The impact and measure of adverse childhood experiences: reflections of undergraduates and graduates in England

Abstract

Aim

This research aimed to explore the usefulness of measuring perceived levels of trauma to distinguish non-traumatic from traumatic adverse childhood experiences (ACEs).

Subject and Methods

This article shares findings from an online questionnaire of 156 graduates and undergraduates which sought to capture and describe the range of ACEs participants were exposed to before the age of 18, including those not associated with the ACE study survey (Felitti et al. 1998). The research built upon the original study with the inclusion of open-ended questions to capture any additional ACEs participants felt they experienced.

Results

This distinction was used to investigate whether the inclusion of additional ACEs and the exclusion of perceived non-traumatic ACEs significantly affected the participants’ overall ACE score. A Wilcoxon signed-rank test revealed a significant difference between ACE scores (z = −5.84, p < .001, r = −.33).

Conclusion

The analysis suggests that the ACE survey did not capture the range of adversities experienced by this sample and suggests that an open-ended approach should be considered for future ACE measures.

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References

  1. Agnew R (1992) Foundation for a general strain theory of crime and delinquency. Criminology 30:47–88

  2. Agnew R (2001) Building on the foundation of general strain theory: Specifying the types of strain most likelyto lead to crime and delinquency. J Res Crime Delinq 38:319–361

  3. Alemany S, Goldberg X, van Winkel R, Gastó C, Peralta V, Fananas L (2013) Childhood adversity and psychosis: examining whether the association is due to genetic conditioning using a monozygotic twin differences approach. Eur Psychiatry 28:207–212

    PubMed  CAS  Google Scholar 

  4. Altman D, Royston P (2006) The cost of dichotomising continuous variables. Br Med J 32:1080

    Google Scholar 

  5. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. Am Psychiatric Association, Arlington

    Google Scholar 

  6. American Psychological Association (2016) Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. Am Psychol Association

  7. Anda R, Butchart A, Felitti V, Brown D (2010) Building a framework for global surveillance of the public health implications of adverse childhood experiences. Am J Prev Med 39:93–98

    PubMed  Google Scholar 

  8. Anda R, Porter L, Brown D (2020) Inside the adverse childhood experience score: strengths, limitations, and misapplications. Am J Preventative Med 1-3

  9. Bellis M, Highes K, Leckenby N, Perkins C, Lowey H (2014) National household survey of adverse childhood experiences and their relationship with resilience to health-harming behaviours in England. Br Med Coun 12:1–10

    Google Scholar 

  10. Bellis MA, Hardcastle K, Ford K, Hughes K, Ashton K, Quigg Z, Butler N (2017) Does continuous trusted adult support in childhood impart life-course resilience against adverse childhood experiences - a retrospective study on adult health-harming behaviours and mental well-being. Br Med Counc Psychiatry 17:110–122

    Google Scholar 

  11. Bethell CD, Carle A, Hudziak J, Gombojav N, Powers K, Wade R, Braveman P (2017) Methods to assess adverse childhood experiences of children and families: toward approaches to promote child well-being in policy and practice. Acad Pediatr 17:251–269

    Google Scholar 

  12. British Educational Research Association (2018) Ethical guidelines for educational research. BERA, London

    Google Scholar 

  13. Brown DW, Anda RA, Tiemeier H, Felitti VJ, Edwards VJ, Croft JB, Giles WH (2009) Adverse childhood experiences and the risk of premature mortality. Am J Prev Med 37:389–396

    PubMed  Google Scholar 

  14. Bucci M, Wang LG, Koita K, Purewal S, Marques S, Harris NB (2015) ACE Questionnaire: User guide. Center for Youth Wellness, San Francisco

    Google Scholar 

  15. Bucci M, Marques S, Oh D, Harris NB (2016) Toxic stress in children and adolescents. Adv Pediatr Infect Dis 63:403–428

    Google Scholar 

  16. Burke NJ, Hellman JL, Scott BG, Weems CF, Carrion VG (2011) The impact of adverse childhood experiences on an urban pediatric population. Child Abuse Negl 35:408–413

    PubMed  PubMed Central  Google Scholar 

  17. Campbell JA, Walker RJ, Egede LE (2016) Associations between adverse childhood experiences, high-risk behaviors, and morbidity in adulthood. Am J Prev Med 50:344–352

