Adverse childhood experiences

158:(BRFSS). In the first year data was collected across five US states and included over 24,000 people. The prevalence of each ACE ranged from a high of 29.1% for household substance abuse to a low of having an incarcerated family member (7.2%). Approximately one quarter (25.9%) of respondents reported verbal abuse, 14.8% reported physical abuse, and 12.2% reported sexual abuse. For ACEs measuring family dysfunction, 26.6% reported separated or divorced parents; 19.4% reported that they had lived with someone who was depressed, mentally ill, or suicidal; and 16.3% reported witnessing domestic violence. Men and women reported similar prevalences for each ACE, with the exception of sexual abuse (17.2% for women and 6.7% for men), living with a mentally ill household member (22.0% for women and 16.7% for men), and living with a substance-abusing family member (30.6% for women and 27.5% for men). Younger respondents more often reported living with an incarcerated and/or mentally ill household member. For each ACE, a sharp decrease was observed in prevalence reported by adults aged ≥55 years. For example, the prevalence of reported physical abuse was 16.9% among adults aged 18--24 years compared with 9.6% among those aged ≥55 years. 560:

the Health Appraisal Clinic completes a standardized medical questionnaire. The medical history is completed by a health care provider who also performs a general physical examination and reviews laboratory test results with the patient. Appointments for most members are obtained by self-referral with 20% referred by their health care provider. A review of Kaiser Permanente members aged 25 years or older in San Diego and continuously enrolled between 1992 and 1995 revealed that 81% of those members had been evaluated at the Health Appraisal Clinic. All Kaiser members who completed medical examinations at the Health Appraisal Clinic between August and November of 1995, between January and March of 1996 (Wave I: 13,494 persons), and between April and October of 1997 (Wave II: 13,330 persons) were eligible to participate in the ACE Study. Within two weeks after a member's visit to the Health Appraisal Clinic, a Study questionnaire was mailed asking questions about health behaviours and adverse childhood experiences. A total of 17,421 (68%) persons responded; 84 persons had incomplete information on race and educational attainment leaving 17,337 persons available in the baseline cohort.

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stable attachments. Physical movement in the form of "brain energizers" can help regulate children's brains and alleviate stress when done 1–2 times during the school day. In one study, both behavior and literacy skills were assessed to see how effective the physical movement, or "brain energizers" were. Literacy scores for a classroom that used the brain energizers (which ranged from movement activities found online to other movement activities selected by the teacher and students), improved by 117% from beginning to end of year. In a school setting, the person who has experienced trauma and the person who is in the moment with the person trying to talk or write about it can connect, even when language fails to adequately describe the depth and complexity of the emotions felt. While there is an inherent discomfort in this, educators can embrace this discomfort and give children a space to express this, as best they can, in the classroom. Those who are able to develop more "resilience" might be able to function better in school, but this is dependent on the ratio of protective factors compared to ACEs.

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disruption in education and instability in the home, as a result of the family's journey, can lead to gaps in exposures to literacy in the home . Literacy experiences outside of school include parents reading with kids and borrowing or buying books for the home. Early-childhood literacy education includes explicit teaching of reading and writing skills, building phonological awareness, and academic vocabulary. Resettlement affects children's phonemic awareness and exposure to academic vocabulary since many families are unable to fully provide these out of school experiences. If the child was non-English speaking, then they are acquiring English as a new language. There already exists an achievement gap between native-English speakers in the United States and students who are learning English as their second (or third or fourth) language.

422:, and attention. The parts of the brain and hormones that register fear and stress are in overdrive, whereas the prefrontal cortex, which regulates executive functions, is compromised. This impacts impulse control, focus, and critical thinking. Memory is also a struggle as there is less capacity to process new input. The stress of ACEs creates a state of "fight, flight, or freeze" which leaves children unavailable for learning. The ability to process new information or collaborate with peers in school is eclipsed by the brain's necessity to survive the stress experienced in their environment outside of school. The inconsistency and instability of the home environment alters the many cognitive processes necessary for effective literacy acquisition. 166:

one another. Non-Hispanic blacks were less likely to report five or more ACEs (4.9%) compared with non-Hispanic whites (8.9%), Hispanics (9.1%), and other non-Hispanics (11.7%). However, non-Hispanic black respondents were not significantly more likely to report zero ACEs compared with other racial/ethnic groups. Respondents with the lowest educational attainment were significantly more likely to report five or more ACEs compared with those with higher education levels (14.9% versus 8.7% among high school graduates and 7.7% in those with more than a high school education). Overall, little state-by-state variation was observed in the number of ACEs reported by each respondent.

339:'s process demonstrated the challenges associated with community implementation. The Pottstown Trauma-Informed Community Connection (PTICC) initiative evolved from a series of prior collectives that all had similar goals of creating community resilience in order to prevent and treat ACEs. Over the course of the two-year study, over 230 individuals from nearly 100 organizations attended one training offered by the PTICC, raising the number of engaged public sectors from 2 to 14. Participation in training and events was fairly steady and this was largely due to community networking. 394:(NCTSN) describes a trauma-informed school system as a place where school community members work to provide trauma awareness, knowledge and skills to respond to potentially negative outcomes following traumatic stress. The NCTSN published a study that discussed the Attachment, Self-Regulation, and Competency (ARC) model, which other researchers have based their subsequent studies of trauma-informed education practices off of. Trauma-sensitive or trauma-informed schooling has become increasingly popular in Washington, Massachusetts, and California in the last 10 years. 477:

support and a sense solidarity, and supportive relationships with adults that are based on empathy, active listening and non-judgement. Practical support meant information about the available services, practical advice about everyday challenges and respite from these challenges through recreation. Young people expected service delivery to be continuous and dependable, and they needed flexibility and control over the support processes. The needs of young people with ACEs were found not to match the types of support they are offered.

