Profiles of Early Childhood Adversity in an Urban Pediatric Clinic: Implications for Pediatric Primary Care.

Pediatricians are well-positioned to screen for early childhood adversities, but effective responses to positive screens require an understanding of which adversities typically co-occur, and to what extent they are associated with other risk or protective factors. Among children seen at an urban academic pediatric practice, this study aimed to (1) examine the prevalence of different types of early adversity and protective experiences reported by primary caregivers, and (2) define latent classes of co-occurring adversities. Of 1434 children whose parents completed the Safe Environment for Every Kid (SEEK) at well-child visits during November 2019-January 2021, three classes of adverse experiences emerged, including those reporting low adversity (L; 73%), caregiver stress (CS; 17%), and both caregiver stress and depression (CSD; 10%). Among those who also completed the Adverse Childhood Experiences Questionnaire (ACE-Q, n = 1373) and the Protective and Compensatory Experiences Scale (PACES, n = 1377), belonging to the L class was associated with lower ACE-Q and higher PACES scores. For parent-respondents only, ACE-Q scores were significantly greater for the CSD class compared to the CS and L classes. Pediatricians should attend to the needs of caregivers reporting both stress and depression, as these families may face especially high levels of adversity and low levels of protective factors.

Associations between early childhood adversity and behavioral, substance use, and academic outcomes in childhood through adolescence in a U.S. longitudinal cohort.

BACKGROUND: Childhood adversity is strongly associated with adolescent substance use, but few epidemiologic studies have investigated early childhood adversity (ECA) before age 5. This study investigated pathways by which ECA is associated with adolescent alcohol and cannabis use and high school completion through childhood behavioral and academic mediators and their reciprocal effects. METHODS: Data were from the National Longitudinal Survey of Youth 1979-Child/Young Adult Cohort which surveyed children born 1984-1999 and followed through 2016 (n = 5521). Outcomes included alcohol and cannabis use frequency at ages 15-18, and high school completion by age 19. ECA at ages 0-4 was a cumulative score of maternal heavy drinking/drug use, low emotional support, low cognitive stimulation, and household poverty. Multilevel path models were conducted with ECA, childhood mediators (behavioral (externalizing and internalizing problems) and academics (reading and math scores), accounting for demographics and confounders. RESULTS: ECA was indirectly associated with adolescent cannabis frequency through mediators of externalizing/internalizing problems, low academics, and early cannabis onset before age 14. ECA was also indirectly associated with alcohol frequency via the same mediators, but not early alcohol onset. Greater behavioral problems elevated substance use risk; whereas, low academics reduced risk. Reciprocal effects were evident between childhood behavioral problems and cannabis frequency to high school completion. CONCLUSION: Adversity from birth to age 4 is associated with childhood behavioral problems and lower academics, which increased adolescent alcohol and cannabis use and lowered high school completion. Early childhood interventions with parents and preschools/daycare may reduce early onset and adolescent substance use.

Testing the Identity Disruption Model among Adolescents: Pathways Connecting Adverse Childhood Experiences to Body Dissatisfaction.

The Identity Disruption Model posits that early adversity is associated with lower self-concept clarity, which in turn increases vulnerability to sociocultural appearance factors and body dissatisfaction, but this model has not previously been tested among adolescents. Testing the model during adolescence is critical because this is a key point of development of both identity and body dissatisfaction. This paper presents two studies with adolescents recruited through social media (Study 1: n = 213; 78% female; mean age = 15.7 years, SD = 1.14) and from high schools (Study 2; n = 228; 43% female; mean age = 13.8 years, SD = 1.15). In both studies, self-reported early adversity was associated with lower self-concept clarity; lower self-concept clarity was associated with greater internalization of appearance ideals and more frequent appearance comparisons; and internalization and appearance comparisons were associated with greater body dissatisfaction. This research builds on previous sociocultural models of body dissatisfaction by pointing to processes that occur early in life that could be potential targets of intervention and prevention efforts.

The Relationship Between Adverse Childhood Experiences and Utilization of Different HIV Testing Strategies Among Young Men Who Have Sex with Men in Texas.