    PubMed  Google Scholar 

  18. Center for Disease Control and Prevention (2019) About adverse childhood experiences. Retrieved from: https://www.cdc.gov/violenceprevention/childabuseandneglect/ acestudy/about.html

  19. Chronholm PF, Forke CM, Wade R, Bair-Merritt, Davis M, Harkins-Schwarz et al. (2015) Adverse childhood experiences: expanding the concept of adversity. J Affect Disord 82:217-225

  20. Cohen J (1992) A power primer. Psychol Bull 112:155–159

    PubMed  CAS  Google Scholar 

  21. Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care., Section on Developmental and Behavioral Pediatrics, Garner A, Shonkoff JP, Siegel BS, Dobbins MI, Earls MF, Garner DS et al (2012) Early childhood adversity, toxic stress, and the role of the paediatrician: translating developmental science into lifelong health. Paediatrics 129:224–231

    Google Scholar 

  22. Connolly EJ (2020) Further evaluating the relationship between adverse childhood experience, antisocial behaviour, and violent victimisation: a sibling-comparison analysis. Youth Violence Juvenile Justice 18:3–23

    Google Scholar 

  23. Craig JM, Piquero AR, Farrington DP, Ttofi MM (2017) A little early risk goes a long bad way: adverse childhood experiences and life-course offending in the Cambridge study. J Crim Just 53:34–45

    Google Scholar 

  24. D’Onofrio BM, Lahey BB, Turkheimer E, Lichtenstein P (2013) Critical need for family-based, quasi-experimental designs in integrating genetic and social science research. Am J Public Health 103:46–55

    Google Scholar 

  25. DeCastellarnau A (2018) A classification of response scale characteristics that affect data quality: a literature review. Qual Quant 52:1523–1559

    PubMed  Google Scholar 

  26. Devries K, Knight L, Petzold M, Merrill KG, Maxwell L, Williams A et al (2018) Who perpetrates violence against children? A systematic analysis of age-specific and sex specific data. Br Med J Paediatrics Open 2:1–15

    Google Scholar 

  27. Dube S, Anda MD, Felitti MD (2001) Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the adverse childhood experiences study. J Am Med Assoc 286:3089–3096

    CAS  Google Scholar 

  28. Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Beh Res Methods 39:175–191

    Google Scholar 

  29. Felitti VJ (2002) The relation between adverse childhood experiences and adult health: turning gold into lead. Permanente J 6:44–47

    Google Scholar 

  30. Felitti VJ, Anda RF (2014) The lifelong effects of adverse childhood experiences. In: Chadwick DL, Giardino AP, Alexander R, Thackeray JD, Esernio-Jenssen D (eds). Chadwick’s child maltreatment: sexual abuse and psychological maltreatment. 4th ed. Vol. 2. STM Learning, Inc., Florissant, pp 203–215

  31. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Koss MP, Marks JS (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 14:245–258

    CAS  Google Scholar 

  32. Finkelhor D (2018) Screening for adverse childhood experiences (ACEs): cautions and suggestions. Child Abuse Negl 85:174–179

    PubMed  Google Scholar 

  33. Finkelhor D, Shattuck A, Turner H, Hamby S (2013) Improving the adverse childhood experiences study scale. J Am Med Assoc Pediatr 167:70–75

    Google Scholar 

  34. Finkelhor D, Shattuck A, Turner H, Hamby S (2015) A revised inventory of adverse childhood experiences. Child Abuse Negl 48:13–21

    PubMed  Google Scholar 

  35. Ford DC, Merrick MT, Parks SE, Breiding MJ, Gilbert LK, Edwards VJ et al (2014) Examination of the factorial structure of adverse childhood experiences and recommendations for three subscale scores. Psychol Violence 4:432–444

    PubMed  PubMed Central  Google Scholar 

  36. Forsman M, Långström N (2012) Child maltreatment and adult violent offending: population-based twin study addressing the ‘cycle of violence’ hypothesis. Psychol Med 42:1977–1983

    PubMed  CAS  Google Scholar 

  37. Fox BH, Perez N, Cass E, Baglivio MT, Epps N (2015) Trauma changes everything: examining the relationship between adverse childhood experiences and serious, violent and chronic juvenile offenders. Child Abuse Negl 46:163–173

    PubMed  Google Scholar 

  38. Gilbert LK, Breiding MJ, Merrick MT (2010) Childhood adversity and adult chronic disease: an update from ten states and the District of Columbia. Am J Prev Med 48:345–349