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interaction with their students. In a national survey conducted for the American Association of University Women Educational Foundation in 2000, it was found that roughly 290,000 students experienced some sort of physical sexual abuse by a public school employee between 1991 and 2000. A major 2004 study commissioned by the U.S. Department of Education found that nearly 10 percent of U.S. public school students reported having been targeted with sexual attention by school employees.

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trusting others, and can lead to negative cognitive effects. One study found that a child with 4 or more ACEs was 32 times more likely to be labeled with a behavioral or cognitive problem than a child with no ACEs. Another study found that students with at least three ACEs are three times as likely to experience academic failure, six times as likely to have behavioral problems, and five times as likely to have attendance problems. The

490:(ADHD) diagnoses are in fact reactions to trauma. Children who have experienced four or more ACEs are three times as likely to take ADHD medication when compared with children with less than four ACEs. Screening parents for their ACEs allows doctors to provide the appropriate support to parents who have experienced trauma, helping them to build resilience, foster attachment with their children, and prevent a family cycle of ACEs. 817:, is an annual survey conducted in waves by groups of individual state and territory health departments. An expanded ACE survey instrument was included in several states found each state. Adverse childhood experiences were even more frequent in studies in urban Philadelphia and in a survey of young mothers (mostly younger than 19). Surveys of adverse childhood experiences have been conducted in multiple EU member countries. 162:

whites of physical abuse, witnessing domestic violence, and having an incarcerated family member (p<0.05). Those respondents with less than a high school education compared with those with more than a high school education had a greater prevalence of physical abuse, an incarcerated family member, substance abuse, and separation/divorce. Among the five states, little variation was observed.

1357: 1249: 607:(CDC) went on to survey childhood trauma experiences of over 17,000 Kaiser Permanente patient volunteers. The 17,337 participants were volunteers from approximately 26,000 consecutive Kaiser Permanente members. About half were female; 74.8% were white; the average age was 57; 75.2% had attended college; all had jobs and good health care, because they were members of the Kaiser 829: 280:

response relationships with ACEs, with an ACE score of one increasing the risk of depressive symptoms by 50% and an ACE score of four or more showing a fourfold increase. Later research also demonstrated that ACE scores are related to increased rates and severity of psychiatric and mental disorders, as well as higher rates of prescription psychotropic medication use.

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obstacles to adoption include that the technique is not taught in medical schools, is not billable, and the nature of the conversation makes some doctors personally uncomfortable. Some public health centers see ACEs as an important way (especially for mothers and children) to target health interventions for individuals during sensitive periods of development.

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lifestyle behavior including sexual risk taking, smoking, heavy drinking, and obesity. The associations between these lifestyle issues and ACEs shows a dose response relationship with people having four or more ACEs have significantly more of these lifestyle problems. Physical health problems arise in people with ACEs with a similar

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developing nervous, immune, and metabolic systems of children. ACEs are associated with lifelong physical and mental health problems that emerge in adolescence and persist into adulthood, including cardiovascular disease, chronic obstructive pulmonary disease, autoimmune diseases, substance abuse, and depression.

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ACEs in childhood and adolescence can affect literacy development in many ways. Children who have faced trauma encounter more learning challenges in school and higher levels of stress internally. Building literacy skills can be negatively impacted both by the lack of literacy experiences in the home,

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Adults with ACE exposure report having worse mental and physical health, more serious symptoms related to illnesses, and poorer life outcomes. Across numerous studies these effects go beyond behavioral and medical issues, and include damage to DNA, higher levels of stress hormones, and reduced immune

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Approximately 41% of respondents reported having no ACEs, 22% reported one ACE, and 8.7% reported five or more ACEs. Men (6.9%) were less likely to report five or more ACEs compared with women (10.3%). Respondents aged ≥55 years reported the fewest ACEs, but the younger age groups did not differ from

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Non-Hispanic black respondents reported the lowest prevalence of each ACE category among all racial/ethnic groups, with the exception of having had an incarcerated family member, parental separation or divorce, and witnessing domestic violence. Hispanics reported a higher prevalence than non-Hispanic

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About two-thirds of individuals reported at least one adverse childhood experience; 87% of individuals who reported one ACE reported at least one additional ACE. The number of ACEs was strongly associated with adulthood high-risk health behaviors such as smoking, alcohol and drug abuse, promiscuity,

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The ACE Study was based at Kaiser Permanente's San Diego Health Appraisal Clinic, a primary care clinic where each year more than 50,000 adult members of the Kaiser Permanente Health Maintenance Organization receive an annual, standardized, biopsychosocial medical examination. Each member who visits

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approaches that help to prevent ACEs or minimize their impact. Utilizing tools that screen for trauma can help a social service worker direct their clients to interventions that meet their specific needs. Trauma-informed practices can also help social service providers look at how trauma impacts the

