Some researchers have chosen to study the impact of a variety of different childhood events, particularly adverse events, comparing these self-reported childhood events to behavior that occurs in adulthood. The findings of this study are reported separately, since not all adverse events were specific forms of child abuse.

Based on Adverse Childhood Experiences (ACEs), a study of thousands of subjects drawn from a population of individuals receiving medical care at the Health Appraisal Clinic in San Diego, California, part of Kaiser Permanente's health maintenance organization, the researchers found that 64% of the sample reported one or more ACEs. Common ACEs were physical abuse in childhood (28%) and alcohol or substance abuse by a family member during the individual's childhood (about 27%).

Researchers using data drawn from the ACE study have discovered that those adults who suffered from childhood abuse and/or other severe adverse childhood events are more likely to suffer as adults.

The eight categories of ACEs that were considered are as follows:

-           Individuals who experienced recurrent childhood emotional abuse

-           Those who suffered from childhood physical abuse

-           Those who experienced sexual abuse

-           Individuals who witnessed violence against their mothers in childhood

-           Those who lost a biological parent in childhood for any reason

-           Those who lived with someone in the household with mental illness (depression, suicide or other mental illness)

-           Those who lived with someone who abused drugs or alcohol

-           Those who lived in a household in which a member was incarcerated for crimes

Females v. males

For all Adverse Childhood Experiences except physical abuse, female respondents reported a higher prevalence of ACEs. For example, 25% of the women reported experiencing sexual abuse in childhood, compared to 16% of the men. About 30 percent of the women reported household alcohol/drug abuse in childhood, compared to 24% of the men. Of the women, 13% reported childhood emotional abuse, compared to 8% of the men. In the case of physical abuse, however, 30% of the men reported experiencing this form of childhood abuse, compared to 27% of the women.

Women were also more likely to report a greater number of Adverse Childhood Experiences; for example, 2% of the male subjects reported four or more ACEs, compared to 4% of the women. As a result, women were at a greater risk than men for suffering from the negative health and behavioral consequences in adulthood that stem from experiencing more ACEs in childhood.

Researchers have found that adults with a past history of Adverse Childhood Experiences were more likely than those with no ACEs to

-           Become substance abusers of drugs and/or alcohol

-           Abuse their own children

-           Suffer from psychiatric emotional disorders, such

-           Depression or Anxiety Disorders

-           Commit Suicide (the suicide rate for women was about three times higher than for men)

-           Have unintended pregnancies

-           Contract sexually transmitted diseases

-           Have marital problems

-           Smoke heavily (more than a pack a day)

-           Become obese or severely obese

It is also true that the Adverse Childhood Experiences risk factors have been found to have a multiplier effect, which means that the greater the number of the adverse experiences in childhood, the higher the probability of problems in adulthood. For example, according to a study reported in Pediatrics in 2003, when comparing people with no adverse childhood experiences to those individuals with five or more ACEs, the individuals with the five ACEs had a seven to 10 times greater risk of using illegal drugs or being addicted to illicit drugs, as well as injecting drugs.

Said the researchers, "Because ACEs seem to account for one half to two thirds of serious problems with drug use, progress in meeting the national goals for reducing drug use will necessitate serious attention to these types of stressful and disturbing childhood experiences."

Health risks.

Adverse childhood experiences are also linked to health risks. As pointed out by Valerie Edwards in her chapter in Child Maltreatment on the wide-ranging health outcomes of ACEs, adults with four or more ACEs were about twice as likely to report having cancer, as well as more than twice as likely to have ischemic heart disease. In addition, adults with four or more ACEs were more than twice as likely to describe their own health as poor.

Sexual risk behaviors.

Researchers have found that women with four or more Adverse Childhood Experiences were nearlysix times more likely to have initiated sexual activity by the age of 15 years and 5.5 times more likely than others to report 30 or more lifetime sexual partners. They were also more than twice as likely to describe themselves as at risk for developing acquired immunodeficiency syndrome (AIDS).

Psychosocial problems.

Edwards said that the risk of psychosocial problems increased with a greater number of Adverse Childhood Experiences: "For instance, women with five or more ACEs were 3.3 times more likely to report that they were presently having serious family problems, 2.9 times more likely to report job problems, and 4.5 times more likely to report uncontrollable anger."

Psychiatric problems.

The risk of suffering from depression as well as alcoholism in adulthood was found to be greater among those with ACEs, according to a 2002 study reported in Psychiatric Services by Robert F. Anda, M.D., et al. The researchers found that the risk for experiencing all ACEs was significantly greater among the 20% of the respondents who reported parental alcohol abuse.

The researchers concluded, "Depression among adult children of alcoholics appears to be largely, if not solely, due to the greater likelihood of having had adverse childhood experiences in a home with alcohol-abusing parents."

They also said that "Improved recognition andtreatment of alcoholism in adults and tandem family interventions to reduce the burden of adverse childhood experience in alcoholic households would probably decrease the long-term risk of alcoholism, depression, and other adverse effects of trauma observed among adult children of alcoholics."

Suicide.

In a study reported in the Journal of the American Medical Association in 2001, researchers Shanta Dube et al. compared and contrasted the prevalence of individuals who had experienced various adverse events in their childhoods to their lifetime risk of an attempted suicide. Childhood abuse was one of the adverse events that increased the risk for suicide in adulthood. Researchers have found that for every increase in ACE score (each ACE is scored as one point), the risk of a suicide attempt by an individual increases by 60%.