    Google Scholar 

  39. Greeson JKP, Briggs EC, Kisiel CL, Layne CM, Ake GS, Ko SJ, Gerrity ET, Steinberg AM, Howard ML, Pynoos RS, Fairbank JA (2011) Complex trauma and mental health in children and adolescents placed in foster care: Findings from the national child traumatic stress network. Child Welfare 90:91–108

  40. Hambrick EP, Rubens SL, Brawner TW, Taussig N (2017) Do sleep problems mediate the link between adverse childhood experiences and delinquency in preadolescent children in foster care? J Child Psychol Psychiatry 59:140–149

    PubMed  PubMed Central  Google Scholar 

  41. Hanninen DT, Soininen H (2012) Age-associated memory impairment. Drugs Aging 11:480–489

    Google Scholar 

  42. Harding J (2019) Qualitative data analysis. Sage, London

    Google Scholar 

  43. Hardt J, Rutter M (2004) Validity of adult retrospective reports of adverse childhood experiences: review of the evidence. J Child Psychol Psychiatry 45:260–273

    PubMed  Google Scholar 

  44. Heard-Garris N, Davis M, Szilagyi M, Kan K (2018) Childhood adversity and parent perceptions of child resilience. Br Med Council Pediatrics 18:204–220

    Google Scholar 

  45. Herzog JI, Schmahl C (2018) Adverse childhood experiences and the consequences of neurobiological, psychosocial, and somatic conditions across the lifespan. Front Psychiatry 29:172–178

    Google Scholar 

  46. Jaffee S, Caspi A, Moffitt TE, Taylor A (2004) Physical maltreatment victim to antisocial child: evidence of an environmentally mediated process. J Abnorm Psychol 113:44–55. https://doi.org/10.1037/0021-843X.113.1.44

    Article  PubMed  Google Scholar 

  47. Johnson SB, Riley AW, Granger DA, Riis J (2013) The science of early life toxic stress for pediatric practice and advocacy. Pediatrics 131:319–327

    PubMed  PubMed Central  Google Scholar 

  48. Kalmakis KA, Chandler GE (2015) Health consequences of adverse childhood experiences: a systematic review. J Am Assoc Nurse Pract 27:457–465

    PubMed  PubMed Central  Google Scholar 

  49. Karatekin C (2018) Adverse childhood experiences (ACEs), stress and mental health in college students. Stress Health 34:36–45

    PubMed  Google Scholar 

  50. Kelly-Irving M, Lepage B, Dedieu D, Bartley M, Blane D, Grosclaude P et al (2013) Adverse childhood experiences and premature all-cause mortality. Eur J Epidemiol 28:721–734

    PubMed  PubMed Central  Google Scholar 

  51. Kendler KS, Gardner CO (2010) Dependent stressful life events and prior depressive episodes in the prediction of major depression: the problem of causal inference in psychiatric epidemiology. Arch Gen Psychiatry 67:1120–1127

    PubMed  PubMed Central  Google Scholar 

  52. Kendler KS, Eaves LJ, Loken EK, Pedersen NL, Middeldorp CM, Reynolds C, Boomsma D, Lichtenstein P, Silberg J, Gardner CO (2011) The impact of environmental experiences on symptoms of anxiety and depression across the life span. Psychol Sci 22:1343–1352

  53. Kerker BD, Storfer-Isser A, Szilagyi SRE, Garner AS, O'Connor KG et al (2016) Do pediatricians ask about adverse childhood experiences in pediatric primary care? Acad Pediatr 16:154–160

    PubMed  Google Scholar 

  54. Kidman R, Smith D, Piccolo L, Kohler P (2019) Psychometric evaluation of the adverse childhood experience international questionnaire in Malawian adolescents. Child Abuse Negl 92:139–145

    PubMed  PubMed Central  Google Scholar 

  55. Kottenstetteb S, Segala R, Roederb L, Rochford H, Schnieders E, Bayman L et al (2020) Two-generational trauma-informed assessment improves documentation and service referral frequency in a child protection program. Child Abuse Negl 101:1–11

    Google Scholar 

  56. Krupnik V (2019) Trauma or adversity? Traumatology 25:256–261

    Google Scholar 

  57. Laporte L, Paris J, Guttma H, Russell J (2011) Psychopathology, childhood trauma, and personality traits in patients with borderline personality disorder and their sisters. J Personal Disord 25:448–462