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Multiple mental health conditions found to have a dose response relationship with symptom severity and prevalence including depression, attention-deficit/hyperactivity disorder, anxiety suicidality, bipolar disorder and schizophrenia. Depressive symptoms in adulthood showed one of the strongest dose

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who experience ACEs are more likely than their similar-aged peers to experience challenges in their biological, emotional, social, and cognitive functioning. Also, children who have experienced an ACE are at higher risk of being re-traumatized or suffering multiple ACEs. The amount and types of ACEs

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A study in the UK looked at the views of young people exposed to ACEs on what support they needed from social services. The study grouped the findings into three categories: emotional support, practical support and service delivery. Emotional support included interacting with other young people for

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However, the PTICC faced several challenges similar to those predicted by the Building Community Resilience model. These barriers included availability of resources over time, competition for power within the group, and the lack of systemic change needed to support long-term goals. Still, Pottstown

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against the effects of exposure to ACEs. Increasing resilience in children can help provide a buffer for those who have been exposed to trauma and have a higher ACE score. People and children who have fostered resiliency have the skills and abilities to embrace behaviors that can foster growth. In

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during childhood. The categories are verbal abuse, physical abuse, contact sexual abuse, a battered mother/father, household substance abuse, household mental illness, incarcerated household members, and parental separation or divorce. The experiences chosen were based upon prior research that has

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that show that such measures can be used to actually improve health outcomes, the scale collapses items and has limited item coverage, there are no standard protocols for how to use the information gathered, and that revisiting negative childhood experiences could be emotionally traumatic. Other

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Trauma-informed approaches can improve child welfare services by openly discussing trauma and addressing parental trauma. The New Hampshire Division for Children Youth and Families (DCYF) is taking a trauma-informed approach to their foster care services by educating staff about childhood trauma,

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In their 2002 survey, the AAUW reported that, of students who had been harassed, 38% were harassed by teachers or other school employees. One survey that was conducted with psychology students reports that 10% had sexual interactions with their educators; in turn, 13% of educators reported sexual

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Screening for or talking about ACEs with parents and children can help to foster healthy physical and psychological development and can help doctors understand the circumstances that children and their parents are facing. By screening for ACEs in children, pediatric doctors and nurses can better

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educators and clinicians can help remediate both young children and adolescents in school. With a knowledge and sensitivity of ACEs and their effects, proper and effective interventions can be implemented. This can also begin to create a stable environment in which children can learn and create

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With one in four children experiencing or witnessing a potentially traumatic event, the relationship between ACEs and poor health outcomes has been established for years. With multiple adverse childhood experiences being equal to various stresses, and adversity. Children who grow up in an unsafe

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The Adverse Childhood Experiences (ACE) Study was a collaborative effort between Kaiser Permanente (San Diego, CA) and the Centers for Disease Control and Prevention (Atlanta, GA) designed to examine the long-term relationship between adverse childhood experiences (ACEs) and a variety of health

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ACEs have been linked to numerous negative health and lifestyle issues into adulthood across multiple countries and regions including the United States, the European Union, South Africa, and Asia. Across all these groups researchers have reported seeing the adoption of higher rates of unhealthy

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There are no reliable global estimates for the prevalence of child maltreatment. Data for many countries, especially low- and middle-income countries, are lacking. Current estimates vary widely depending on the country and the method of research used. Approximately 20% of women and 5–10% of men

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is mounting that such adverse childhood experiences (ACEs) have a profound long-term effect on health. Research shows that exposure to abuse and to serious forms of family dysfunction in the childhood family environment are likely to activate the stress response, thus potentially disrupting the

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can sometimes recreate control and power dynamics associated with clients' early trauma. This can be reduced through trauma-informed practices, such as training staff to be respectful of clients' space by scheduling appointments and not letting themselves into clients' private spaces, and also

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ACEs exposure is widespread globally, one study from the National Survey of Children's Health in the United States reported that approximately 68% of children 0–17 years old had experienced one or more ACEs. The impact of ACEs on children can manifest in difficulties focusing, self regulating,

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Indigenous populations show similar patterns of mental and physical health challenges as other minority groups. Interventions have been developed in American Indian tribal communities and have demonstrated that social support and cultural involvement can ameliorate the negative physical health

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Young people who are refugees experience trauma whether they were part of the immigration process or were born in the country (where they currently attend school) where the family settled. During this resettlement phase many of the second-generation refugee child's problems come to light. The

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The resulting literacy issues from trauma, reflected in low reading scores, puts children with ACEs at-risk for grade retention. As students, they are almost twice as likely to leave high school without graduating. While there are many years from when a young child starts kindergarten and an

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missing parts of early-childhood education, and by actually altering brain development. There are techniques that can be employed by educators and clinicians to try and remediate the effects of the adverse experiences and move children forward in their literacy and educational development.

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Adverse childhood experiences often occur together. Almost 40% of the original sample reported two or more ACEs and 12.5% experienced four or more. Because ACEs occur in clusters, many subsequent studies have examined the cumulative effects of ACEs rather than the individual effects of

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Mental health issues have been well known in the face of childhood trauma and exposure to ACEs is no different. According to a large study conducted in 21 countries nearly one in three mental health conditions in adulthood are directly related to an adverse childhood experience.

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behaviours and health outcomes in adulthood. An underlying thesis of the ACE Study is that stressful or traumatic childhood experiences have negative neurodevelopmental impacts that persist over the lifespan and that increase the risk of a variety of health and social problems.

