Childhood trauma is linked to learning and behavioral problems and obesity, according to the results of a chart review reported online June 8 in Child Abuse & Neglect The International Journal.
"Adverse childhood experiences (ACEs) including abuse, neglect, and histories of domestic and community violence are significant public health concerns in the United States," write Nadine J. Burke, MD, MPH, from the Department of Pediatrics, California Pacific Medical Center, Bayview Child Health Center in San Francisco, and colleagues. "In order to study the effects of traumatic experiences on child development, we studied the relationship between the prevalence of ACE categories in a specific urban population and both psychological and physical outcomes: learning and behavior problems as identified by the primary care physician (psychological development) and obesity (physical development). These particular outcomes were chosen because they are risk factors for adult chronic conditions."
The investigators reviewed medical records of 701 patients seen at the Bayview Child Health Center in San Francisco and coded medical chart documentation of ACEs. Each ACE criterion endorsed by a traumatic event received a score of 1, for a total score ranging from 0 to 9.
A clinical measure reported by the pediatrician, based on both objective learning data (eg, low academic achievement) and objective behavioral data (eg, history of violent behavior), was used to classify learning/behavior problems. Overweight or obese was defined as a body mass index (BMI) within the 85th percentile or above.
At least 1 category of ACEs was documented for most patients (67.2%, N = 471), and 4 or more ACEs were documented for 12.0% of patients (N = 84).
Increased ACE scores, and exposure to 4 or more ACE categories, were associated with an increased risk for learning/behavior problems and obesity.
"There was a significant prevalence of endorsed ACE categories in this urban population," the study authors write. "Results from this study demonstrate the need both for screening of ACEs among youth in urban areas and for developing effective primary prevention and intervention models."
Limitations of this study include cross-sectional design; history of ACEs obtained from the caregiver, creating sampling bias; and lack of formal assessment of learning/behavior problems.
"Future studies should look prospectively to evaluate whether targeted interventions may attenuate the risk of chronic problems, such as learning/behavior problems and obesity, and assess whether universal screening and early intervention can reduce the risk of subsequent adverse events," the study authors conclude.
The Lennar Urban Corporation supported this study. The study authors have disclosed no relevant financial relationships.
Child Abuse Negl. Published online June 8, 2011. Abstract
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