    Google Scholar 

  58. Lundmark S, Gilljam M, Dahlberg S (2016) Measuring generalized trust: an examination of question wording and the number of scale points. Public Opin 80:26–43

    Google Scholar 

  59. Machtinger EL, Cuca YP, Khanna N, Rose CD, Kimberg LS (2015) From treatment to healing: the promise of trauma-informed primary care. Womens Health Issues 25:193–197

    PubMed  Google Scholar 

  60. Marie-Mitchell A, O’Connor TG (2013) Adverse childhood experiences: translating knowledge into identification of children at risk for poor outcomes. Acad Pediatr 13:14–19

    PubMed  Google Scholar 

  61. Marsac M, Kassam-Adams N, Hildenbrand AK, Nicholls E, Winston FK, Leff SS et al (2016) Implementing a trauma-informed approach in pediatric health care networks. Pediatrics 17:70–77

    Google Scholar 

  62. McEwen C, Gregerson S (2019) A critical assessment of the adverse childhood experiences study at 20 years. Am J Prev Med 56:790–794

    PubMed  Google Scholar 

  63. McGavock L, Spratt T (2014) Prevalence of adverse childhood experiences in a university population: associations with use of social services. Brit J Soc Work 44:657–674

    Google Scholar 

  64. McLafferty M, Armour C, McKenna A, O’Neil S, Murphy S, Bunting B (2015) Childhood adversity profiles and adult psychopathology in a representative Northern Ireland study. J Anxiety Disord 35:42–48

    PubMed  Google Scholar 

  65. McMillan D, Hastings RP, Salter DC, Skuse DH (2008) Developmental risk factor research and sexual offending against children: a review of some methodological issues. Arch Sex Behav 37:877–890

    PubMed  Google Scholar 

  66. Mersky JP, Janczewski CE, Topitzes J (2017) Rethinking the measurement of adversity: moving toward second-generation research on adverse childhood experiences. Child Maltreat 22:58–68

    Google Scholar 

  67. Metzler M, Merrick MT, Klevens J, Ports KA, Ford DC (2017) Adverse childhood experiences and life opportunities: shifting the narrative. Child Youth Serv Rev 72:141–149

    Google Scholar 

  68. Moses JM, Knutsen TL (2007) Ways of knowing. Palgrave Macmillan, Basingstoke

    Google Scholar 

  69. Murphy A, Steele M, Dube SR, Bate J, Bonuck K, Meissner P, Steele H (2014) Adverse childhood experiences (ACEs) questionnaire and adult attachment interview (AAI): implications for parent-child relationships. Child Abuse Negl 38:224–233

    PubMed  Google Scholar 

  70. Murphy A, Steele H, Steele M, Allman B, Kastner T, Dube SR (2016) The clinical adverse childhood experiences (ACEs) questionnaire: implications for trauma-informed behavioral healthcare. In: Briggs R (ed) Integrated early childhood behavioral health in primary care. Springer, Cham

    Google Scholar 

  71. National Scientific Council on the Developing Child (2014) Excessive stress disrupts the architecture of the developing brain: working paper 3. Updated Edition. Center on the Developing Child, Cambridge

  72. Newbury J, Arseneault L, Moffitt T, Caspi A, Danese A, Baldwin JR, Fisher HL (2018) Measuring childhood maltreatment to predict early-adult psychopathology: comparison of prospective informant-reports and retrospective self-reports. J Psychiatr Res 96:57–64

    PubMed  PubMed Central  Google Scholar 

  73. Office of the California Surgeon General (2020) ACEs aware. http://acesaware.org/. Accessed 21 April 2020

  74. Oh DL, Jerman P, Purewal Boparai SK, Koita BS, Bucci M, Burke Harris N (2018) Review of tools for measuring exposure to adversity in children and adolescents. J Pediatr Health Care 32:564–583

    PubMed  Google Scholar 

  75. Oral R, Ramirez M, Coohey C, Nakada S, Walz A, Kuntz A et al (2016) Adverse childhood experiences and trauma-informed care: the future of healthcare. Pediatr Res 79:227–233

    PubMed  CAS  Google Scholar 

  76. Oransky M, Hahn H, Stover CS (2013) Caregiver and youth agreement regarding youths’ trauma histories: implications for youths’ functioning after exposure to trauma. J Youth Adol 42:1528–1542