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which became the first trauma-informed community in 2011. Trauma-informed initiatives in Tarpon Springs include trauma-awareness training for the local housing authority, changes in programs for ex-offenders, and new approaches to educating students with learning difficulties.

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Kaminer D, Bravo AJ, Mezquita L, Pilatti A, Bravo AJ, Conway CC, et al. (Cross-Cultural Addictions Study Team) (2022-03-29). "Adverse childhood experiences and adulthood mental health: a cross-cultural examination among university students in seven countries".

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school movement aims to train teachers and staff to help children self-regulate, and to help families that are having problems that result in children's normal response to trauma. It also seeks to provide behavioral consequences that will not re-traumatize a child.

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has built a trauma-informed community foundation and offers lessons to other communities who have similar goals: start with a dedicated small team, identify community connectors, secure long-term financial backing, and conduct data-informed evaluations throughout.

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is the ability to adapt or cope in the face of significant adversity and threats such as health problems, stress experienced in the workplace or home. Resiliency can mediate the relationship of the effects of ACEs and health problem in adulthood. Being able use

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and resilience-building practices. This work has been over 20 years in the making bringing together research are implemented in communities, education settings, public health departments, social services, faith-based organizations and criminal justice.

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under the program. Vincent Felitti, head of Kaiser Permanente's Department of Preventive Medicine in San Diego, conducted interviews with people who had left the program, and discovered that a majority of 286 people he interviewed had experienced

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Dorado JS, Martinez M, McArthur LE, Leibovitz T (2016). "Healthy Environments and Response to Trauma in Schools (HEARTS): A Whole-School, Multi-Level, Prevention and Intervention Program for Creating Trauma-Informed Safe and Supportive Schools".

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Adverse childhood experiences are common. For example, 28% of study participants reported physical abuse and 21% reported sexual abuse. Many also reported experiencing a divorce or parental separation, or having a parent with a mental and/or

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screening children entering foster care for trauma, using trauma-informed language to mitigate further traumatization, mentoring birth parents and involving them in collaborative parenting, and training foster parents to be trauma-informed.

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Carbone EA, Pugliese V, Bruni A, Aloi M, Calabrò G, Jaén-Moreno MJ, et al. (December 2019). "Adverse childhood experiences and clinical severity in bipolar disorder and schizophrenia: A transdiagnostic two-step cluster analysis".

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Allen, LaRue; Kelly, Bridget B.; Success, Committee on the Science of Children Birth to Age 8: Deepening and Broadening the Foundation for; Board on Children, Youth; Medicine, Institute of; Council, National Research (23 July 2015).

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The ACE Study has produced more than 50 articles that look at the prevalence and consequences of ACEs. It has been influential in several areas. Subsequent studies have confirmed the high frequency of adverse childhood experiences.

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Due to many of the early life stressors caused by exposure to ACEs there are noted changes the body in people with ACE exposures compared to people with little to no ACE exposure. This is most evident in structural changes in the

4809:"Examining protective and buffering associations between sociocultural factors and adverse childhood experiences among American Indian adults with type 2 diabetes: a quantitative, community-based participatory research approach" 292:

transmission may occur due to stress during pregnancy or during interactions between mother and newborns. Maternal stress, depression, and exposure to partner violence have all been shown to have epigenetic effects on infants.

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The ACE Pyramid represents the conceptual framework for the ACE Study, which has uncovered how adverse childhood experiences are strongly related to various risk factors for disease throughout the lifespan, according to the

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Baiden P, Onyeaka HK, Kyeremeh E, Panisch LS, LaBrenz CA, Kim Y, Kunz-Lomelin A (2022-02-23). "An Association of Adverse Childhood Experiences with Binge Drinking in Adulthood: Findings from a Population-Based Study".

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people are able to protect themselves from the potential negative effects of stressors. These skills can be taught to people but people living with ACEs score lower on measures of resilience and emotion regulation.

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Brindle RC, Pearson A, Ginty AT (March 2022). "Adverse childhood experiences (ACEs) relate to blunted cardiovascular and cortisol reactivity to acute laboratory stress: A systematic review and meta-analysis".

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Artigas R, Vega-Tapia F, Hamilton J, Krause BJ (October 2021). "Dynamic DNA methylation changes in early versus late adulthood suggest nondeterministic effects of childhood adversity: a meta-analysis".

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function. The effects of ACEs goes beyond just physical and behavioral health with studies reporting that people with high ACEs scores showed less trust in government COVID-19 information and policies.

6228:"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" 2696:

Kraaijenvanger EJ, Pollok TM, Monninger M, Kaiser A, Brandeis D, Banaschewski T, Holz NE (June 2020). "Impact of early life adversities on human brain functioning: A coordinate-based meta-analysis".

782:. These findings are important because they provided a link between the effects of child maltreatment and negative effects later in life which had not been established as clearly before this study. 4196:"Maltreatment in childhood substantially increases the risk of adult depression and anxiety in prospective cohort studies: systematic review, meta-analysis, and proportional attributable fractions" 54:

shown to them to have significant negative health or social implications, and for which substantial efforts are being made in the public and private sector to reduce their frequency of occurrence.

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Lin WH, Chiao C (January 2022). "The Relationship Between Adverse Childhood Experience and Heavy Smoking in Emerging Adulthood: The Role of Not in Education, Employment, or Training Status".

