Adverse Childhood Events

Question 1

What are the three main categories of adverse childhood events?

Answer 1

1. Abuse (physical, emotional, and/or sexual)
2. Household challenges (domestic violence, substance abuse, mental illness, parental divorce/separation/incarceration)
3. Neglect (emotional and/or physical)

Question 2

Describe the progression of events that often occurs in leading children who face multiple adverse childhood events to an earlier death than would be otherwise expected.

Answer 2

Question 3

True/False.

Adverse childhood events and negative outcomes follow a dose-response relationship. As the ACE score goes up, the percentage of people with health and social problems also goes up.

Answer 3

True.

Question 4

Long-term adverse childhood outcomes are often better predicted by the ________ (number/type) of risk factors rather than the ________ (number/type) of risk factors.

Answer 4

Long-term adverse childhood outcomes are often better predicted by the number of risk factors rather than the type of risk factors.

(This is the _cumulative risk model_.)

Question 5

Having _____ or more adverse childhood events drastically increases one’s risk of a host of developmental, social, physical, and mental issues.

Answer 5

Having 4 or more adverse childhood events drastically increases one’s risk of a host of developmental, social, physical, and mental issues.

Question 6

Having ≥ 4 ACEs is associated with an increase in the likelihood of what sorts of mental and behavioral issues?

Answer 6

Developmental delay;

smoking, alcohol, and substance abuse;

depression, poor self-rated health, suicide;

multiple sexual partners (≥50 sexual intercourse partners), sexually transmitted disease

Question 7

Having ≥ 4 ACEs is associated with an increase in the likelihood of what sorts of physical health issues?

Answer 7

Heart disease and stroke;

chronic lung disease,

diabetes, liver disease

cancer;

injuries;

HIV, STDs;

Question 8

How much is average life expectancy likely to change if an individual has experienced more than 5 adverse childhood events?

Answer 8

-20 years

(For comparison: smoking = -10 years; obesity = -7 years, diabetes = -8 years, hypertension = -5 years)

Question 9

What proportion of the population have experienced more than 4 adverse childhood events?

Answer 9

1/8

Question 10

What term refers to the condition when a single factor increases risk for a variety of outcomes?

Answer 10

Equifinality

(Example: Maternal depression increases the risk for the following in the child: insecure attachment, language and cognitive delays, emotion regulation problems, behavioral problems, and socio-interactive problems.)

Question 11

What term refers to the condition when multiple factors all increase risk for a certain outcome?

Answer 11

Multifinality

(Example: Insecure attachment, maternal depression, difficult temperament, and parental conflict all increase the risk for aggression in preschoolers.)

Question 12

Name a few risk factors associated increased likelihood of a child experiencing adverse childhood events.

Answer 12

Poverty,

parental mental illness,

parental substance abuse,

abuse/neglect,

teenage parenthood,

low birthweight

Question 13

Children exposed to ≥____ risk factors for adverse childhood events are 4 times more likely to have developmental delays.

Answer 13

Children exposed to ≥ 4 risk factors for adverse childhood events are 4 times more likely to have developmental delays.

Question 14

Describe the relationship between the number of risk factors for adverse childhood events that a child faces and the likelihood that the child experiences some developmental delay.

Answer 14

Question 15

One study of adverse childhood events surveyed 17,000+ mostly white, middle-class, college-educated 19-24 year olds.

What percent reported physical abuse?

Emotional abuse?

Sexual abuse?

Answer 15

25%

10%

20%

Question 16

One study of adverse childhood events surveyed 17,000+ mostly white, middle-class, college-educated 19-24 year olds.

What percent reported physical neglect?

Emotional neglect?

Answer 16

10%

15%

Question 17

True/False.

Adverse childhood events are much, much more common than one might expect.

Answer 17

True.

67% of the population has at least one.

Question 18

Adverse childhood events are highly interrelated. When there was one ACE, there was an ____% likelihood that at least one of the other 9 ACEs also occurred.

Answer 18

Adverse childhood events are highly interrelated. When there was one ACE, there was an 87% likelihood that at least one of the other 9 ACEs also occurred.

Question 19

Describe the findings of the Philadelphia Urban ACE Survey in regards to sexual, emotional, and physical abuse.

Answer 19

1/6 reported sexual abuse

1/3 reported physical and/or emotional abuse

Question 20

What did the Philadelphia Urban ACE Survey discover in terms of racial differences in experience of adverse childhood events?

Answer 20

Black respondents reported the following:

• more urban ACEs
• higher rates of sexual abuse and physical neglect
• 2x greater likelihood of witnessing violence

White respondents reported the following:

• higher rates of emotional abuse

Question 21

What does it mean when we talk about sensitive periods of brain development?

