, Humans, Social Environment
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