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adolescent enters high school, there is a link between weak emergent literacy leading to eventually dropping out of high school. It is crucial to intervene as early as possible.

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Mandelli L, Petrelli C, Serretti A (September 2015). "The role of specific early trauma in adult depression: A meta-analysis of published literature. Childhood trauma and adult depression".

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Cameron LD, Carroll P, Hamilton WK (May 2018). "Evaluation of an intervention promoting emotion regulation skills for adults with persisting distress due to adverse childhood experiences".

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Chen H, Fan Q, Nicholas S, Maitland E (August 2021). "The long arm of childhood: The prolonged influence of adverse childhood experiences on depression during middle and old age in China".

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environment are at risk for developing adverse health outcomes, affecting brain development, immune systems, and regulatory systems. Adverse childhood experiences can alter the structural

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A study of high school students in Chicago showed significantly elevated levels of school problems, hyperactivity, and lower levels of personal adjustment as number of ACEs increased.

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with many health problems. As researchers followed participants over time, they discovered that a person's cumulative ACEs score has a strong, graded relationship to numerous health,

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Wiss DA, Brewerton TD (September 2020). "Adverse Childhood Experiences and Adult Obesity: A Systematic Review of Plausible Mechanisms and Meta-Analysis of Cross-Sectional Studies".

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Hagan MJ, Sulik MJ, Lieberman AF (July 2016). "Traumatic Life Events and Psychopathology in a High Risk, Ethnically Diverse Sample of Young Children: A Person-Centered Approach".

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and may have long-term effects on the body, including speeding up the processes of disease and aging and compromising immune systems. Further research on ACEs determined that

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Trauma-informed education refers to the specific use of knowledge about trauma and its expression to modify support for children to improve their developmental success. The

264:. Chronic illnesses such as asthma, arthritis, cardiovascular disease, cancer, diabetes, stroke, and migraines show increased symptom severity in step was exposure to ACEs. 6766:. Atlanta, Georgia: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention. May 2014. Archived from 6492:. Atlanta, Georgia: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention. May 2014. Archived from 6440:. Atlanta, Georgia: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention. May 2014. Archived from 2849:

Paquola C, Bennett MR, Lagopoulos J (October 2016). "Understanding heterogeneity in grey matter research of adults with childhood maltreatment-A meta-analysis and review".

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Stoltenborgh M.; Van IJzendoorn M.H.; Euser E.M.; Bakermans-Kranenburg M.J. (2011). "A global perspective on child abuse: Meta-analysis of prevalence around the world".

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documenting the experiences of communities who have attempted to implement information about ACEs and trauma-informed practice into widespread public action. A study on

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Globally knowledge about the prevalence and consequences of adverse childhood experiences has shifted policy makers and mental health practitioners towards increasing,

6865: 5353:"Psychosocial adversity in early childhood and language and literacy skills in adolescence: the role of speech-language pathology in prevention, policy, and practice" 5088: 5066: 847: 699: 5802: 2147:

Benedini KM, Fagan AA, Gibson CL (September 2016). "The cycle of victimization: The relationship between childhood maltreatment and adolescent peer victimization".

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in these regions of the brain. Multiple effects have been noted including diminished thickness, reduced size, and reduced size of connective networks in the brain.

857: 3129:"Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention – 25 States, 2015–2017" 5478:

Guerrero, A; Herman, A; Teutsch, C; Dudovitz, R (2022). "Improving knowledge and attitudes about child trauma among parents and staff in head start programs".

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Hu Z, Kaminga AC, Yang J, Liu J, Xu H (July 2021). "Adverse childhood experiences and risk of cancer during adulthood: A systematic review and meta-analysis".

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Morrow, Anne; Villodas, Miguel (2018). "Direct and indirect pathways from adverse childhood experiences to high school dropout among high-risk adolescents".

2894:"Structural and Functional Brain Abnormalities Associated With Exposure to Different Childhood Trauma Subtypes: A Systematic Review of Neuroimaging Findings" 2225:

Yohros A (February 2022). "Examining the Relationship Between Adverse Childhood Experiences and Juvenile Recidivism: A Systematic Review and Meta-Analysis".

1903:"Windows of Vulnerability: Understanding how early stress alters trajectories of brain development and sets the stage for the emergence of mental disorders" 4394:"Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study" 5397:

Kupzyk, Sara; Banks, Brea; Chadwell, Mindy (2016). "Collaborating with refugee families to increase early literacy opportunities: a pilot investigation".

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Petruccelli K, Davis J, Berman T (November 2019). "Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis".

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and shortened lifespan. Compared to an ACE score of zero, having four adverse childhood experiences was associated with a seven-fold (700%) increase in

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Adverse childhood experiences are common across all parts of societies, in 2009 the CDC started collecting data on the prevalence of ACEs as part of the

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Giano Z, Hubach RD (December 2019). "Adverse childhood experiences and mental health: Comparing the link in rural and urban men who have sex with men".

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6895:"Adverse Childhood Experiences in Iowa: A New Way of Understanding Lifelong Health: Findings From the 2012 Behavioral Risk Factor Surveillance System" 3084:

Teicher MH, Samson JA, Anderson CM, Ohashi K (September 2016). "The effects of childhood maltreatment on brain structure, function and connectivity".

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Waterhouse JA (2022-02-02). "Adverse childhood experiences, safeguarding and the role of the school nurse in promoting resilience and wellbeing".