Adverse childhood experiences (ACEs) are a well-documented HIV-risk factor, but less is known about the relationship between ACEs and different HIV testing strategies. This study used data from an LGBTQ + community health assessment, that was part of a multi-staged community-based participatory research project in San Antonio, Texas. Overall, 464 young men who have sex with men (YMSM; < 36-years-old) completed an online, cross-sectional survey that included questions about ACEs and HIV testing behavior. An association between increased ACEs exposure and the odds of clinic-based testing and HIVST HIV significantly decreased relative to never testing for HIV. Additionally, greater ACEs exposure was significantly associated with increased odds of reporting community-based testing (AOR = 1.09, 95% CI = 1.00, 1.20) and significantly reduced odds of HIV self-testing (AOR = 0.72, 95% CI = 0.63, 0.82) compared to clinic-based testing. Cumulative ACEs exposure is important in understanding HIV testing behaviors in YMSM and should be considered when developing HIV testing programs.

Effects of oxytocin and vasopressin administration on human fathers' sensitive and challenging parenting: A randomized within-subject controlled trial.

This randomized, double-blind, placebo-controlled within-subject study examined the effects of intranasal administration of oxytocin and vasopressin on fathers' sensitive and challenging parenting behaviors. Furthermore, we examined the moderating role of fathers' early childhood experiences. The sample consisted of 70 fathers with their 2- to 12-month-old infants. All fathers were assigned to each of the three experimental sessions (oxytocin, vasopressin, and placebo), on three separate days, with random order and intervening periods of one to two weeks. Sensitive and challenging parenting behaviors (CPB) were observed during a 10-minute free play task. Results showed no effects of vasopressin administration on paternal sensitivity. Fathers in the oxytocin condition were less sensitive than fathers in the placebo condition, and this effect was moderated by fathers' own childhood experiences: Fathers who reported higher levels of experienced parental love withdrawal were less sensitive in the oxytocin condition as compared to the placebo condition, whereas fathers with less experienced parental love withdrawal showed no difference in sensitivity between the oxytocin and placebo condition. No effects were found of oxytocin and vasopressin administration on fathers' CPB. Our results, although partly unexpected, are largely in line with previous literature showing that oxytocin administration can exert negative effects in individuals with adverse childhood experiences.

Extracellular Vesicles in Premature Aging and Diseases in Adulthood Due to Developmental Exposures.

The developmental origins of health and disease (DOHaD) is a paradigm that links prenatal and early life exposures that occur during crucial periods of development to health outcome and risk of disease later in life. Maternal exposures to stress, some psychoactive drugs and alcohol, and environmental chemicals, among others, may result in functional changes in developing fetal tissues, creating a predisposition for disease in the individual as they age. Extracellular vesicles (EVs) may be mediators of both the immediate effects of exposure during development and early childhood as well as the long-term consequences of exposure that lead to increased risk and disease severity later in life. Given the prevalence of diseases with developmental origins, such as cardiovascular disease, neurodegenerative disorders, osteoporosis, metabolic dysfunction, and cancer, it is important to identify persistent mediators of disease risk. In this review, we take this approach, viewing diseases typically associated with aging in light of early life exposures and discuss the potential role of EVs as mediators of lasting consequences.

Toxic and Teratogenic Effects of Prenatal Alcohol Exposure on Fetal Development, Adolescence, and Adulthood.

Prenatal alcohol exposure (PAE) can have immediate and long-lasting toxic and teratogenic effects on an individual's development and health. As a toxicant, alcohol can lead to a variety of physical and neurological anomalies in the fetus that can lead to behavioral and other impairments which may last a lifetime. Recent studies have focused on identifying mechanisms that mediate the immediate teratogenic effects of alcohol on fetal development and mechanisms that facilitate the persistent toxic effects of alcohol on health and predisposition to disease later in life. This review focuses on the contribution of epigenetic modifications and intercellular transporters like extracellular vesicles to the toxicity of PAE and to immediate and long-term consequences on an individual's health and risk of disease.

The Complex Associations Between Early Childhood Adversity, Heart Rate Variability, Cluster B Personality Disorders, and Aggression.