    Google Scholar 

  77. Public Health Directorate (2018) The annual report of the director of public health 2018: adverse childhood experiences, resilience and trauma-informed care. Public Health, Inverness

    Google Scholar 

  78. Schwartz JA, Wright EM, Valgardson BA (2019) Adverse childhood experiences and deleterious outcomes in adulthood: a consideration of the simultaneous role of genetic and environmental influences in two independent samples from the United States. Child Abuse Negl 88:420–431

    PubMed  Google Scholar 

  79. Sege R, Linkenbach J (2014) Essentials for childhood: promoting healthy outcomes from positive experiences. Pediatrics 133(6):1489–1491

    Google Scholar 

  80. Slack SS, Font SA, Jones J (2016) The complex interplay of adverse childhood experiences, race, and income. National Association of Social Workers 42:24–31

  81. Stover CS, Hahn H, In JJ, Berkowitz S (2010) Agreement of parent and child reports of trauma exposure and symptoms in the peritraumatic period. Psyc Trauma, Theory, Res, Pract Policy 2:159–168

    Google Scholar 

  82. Substance Abuse and Mental Health Services Administration (2014) SAMHSA’s concept of trauma and guidance for a trauma-informed approach. Substance Abuse and Mental Health Services Administration

  83. Thomas J (2016) Adverse childhood experiences among masters and social work students. J Teach Soc Work 36:235–255

    Google Scholar 

  84. Van Os J, Kenis G, Rutten BP (2010) The environment and schizophrenia. Nature 468:2013–2212

    Google Scholar 

  85. Wade R, Cronholm PE, Fein JS, Forke CM, Davis MB, Harkins-Schwarz M et al (2016) Household and community-level adverse childhood experiences and adult health outcomes in a diverse urban population. Child Abuse Negl 52:135–145

    Google Scholar 

  86. Widom CS, Horan J, Brzustowicz L (2015) Childhood maltreatment predicts allostatic load in adulthood. Child Abuse Negl 47:59–69

    PubMed  PubMed Central  Google Scholar 

  87. World Health Organization (2012) Adverse childhood experiences international questionnaire (ACE-IQ) rationale for ACE-IQ. WHO, Geneva

    Google Scholar 

  88. World Health Organization (2018) Adverse childhood experiences international questionnaire. In adverse childhood experiences international questionnaire (ACE-IQ). WHO, Geneva

  89. World Health Organisation (2019) Adverse childhood experiences international questionnaire (ACE-IQ). Retreived from: https://www.who.int/violence_injury_prevention/violence/activities/adverse_childhood_experiences/en/

  90. Young-Wolff KC, Kendler KS, Ericson ML, Prescott CA (2011) Accounting for the association between childhood maltreatment and alcohol-use disorders in males: a twin study. Psychol Med 41:59–70

    PubMed  CAS  Google Scholar 

  91. Zimmerman GM, Farrell AS (2013) Gender differences in the effects of parental underestimation of youths’ secondary exposure to community violence. J Youth Adol 42:1512–1527

    Google Scholar 

  92. Zosky DL (2013) Wounded healers: Graduate students with histories of trauma in a family violence course. J Teach Soc Work 33:239–250

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Acknowledgements

The authors would like to thank Dr. Wendy Thorley (CEL&T, ACE Network North East) for her invaluable insight and expertise that enhanced the quality of the manuscript, and Noah Chisholm for their role as a research assistant.

Funding

The University of Sunderland funded this work as part of the interdisciplinary research network Adverse Childhood Experiences.

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Contributions

Sarah Martin-Denham conceptualised and designed the study. Material preparation and data collection were performed by Sarah Martin-Denham. Analysis was performed by Sarah Martin-Denham and Jacob Donaghue. The first draft of the manuscript was written by Sarah Martin-Denham, and all authors reviewed and edited previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sarah Louise Martin-Denham.

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The authors declare that they have no conflict of interest.

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The research was approved by the University of Sunderland Ethics Committee.

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Informed consent was obtained from participants who took part in the study.

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Participants consented to the publishing of the study.

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Martin-Denham, S.L., Donaghue, J.J. The impact and measure of adverse childhood experiences: reflections of undergraduates and graduates in England. J Public Health (Berl.) (2020). https://doi.org/10.1007/s10389-020-01359-z

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Keywords

  • Adverse childhood experience
  • Children
  • Measurement tools
  • Education
  • Trauma
  • Exploratory