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Tietjen GE, Khubchandani J, Herial NA, Shah K (June 2012). "Adverse childhood experiences are associated with migraine and vascular biomarkers".

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Brown, David W.; Anda, Robert F.; Felitti, Vincent J.; Edwards, Valerie J.; Malarcher, Ann Marie; Croft, Janet B.; Giles, Wayne H. (2010-01-19).

3883:"Association between adverse childhood experiences and adult diseases in older adults: a comparative cross-sectional study in Japan and Finland" 6702: 5047: 726:, and behavioral problems throughout their lifespan, including substance use disorders. Furthermore, many problems related to ACEs tend to be 5753: 5649: 5493:

Dutro, Elizabeth (2013). "Towards a pedagogy of the incomprehensible: trauma and the imperative of critical witness in literacy classrooms".

3731:"Relationship Between Cumulative Adverse Childhood Experiences and Myocardial Infarction in Adulthood: a Systematic Review and Meta-analysis" 6433: 2595:"Associations between adverse childhood experiences, attitudes towards COVID-19 restrictions and vaccine hesitancy: a cross-sectional study" 956:

De Bellis, Michael D; Keshavan, Matcheri S; Clark, Duncan B; Casey, B.J; Giedd, Jay N; Boring, Amy M; Frustaci, Karin; Ryan, Neal D (1999).

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The different adverse childhood experiences are not isolated and in many cases multiple ACEs impact someone at the same time.

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108:

Observing violence occurring between individuals in a domestic setting, such as between parents or other family members.

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in children. Additionally behavioral challenges can arise in children who have been exposed to ACEs including juvenile

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before the age of 18 and causing mental or physical harm. There are 10 types of ACEs:

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in childhood contribute to health problems decades later. These include

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For people whose adverse childhood experiences were of abuse or neglect

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State ACEs Study surveys diagram color coded from the year 2009 to 2015

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This article incorporates text from this source, which is in the

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This article incorporates text from this source, which is in the

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Adverse childhood experiences among Hispanic and Latino Americans

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The original study questions have been used to develop a 10-item

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Washington State University Health Education Center: Spokane, WA

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can cause significant negative impacts and increase the risk of

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The concept of adverse childhood experiences refers to various

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can be fostered from having a caring adult in a child's life.

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The ACE study's results suggest that maltreatment and

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Objections to screening for ACEs include the lack of

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ACEs affect parts of the brain that involve memory,

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traumatic events or circumstances affecting children

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Sexual harassment in education in the United States