Early childhood adversity can cause an imbalance in the autonomic function, which may in turn lead to the development of trauma-spectrum disorders and aggressive behavior later in life. In the present study, we investigated the complex associations between early adversity, heart rate variability (HRV), cluster B personality disorders, and self-reported aggressive behavior in a group of 50 male forensic inpatients (M age = 41.16; SD = 10.72). Structural Equation Modeling analysis revealed that patients with cluster B personality disorders were more likely to have adverse early childhood experiences and reduced sympathetic dominance in response to a threat than patients without cluster B personality disorders. In addition, HRV and cluster B personality disorders did not significantly mediate the association between early childhood adversity and self-reported aggressive behavior. These findings are important for clinical practice to facilitate specific treatment programs for those affected.

¿En qué medida la adversidad temprana y la depresión explican la satisfacción de pareja? / How does early adversity and depression explain satisfaction of a couple?

Las experiencias adversas durante la infancia pueden constituirse en eventos traumáticos que impactan la calidad de los vínculos y la salud mental a lo largo del ciclo vital, siendo la depresión un trastorno frecuente en quienes reportan estas vivencias. La depresión ha sido asociada positivamente a la adversidad temprana y negativamente con la satisfacción de pareja durante la adultez, pero se desconoce el valor explicativo de la adversidad temprana y la depresión en los niveles de satisfacción de pareja. Considerando estos antecedentes, se desarrolló un estudio transversal, correlacional y comparativo en 160 madres y padres chilenos(as). Los resultados mostraron altos niveles de satisfacción de pareja y una asociación positiva entre las experiencias adversas y la depresión en padres y madres. Las madres presentaron mayores puntajes que los padres en depresión [t(79) =4.72, p<.001] y en experiencias adversas tempranas [t(79)= 3.468, p<.001], explicando la depresión materna y paterna junto a la satisfacción de pareja paterna un 51.8% de la satisfacción de pareja en las mujeres. En cuanto a los padres, su sintomatología depresiva y la satisfacción de la madre, explicaron un 58.9% de su satisfacción de pareja. Se discute la relevancia y las implicancias clínicas de los resultados

Adverse experiences in childhood are often traumatic events that affect relationships and mental health throughout the life cycle, with depression being a prevalent disorder in those who report them. Although depression has been positively associated with early adver-sity and negatively with couple satisfaction during adulthood, there are no studies that evaluate the explanatory value of both variables at the level of couple satisfaction. Therefore, a cross-sectional, correlational and comparative study was carried out in 160 fathers and mothers. The results showed high levels of couple satisfaction and a positive association between childhood adverse experiences and depression in parents. Mothers showed higher scores than fathers in depression [t(79) = 4.72; p <, 001] and in childhood adverse experiences [t(79) = 3,468 p <.001]. Moreover, for them, depression explained 53% of couple satisfaction. As for the father, a depressive symptomatology, childhood adverse experiences and the mother's depressive symptomatology explained 35% of his couple satisfaction

Stress, epigenetics and depression: A systematic review.

Environmental stressors, such as childhood maltreatment, have been recognized to contribute to the development of depression. Growing evidence suggests that epigenetic changes are a key mechanism by which stressors interact with the genome leading to stable changes in DNA structure, gene expression, and behaviour. The current review aimed to evaluate the relationship between stress-associated epigenetic changes and depression. Human studies were identified via systematic searching of PubMed/Medline from inception to February 2018. Seventeen articles were identified. Stress-associated epigenetic changes in the following genes were correlated with depression: NRC31, SLCA4, BDNF, FKBP5, SKA2, OXTR, LINGO3, POU3F1 and ITGB1. Epigenetic changes in glucocorticoid signaling (e.g., NR3C1, FKBP5), serotonergic signaling (e.g. SLC6A4), and neurotrophin (e.g., BDNF) genes appear to be the most promising therapeutic targets for future research. However, continued research is warranted due to inconsistent findings regarding the directionality of epigenetic modification. Future studies should also aim to control for the use of psychotropic agents due to their widespread use in depressed populations and established effects on DNA methylation.

Characterizing adverse prenatal and postnatal experiences in children.