The incarceration of a family member was also a risk factor for suicide. Among those who did not have incarcerated family members in childhood, 3.5% had attempted suicide, while among those who did have an incarcerated family member in childhood, the suicide prevalence was 10.8%.

Said the researchers, "In conclusion, we found that adverse childhood experiences dramatically increase the risk of attempting suicide." They added, "Thus, recognition that adverse childhood experiences are common and frequently take place as multiple events may be the first step in preventing their occurrence; identifying and treating persons who have been affected by such experiences may have substantial value in our evolving efforts to prevent suicide."

Smoking and ACEs.

Individuals with five or more Adverse Childhood Experiences have nearly three times the risk for becoming heavy smokers (more than one pack per day) in adulthood. They are also more than five times more likely to start smoking by age 14.Sexual abuse that occurred by the age of 14 years is associated with a four times greater risk of initiating smoking.

Resilience in adulthood.

Many studies have been performed on the long-term effects of child abuse, and these studies have demonstrated again and again that many abused children have difficulties in adulthood. However, some abused children have developed an inner resilience that apparently allows them to rise above the abuse and to develop normally.

In many cases, this resilience is most likely to occur among abused children who had a close and positive relationship with an adult during their youth, a person who believed in and emotionally supported him or her. Researchers continue to evaluate other factors that may be related to resilience.

In one study of resilience among adults who were abused or neglected as children, reported in a 2001 issue of Development and Psychopathology by Jean Marie McGloin and Cathy Spatz Widom, the researchers studied 676 formerly abused and neglected subjects, along with 520 control subjects who were not abused or neglected. The researchers considered success (resilience) in factors including education, employment, homelessness, social activity, psychiatric disorder, substance abuse, official arrests and self reported violence.

They found that 22% of the abused and neglected women met their criteria for resilience, and females were more likely to be resilient than males. They stated that more research needed to be performed to determine protective factors and processes that led to greater resilience among abused and neglected children and that aided them into adulthood.

Treatment for adults abused as children.

Many adults who were abused as children may benefit from therapy and from membership in self-help groups that include others who were abused or neglected in a similar manner. If the adult victim of childhood abuse suffers from chronic pain, treatment may help alleviate or at least improve this problem.

References:

1)         Anda, Robert F., M.D., et al. "Adverse Childhood Experiences, Alcoholic Parents, and Later Risk of Alcoholism and Depression." Psychiatric Services 53, no. 8 (August 2002): 1,001-1,009.

2)         Arnow, B. A. "Relationship between Childhood Maltreatment, Adult Health and Psychiatric Outcomes, and Medical Utilization." Journal of Clinical Psychiatry 6, supplement 12 (2004): 10-15.

3)         Brown, Jocelyn, M.D., Kathy Berenson, and Patricia Cohen. "Documented and Self-Reported Child Abuse and Adult Pain in a Community Sample." Clinical Journal of Pain 21, no. 5 (2005): 374-377.

4)         David, Debra, et al. "Are Reports of Childhood Abuse Related to the Experience of Chronic Pain in Adulthood?: A Meta-analytic Review of the Literature." Clinical Journal of Pain 21, no. 5 (2005): 398-405.

5)         Dube, Shanta R., et al. "Childhood Abuse, Household Dysfunction, and the Risk of Attempted Suicide throughout the Life Span: Findings from the Adverse Childhood Experiences Study." Journal of the American Medical Association 286, no. 24 (December 26, 2001): 3,089-3,096.

6)         Dube, Shanta R., et al. "Childhood Abuse, Neglect, and Household Dysfunction and the Risk of Illicit Drug Use: The Adverse Childhood Experiences Study." Pediatrics 111, no. 3 (March 2003): 564-572.

7)         Dube, Shanta R., et al. "Long-Term Consequences of Childhood Sexual Abuse by Gender of Victim." American Journal of Preventive Medicine 28, no. 5 (2005): 430-438.

8)         Edwards, Valerie J., et al. "Relationship between Multiple Forms of Childhood Maltreatment and Adult Mental Health in Community Respondents: Results from the Adverse Childhood Experiences Study." American Journal of Psychiatry 160, no. 8 (August 2003): 1,453-1,460.

9)         Edwards, Valerie J., et al. "The Wide-Ranging Health Outcomes of Adverse Childhood Experiences." In Child Maltreatment. Kingston, N.J.: Civic Research Institute, 2005.

10)       Kendall-Tackett, Kathleen A. "Chronic Pain Syndromes as Sequelae of Childhood Abuse." In Child Maltreatment. Kingston, N.J.: Civic Research Institute, 2005.

11)       McClanahan, Susan F., et al. "Pathways into Prostitution among Female Jail Detainees and Their Implications for Mental Health Services." Psychiatric Services 50, no. 12 (1999): 1,606-1,613.

12)       McGloin, Jean Marie, and Cathy Spatz Widom. "Resilience among Abused and Neglected Children Grown Up." Development and Psychopathology 13 (2001): 1,021-1,038.

13)       Office of Justice Programs. Full Report of the Prevalence, Incidence and Consequences of Violence against Women: Findings from the National Violence Against Women Study. Washington, D.C.: United States Department of Justice, November 2000.

14)       Rayworth, Beth. "Childhood Abuse and Risk of Eating Disorders in Women." Epidemiology 15, no. 3 (May 2004): 271-278.

15)       Wonderlich, Stephen A., et al. "Relationship of Childhood Sexual Abuse and Eating Disorders." Journal of the American Academy of Child & Adolescent Psychiatry 36, no. 8 (August 1997): 1,107-1,115.

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