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December 23, 2012 6886: 6455: 6453: 6451: 5783: 5521: 5434: 4387: 4385: 4383: 4381: 4379: 4377: 4375: 3630: 3336: 3334: 3332: 3330: 3293:Social Psychiatry and Psychiatric Epidemiology 3224: 1928: 1926: 1683: 774:—that are the most common causes of death and 173: 6904: 6752: 6198: 5874:"10 Questions Some Doctors Are Afraid to Ask" 5003: 5001: 3528: 2985: 2641: 1932: 1455: 538:Resilience and access to other resources are 6926: 6665: 6482: 5933: 4059:The American Journal of Geriatric Psychiatry 2111: 1857: 497:has been studied and shown to be effective. 27:Traumatic events that occur during childhood 6839:MMWR. Morbidity and Mortality Weekly Report 6459: 6448: 6426: 5939: 5764: 5634:: CS1 maint: numeric names: authors list ( 5592: 5267:: CS1 maint: numeric names: authors list ( 4372: 4242: 3327: 3133:MMWR. Morbidity and Mortality Weekly Report 2056: 1990:"Study uncovers cost of resiliency in kids" 1923: 1804: 1802: 1372:MMWR. 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World Health Organization. 6800:10.1016/j.chiabu.2022.105681 6730:10.1016/j.chiabu.2019.104127 6609:10.1016/j.eurpsy.2015.04.007 6168:10.1016/j.chiabu.2018.03.005 6119:10.1016/j.chiabu.2015.03.008 6072:10.1016/j.chiabu.2018.03.002 5910:10.1016/j.chiabu.2019.104331 5507:10.1080/1554480X.2013.829280 4104:Journal of Health Psychology 3803:10.1016/j.chiabu.2021.105088 3599:10.1371/journal.pone.0226134 3086:Nature Reviews. Neuroscience 2344:10.1016/j.chiabu.2022.105595 2227:Trauma, Violence & Abuse 2161:10.1016/j.chiabu.2016.08.003 2014:Moffitt TE (November 2013). 1604:10.1016/0145-2134(83)90003-0 1062:(1 Psychobiology): 160–175. 813:(BRFSS) which is run by the 702:, the ACE study found that: 507:randomized controlled trials 354: 216: 178: 7: 7003:. World Health Organization 5771:Stevens JE (29 July 2014). 5571:Stevens JE (30 July 2012). 5370:10.1044/2020_PERSP-20-00120 4964:School Psychology Quarterly 4825:10.1136/bmjopen-2018-022265 4672:. 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Public Health 3182:The Lancet. Public Health 3053:10.1007/s11682-012-9215-y 2469:10.1017/S2040174420001075 2408:The Lancet. Public Health 2332:Child Abuse & Neglect 2239:10.1177/15248380211073846 2196:10.1007/s10802-015-0078-8 2149:Child Abuse & Neglect 2081:10.1017/S0954579411000587 2032:10.1017/S0954579413000801 1988:Sorrow A (May 30, 2013). 1860:Physiology & Behavior 1827:10.1007/s00406-005-0624-4 1751:10.1007/s10826-014-9968-6 1592:Child Abuse & Neglect 1486:World Health Organization 1021:10.1017/S0033291797005242 853:Stress in early childhood 6866:"Finding Your ACE Score" 6338:10.1001/jama.282.17.1652 2911:10.3389/fpsyt.2018.00329 2817:10.3389/fpsyt.2020.00783 2661:10.3389/fpsyt.2018.00420 2383:Allphin M (2020-01-01). 1522:10.1177/1077559511403920 1205:The Lancet Public Health 514:Resilience and resources 249:glucocorticoid receptors 5531:Meister C (July 2012). 2957:10.1023/A:1026021307833 2898:Frontiers in Psychiatry 2804:Frontiers in Psychiatry 2766:10.1073/pnas.2004363117 2648:Frontiers in Psychiatry 2294:10.3390/children9010027 1162:10.1002/2327-6924.12215 916:10.1186/1471-2458-10-20 452:centers – are adopting 348:Tarpon Springs, Florida 337:Pottstown, Pennsylvania 138:Parental separation or 7085:Determinants of health 6526:"Revised ACEs Pyramid" 5752:Ruiz R (7 July 2014). 5220:10.4148/2470-6353.1325 4200:Psychological Medicine 3145:10.15585/mmwr.mm6844e1 2945:Neurochemical Research 1703:10.1542/peds.2011-2663 1009:Psychological Medicine 863:Early childhood trauma 806: 709:substance use disorder 695: 586:childhood sexual abuse 378: 331:There is a paucity of 303:Implementing practices 194:neuroendocrine systems 127:Mental health problems 6547:American Psychologist 5351:Snow, Pamela (2021). 4646:10.1093/fampra/cmz065 4042:– via Springer. 962:Biological Psychiatry 804: 760:household dysfunction 684: 528:cognitive reappraisal 420:executive functioning 376: 296:Further information: 100:Psychological neglect 51:household dysfunction 6213:10.1093/bjsw/bcaa080 5108:School Mental Health 4910:"Community Projects" 3098:10.1038/nrn.2016.111 1551:Garbarino J (1977). 745:chronic lung disease 481:Health care services 63:Definition and types 37:) include childhood 6597:European Psychiatry 6496:on 16 January 2016. 6420:The Huffington Post 5955:on 27 January 2016. 5946:Healthy Generations 5662:10.3310/alert_47388 5618:"ACEs 360-New York" 5599:camh Cross Currents 5065:Blodgett C (2013). 4718:(21): 18370–18381. 4151:Academic Pediatrics 3590:2020PLoSO..1526134W 3243:2019Heliy...503003M 2757:2020PNAS..11722015B 2751:(36): 22015–22023. 1951:2012NYASA1262...93S 1643:2019Heliy...501900P 1068:1997NYASA.821..160T 545:attachment security 284:Special populations 88:Psychological abuse 56:Scientific evidence 5449:10.1111/jora.12332 5293:Pediatric Research 5169:. 24 August 2006. 