BACKGROUND: Prenatal and postnatal adversities, including prenatal alcohol exposure (PAE), prenatal exposure to other substances, toxic stress, lack of adequate resources, and postnatal abuse or neglect, often co-occur. These exposures can have cumulative effects, or interact with each other, leading to worse outcomes than single exposures. However, given their complexity and heterogeneity, exposures can be difficult to characterize. Clinical services and research often overlook additional exposures and attribute outcomes solely to one factor. METHODS: We propose a framework for characterizing adverse prenatal and postnatal exposures and apply it to a cohort of 77 children. Our approach considers type, timing, and frequency to quantify PAE, other prenatal substance exposure, prenatal toxic stress, postnatal threat (harm or threat of harm), and postnatal deprivation (failure to meet basic needs) using a 4-point Likert-type scale. Postnatal deprivation and harm were separated into early (<24 months of age) and late (≥24 months) time periods, giving seven exposure variables. Exposures were ascertained via health records, child welfare records, interviews with birth parents, caregivers, and/or close family/friends. RESULTS: Nearly all children had co-occurring prenatal exposures, and two-thirds had both prenatal and postnatal adversities. Children with high PAE were more likely to experience late postnatal adversities, and children with other prenatal substance exposure were more likely to have early postnatal deprivation. Postnatal adversities were more likely to co-occur. CONCLUSION: This framework provides a comprehensive picture of a child's adverse exposures, which can inform assessment and intervention approaches and policy and will be useful for future research.

The roles of early-life adversity and rumination in neural response to emotional faces amongst anxious and depressed adults.

BACKGROUND: Early-life adversity (ELA) is a risk factor for internalizing psychopathology (IP). ELA is also linked to alterations in neural phenotypes of emotion processing and maladaptive emotion regulatory strategies, such as ruminative brooding, in adulthood. We therefore expected that ELA would predict cortical brain activation to emotional faces in transdiagnostic IP and in turn, mediate the extent of rumination amongst patients with IPs and ELA (IP + ELA). METHOD: One hundred and thirty-two individuals, including 102 treatment-seeking adults with heterogeneous IPs and 30 healthy controls (HCs) performed an Emotional Face-Matching Task during functional magnetic resonance imaging. Whole-brain analyses compared HC (n = 30), IP (n = 52), and IP + ELA (n = 50) neural responses to emotional (angry, fearful, happy, and sad) faces v. shapes, controlling for depression and anxiety symptoms. Parameter estimates of activation were extracted for significant between-group differences and tested as a mediator of ruminative brooding in IP + ELA. RESULTS: IP + ELA demonstrated increased activation in the superior frontal gyrus and anterior cingulate cortex (fear), superior parietal lobule, precuneus, posterior cingulate, and inferior temporal gyrus (fear only), and cuneus (fear and angry). These regions were preferentially correlated with ruminative brooding in IP + ELA, many of which mediated the link between IP + ELA and ruminative brooding. CONCLUSIONS: Results provide evidence that ELA history amongst IP patients augments engagement of brain regions involved in emotion processing, above and beyond what is accounted for by current symptoms. Though longitudinal designs are needed, alterations in the neural correlates of maladaptive processing of socio-emotional information may be a common pathway by which ELA poses risk for psychopathology.

Epigenetics in Personality Disorders: Today's Insights.

Objective: Epigenetic mechanisms have been described in several mental disorders, such as mood disorders, anxiety disorders and schizophrenia. However, less is known about the influence of epigenetic mechanisms with regard to personality disorders (PD). Therefore, we conducted a literature review on existing original data with regards to epigenetic peculiarities in connection with personality disorders. Methods: Systematic literature review using PRISMA guidelines. Search was performed via NCBI PubMed by keywords and their combinations. Used search terms included "epigenetic," "methylation," "acetylation" plus designations of specified personality traits and disorders according to DSM-IV. Results: Search yielded in total 345 publications, 257 thereof with psychiatric topic, 72 on personality disorder or traits, 43 of which were in humans and epigenetic, 23 thereof were original studies. Lastly, 23 original publications fulfilled the intended search criteria and were included. Those are 13 studies on gene methylation pattern with aggressive, antisocial and impulsive traits, 9 with borderline personality disorder (BPD), and 2 with antisocial personality disorder (ASPD). The results of these studies showed significant associations of PD with methylation aberrances in system-wide genes and suggest evidence for epigenetic processes in the development of personality traits and personality disorders. Environmental factors, of which childhood trauma showed a high impact, interfered with many neurofunctional genes. Methylation alterations in ASPD and BPD repeatedly affected HTR2A, HTR3A, NR3C1, and MAOA genes. Summary: Epigenetic studies in PD seem to be a useful approach to elucidate the interaction of co-working risk factors in the pathogenesis of personality traits and disorders. However, the complexity of pathogenesis leads to divergent results and impedes an explicit interpretation. Differing methylation patterns within the selected PD could indicate subgroups which would benefit from patient-oriented therapeutic adjustments. They might play a major role in the future design and observation of early therapeutic intervention and thus could help to prevent severe dysfunctional conduct or full-blown personality disorder in risk subjects.