Answer 21

The brain is prewired to ‘expect’ certain experiential stimuli that influence proper development

Question 22

Experience-________ development refers to the need for specific stimuli that must occur at specific times in order to have the desired effect on brain development.

(Example: the acquisition of language, visual perception, and ability to form attachments all must be stimulated at the proper time or they become impossible.)

Answer 22

Experience-expected development refers to the need for specific stimuli that must occur at specific times in order to have the desired effect on brain development.

(Example: the acquisition of language, visual perception, and ability to form attachments all must be stimulated at the proper time or they become impossible.)

Question 23

Experience-________ development refers to the ability to learn new information throughout one’s life and apply it to those abilities and beliefs already learned.

(Example: the ability to improve upon the quality of one’s relationships.)

Answer 23

Experience-dependent development refers to the ability to learn new information throughout one’s life and apply it to those abilities and beliefs already learned.

(Example: the ability to improve upon the quality of one’s relationships.)

Question 24

The highest number of sensitive periods of cognitive development peak around ____ years of age.

Answer 24

The highest number of sensitive periods of cognitive development peak around 2 years of age.

Question 25

Name some of the cognitive functions that require external input in order to develop properly (usually by/around 2 years of age).

Answer 25

Vision

Hearing

Language

Habitual ways of learning

Question 26

True/False.

Differences in vocabulary growth between children in low socio-economic households and high socio-economic households begin to appear at the earliest as early as 5 years of age (and the difference often only grows from there).

Answer 26

False.

Differences in vocabulary growth between children in low socio-economic households and high socio-economic households begin to appear at the earliest as early as 18 months of age (and the difference often only grows from there).

Question 27

What is the name of the hypothesis that states that repeated socioeconomic stressors can accumulate and increase health vulnerability across multiple body systems in a marginalized group’s life course (i.e. via stress pathways such as the sympathetic and hypothalamic-pituitary-adrenal axes)?

Answer 27

The weathering hypothesis

Question 28

What term refers to the body’s ability to adjust to maintain stability through change?

Answer 28

Allostasis

Question 29

What term refers to the strain put on the body by repeated bouts of distress and activation/inactivation of the sympatho-adrenal pathways.

Answer 29

Allostatic load

Question 30

What is allostatic load?

Answer 30

The physiological load of stress

(the wear and tear that the body experiences due to repeated cycles of allostasis as well as the inefficient activation and inactivation of stress responses)

Question 31

Describe a mechanism by which stress can have genetic effects on an intergenerational scale.

Answer 31

Basic epigenetic effects: Adverse experience → altered genetic methlyation → altered gene expression → altered protein → altered phenotype

(Example: Licking and grooming in mice alters DNA methylation and acetylation of histones of the glucocorticoid receptor (GR) gene early in life, providing a mechanism for these permanent changes in stress responses. This increases the number of GR proteins which bind cortisol, resulting in low-anxiety offspring.)

Question 32

In humans, the ________ promoter in the hippocampus is methlyated via bouts of stress.

Answer 32

In humans, the NR3C1 promoter in the hippocampus is methlyated via bouts of stress.

Question 33

Tulane study: Adverse childhood events are associated with intergenerational effects in shorter infant telomere length across infancy and higher rate of ___________-behavioral problems (aggression) at 18 months.

No associations were found with ___________-behavioral problems (anxiety and depression).

Answer 33

Tulane study: Adverse childhood events are associated with intergenerational effects in shorter infant telomere length across infancy and higher rate of externalizing-behavioral problems (aggression) at 18 months.

No associations were found with internalizing-behavioral problems (anxiety and depression).

Question 34

Generally describe the attributable risk of adverse childhood events to alcohol use, anxiety, depression, suicide, life dissatisfaction, etc.

Answer 34

Question 35

Children who do well despite serious hardships and adverse childhood events typically have had at least one what?

Answer 35

A stable / committed relationship with a supportive parent, caregiver, or other adult

Question 36

True/False.

Childhood resilience typically stems from a mix of supportive relationships, adaptive skill building, and positive experiences.

Answer 36

True.

Question 37

Increased levels of parenting stress increase the risk of aggressive behavior in children, BUT a secure attachment to one ________ can greatly decrease risk of aggressive behavior (even at the highest parenting stress levels).

Answer 37

Increased levels of parenting stress increase the risk of aggressive behavior in children, BUT a secure attachment to one parent can greatly decrease risk of aggressive behavior (even at the highest parenting stress levels).

Question 38

Name some useful interventions for preventing adverse childhood events and lessening their impact.

Answer 38

Affordable, high-quality childcare;

evidence-based home visits;

attachment/behavioral catch-up for maltreated infants/toddlers

Question 39

What treatment is indicated for lessening the health burden of previous adverse childhood events.

Answer 39

Interactions with licensed mental health providers

(e.g. child-parent psychotherapy, parent-child interaction therapy, etc.)