Maternal distress and hair cortisol in pregnancy among women with elevated adverse childhood experiences.

Life-course exposure to stress is associated with a wide-range of health outcomes. Early childhood adversity may affect an individual's future response to stress. This is of particular concern during pregnancy as early maternal stress may impact the stress response in pregnancy, altering fetal exposure. We therefore hypothesized maternal childhood adversity may interact with distress experienced in pregnancy affecting maternal cortisol accumulation in pregnancy. Analyses were conducted within the PRegnancy and Infant Development (PRIDE) Study, a cohort of mother-infant pairs participating in Every Child Succeeds, a home visiting program in Cincinnati, Ohio. Thirty (of 53) healthy pregnant mothers contributed a hair sample and completed a battery of psychologic and stress measures including the Adverse Childhood Experiences (ACE) Scale. We used linear models to estimate the association between symptoms of depression, anxiety, somatization, both pregnancy and perceived stress and cortisol deposition; we generated multiplicative interaction terms generated and models stratified by the dose of ACEs (≥2/<2). Although overall the associations between maternal psychological distress were not associated with hair cortisol, among women who experienced ≥2 ACEs, depressive, somatic, and anxiety symptoms and perceived stress during pregnancy were positively (and significantly for depressive and somatic) correlated with cortisol accumulation. Pregnancy-specific stress was inversely associated with cortisol and also varied by ACEs. Interactions were non-significant (p values 0.11-0.51). We identified an association between measures of distress in pregnancy and hair cortisol only among mothers who experienced high levels of childhood adversity demonstrating importance of recognizing life-course stress.

Risk and resiliency factors related to body dissatisfaction and disordered eating: The identity disruption model.

OBJECTIVE: The current study examined a theoretical model (the identity disruption model) linking negative early life experiences to body dissatisfaction and disordered eating via self-concept clarity and sociocultural factors (internalization of beauty ideals and appearance comparison tendencies). METHOD: 1,023 participants (52% women) completed a series of questionnaires online, including measures of negative early life experiences and childhood abuse, self-concept clarity, internalization of beauty ideals, appearance comparison tendencies, sociocultural pressure to improve one's appearance, body dissatisfaction, and disordered eating. RESULTS: Structural equation modeling indicated that self-reported early adversity was associated with lower self-concept clarity, which in turn was associated with greater internalization of beauty ideals and more frequent appearance comparisons. Internalization and appearance comparisons were associated with body image concerns, which in turn were associated with disordered eating and exercise behaviors. There were few sex differences in these paths. DISCUSSION: These findings provide initial conceptual support for the identity disruption model and extend previous models of body dissatisfaction and disordered eating to include processes that occur earlier in life. This model opens up the possibility for new interventions that are targeted toward those who are most vulnerable to developing body dissatisfaction and disordered eating.

Early childhood adversities and risk of eating disorders in women: A Danish register-based cohort study.

OBJECTIVE: Previous studies evaluating the association between early childhood adversities and eating disorders have yielded conflicting results. The aim of this study is to examine the association between a range of adversities and risk of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS) in 495,244 women. METHOD: In this nationwide, register-based cohort study, nine types of early childhood adversity (family disruption, residential instability, placement in out-of-home care, familial death, parental somatic illness, parental psychiatric illness, parental disability, severe parental criminality, and parental substance use disorder) were defined and exposure during the first 6 years of life was determined. Hazard ratios for eating disorders were calculated using Cox regression. RESULTS: Few adversities were significantly associated with AN, and for each, the presence of the adversity was associated with lower risk for AN. BN, and EDNOS were positively associated with several types of adversities. AN rates were unchanged or reduced by up to 54% by adversities, whereas rates of BN and EDNOS were unchanged or increased by adversities by up to 49 and 89%, respectively. DISCUSSION: Our findings indicate that childhood adversities appear to be associated with an increased risk of BN and in particular EDNOS, whereas they seem to be either unassociated or associated with a decreased risk of AN.

Psychological Manifestations of Early Childhood Adversity in the Context of Chronic Hematologic Malignancy.

BACKGROUND: Myeloproliferative neoplasms (MPNs), a group of chronic hematologic malignancies, carry significant physical and psychological symptom burdens that significantly affect patients' quality of life. OBJECTIVES: We sought to identify the relationship between early childhood adversity (ECA) and psychological distress in patients with MPNs, as ECA may compound symptom burden. METHODS: Patients with MPNs were assessed for ECA (i.e., the Risky Families Questionnaire-subscales include abuse/neglect/chaotic home environment), distress (i.e., Distress Thermometer and Problem List), anxiety (i.e., Hospital Anxiety and Depression Scale-Anxiety [HADS-A]), depression (i.e., Hospital Anxiety and Depression Scale-Depression [HADS-D]), meeting standardized cutoff thresholds for distress (i.e., Distress Thermometer and Problem List≥ 4 or ≥ 7)/anxiety (HADS-A ≥8)/depression (HADS-D ≥ 8), and demographic factors. RESULTS: A total of 117 participants completed the study (78% response rate). ECA was associated with depression (p < 0.000), anxiety (p < 0.000), and distress (p < 0.000) and problem list variables emotional (p < 0.000), physical (p = 0.004), family (p = 0.01), and spiritual (p = 0.01) by bivariate analysis and only with distress (HADS) (p = 0.038) on multivariate analysis. ECA was associated with meeting cutoff threshold criteria for distress (p = 0.007), anxiety (p = 0.001), and depression (p = 0.02). ECA subscale variables abuse and chaotic home environment were associated with psychological outcomes. ECA was higher based on disease subtypes with greater symptom burden (other > polycythemia vera > myelofibrosis > essential thrombocythemia) (p = 0.047) and taking an antidepressant (p = 0.011). CONCLUSION: ECA is associated with psychological distress and meets screening criteria for anxiety and depression in patients with MPNs. ECA may help to explain individual patient trajectories, and further understanding may enhance patient-centered care among patients with MPNs.

Depression and stressful environments: identifying gaps in conceptualization and measurement.

BACKGROUND AND OBJECTIVES: Stress is well known as a trigger of depressive reactions, fear, anxiety, and behavioral disorders. However, there are many gaps in the conceptualization and measurement of environmental stress. RESULTS: Exciting developments in the neuroscience of stress have increasingly expanded our knowledge of mechanisms by which stress may affect emotional and behavioral adjustment. Ironically, environmental stress has often been a silent player in human studies of stress processes. There is a significant need for increased efforts to include environmental stress variables in models of internalizing and other disorders. Measurement and conceptualization issues are prominent, and this article makes the case for improved methods of measuring acute, chronic, and early life stress, and for additional conceptualization of the dynamically changing and bidirectional effects of stress on disorder over time. CONCLUSIONS: There is a critical need for greater focus on and better measurement of the environment and its impact on emotional and other disorders, with emphasis on developmentally informed hypotheses. Empirical findings and new perspectives may contribute enormously to our understanding of normal and abnormal outcomes, and also to the challenge of effective interventions to promote mental health and optimal functioning.

Toxic Stress: Effects, Prevention and Treatment.

Children who experience early life toxic stress are at risk of long-term adverse health effects that may not manifest until adulthood. This article briefly summarizes the findings in recent studies on toxic stress and childhood adversity following the publication of the American Academy of Pediatrics (AAP) Policy Report on the effects of toxic stress. A review of toxic stress and its effects is described, including factors of vulnerability, resilience, and the relaxation response. An integrative approach to the prevention and treatment of toxic stress necessitates individual, community and national focus.