4976:10.1037/spq0000256 4877:10.1002/ajcp.12386 4712:Current Psychology 4304:10.1037/amp0000755 3004:10.1111/jcpp.12507 1500:Child Maltreatment 1480:2015-08-22 at the 807: 786:Subsequent surveys 730:, or co-occurring. 696: 655:household member. 540:protective factors 526:resources such as 524:emotion regulation 471:housing insecurity 466:Supportive housing 379: 333:empirical research 226:Biological changes 7080:Child development 7075:Human development 6845:(49): 1609–1613. 6576:on 9 October 2016 6490:"The ACE Pyramid" 6382:(12): 1627–1640. 6332:(17): 1652–1658. 5968:Stress and Health 5825:BMC Public Health 4687:978-0-12-816065-7 4570:978-0-12-816065-7 4529:978-0-12-816065-7 4488:978-0-12-816065-7 4439:Knowable Magazine 4110:(10): 2373–2389. 3649:10.1111/tsq.12107 3495:10.1111/obr.13204 3188:(11): e848–e857. 2951:(11): 1735–1742. 2414:(11): e836–e847. 1994:medicalxpress.com 1910:The Balanced Mind 1411:BMC Public Health 1378:(49): 1609–1613. 968:(10): 1271–1284. 903:BMC Public Health 835:Psychology portal 633:domestic violence 565:Kaiser Permanente 450:domestic violence 400:Charol Shakeshaft 328:effects of ACEs. 16:(Redirected from 7102: 7013: 7012: 7010: 7008: 7002: 6993: 6987: 6986: 6984: 6982: 6971: 6965: 6964: 6962: 6953: 6947: 6946: 6944: 6942: 6937:. 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4050: 4044: 4043: 4019: 4013: 4012: 4002: 3970: 3964: 3963: 3927: 3921: 3920: 3910: 3878: 3872: 3871: 3861: 3829: 3823: 3822: 3786: 3777: 3776: 3758: 3726: 3720: 3719: 3709: 3677: 3671: 3670: 3660: 3628: 3622: 3621: 3611: 3601: 3569: 3563: 3562: 3526: 3517: 3516: 3506: 3474: 3468: 3467: 3430: 3424: 3423: 3387: 3381: 3380: 3362: 3353:(8): e356–e366. 3338: 3325: 3324: 3290: 3281: 3275: 3274: 3264: 3254: 3222: 3216: 3215: 3205: 3173: 3167: 3166: 3156: 3139:(44): 999–1005. 3124: 3118: 3117: 3081: 3075: 3074: 3064: 3032: 3026: 3025: 3015: 2983: 2977: 2976: 2940: 2934: 2933: 2923: 2913: 2889: 2883: 2882: 2846: 2840: 2839: 2829: 2819: 2795: 2789: 2788: 2778: 2768: 2736: 2730: 2729: 2693: 2684: 2683: 2673: 2663: 2639: 2633: 2632: 2622: 2590: 2584: 2583: 2573: 2563: 2539: 2533: 2532: 2495: 2489: 2488: 2451: 2442: 2441: 2423: 2399: 2393: 2392: 2380: 2374: 2373: 2355: 2338:(Pt 1): 105595. 2323: 2317: 2316: 2306: 2296: 2272: 2259: 2258: 2233:(3): 1640–1655. 2222: 2216: 2215: 2179: 2173: 2172: 2144: 2138: 2137: 2109: 2103: 2102: 2092: 2075:(4): 1107–1124. 2060: 2054: 2053: 2043: 2011: 2005: 2004: 2002: 2000: 1985: 1979: 1978: 1930: 1921: 1920: 1918: 1916: 1907: 1898: 1892: 1891: 1855: 1849: 1848: 1838: 1806: 1797: 1796: 1794: 1793: 1779: 1773: 1772: 1762: 1745:(6): 1650–1659. 1730: 1724: 1723: 1705: 1696:(1): e232–e246. 1681: 1675: 1674: 1664: 1654: 1622: 1616: 1615: 1587: 1581: 1580: 1548: 1542: 1541: 1515: 1513:10.1.1.1029.9752 1495: 1489: 1471: 1465: 1464: 1462: 1453: 1447: 1446: 1436: 1426: 1402: 1396: 1395: 1359: 1358: 1353: 1344: 1343: 1341: 1340: 1325: 1319: 1318: 1316: 1307: 1298: 1297: 1287: 1251: 1250: 1245: 1239: 1238: 1220: 1211:(8): e356–e366. 1196: 1190: 1189: 1141: 1135: 1134: 1110: 1104: 1103: 1047: 1041: 1040: 1000: 994: 993: 953: 947: 946: 936: 918: 894: 837: 832: 831: 830: 663: 404:abuse by priests 94:Physical neglect 21: 7110: 7109: 7105: 7104: 7103: 7101: 7100: 7099: 7055: 7054: 7034: 7022: 7020:Further reading 7017: 7016: 7006: 7004: 7000: 6994: 6990: 6980: 6978: 6973: 6972: 6968: 6960: 6954: 6950: 6940: 6938: 6931: 6927: 6917: 6915: 6910: 6909: 6905: 6897: 6891: 6887: 6879: 6868: 6864:Anda R (2007). 6862: 6858: 6831: 6824: 6779: 6775: 6758: 6757: 6753: 6714: 6710: 6694: 6693: 6689: 6678: 6670: 6666: 6657: 6655: 6651: 6644: 6636: 6632: 6593: 6589: 6579: 6577: 6564: 6563: 6554: 6541: 6540: 6536: 6528: 6524: 6523: 6519: 6506: 6505: 6501: 6488: 6487: 6483: 6473: 6471: 6464: 6458: 6449: 6432: 6431: 6427: 6412: 6403: 6368: 6361: 6318: 6314: 6275: 6271: 6224: 6220: 6207:(3): 999–1017. 6197: 6193: 6148: 6144: 6099: 6095: 6056: 6052: 5999: 5995: 5964: 5960: 5952: 5938: 5934: 5889: 5885: 5872: 5871: 5864: 5817: 5813: 5805: 5794: 5788: 5784: 5769: 5765: 5750: 5746: 5738: 5730: 5726: 5681: 5677: 5648: 5647: 5643: 5627: 5626: 5614: 5610: 5591: 5584: 5569: 5565: 5560:. 15 July 2014. 5556: 5555: 5551: 5535: 5529: 5522: 5491: 5487: 5476: 5472: 5433: 5426: 5395: 5386: 5349: 5338: 5285: 5276: 5260: 5259: 5252: 5250: 5240: 5236: 5199: 5186: 5176: 5174: 5167:www.cbsnews.com 5161: 5160: 5156: 5146: 5144: 5140: 5139: 5135: 5103: 5099: 5091: 5085: 5081: 5069: 5063: 5059: 5044: 5040: 5025: 5021: 5006: 4999: 4960: 4953: 4939: 4935: 4926: 4925: 4921: 4914:ACEs Connection 4906: 4902: 4857: 4850: 4805: 4798: 4753: 4749: 4707: 4703: 4688: 4666: 4662: 4633:Family Practice 4625: 4621: 4590: 4586: 4571: 4549: 4545: 4530: 4508: 4504: 4489: 4467: 4463: 4453: 4451: 4431: 4427: 4390: 4373: 4333: 4329: 4284: 4280: 4241: 4237: 4192: 4188: 4143: 4139: 4100: 4096: 4051: 4047: 4020: 4016: 3971: 3967: 3928: 3924: 3879: 3875: 3830: 3826: 3787: 3780: 3727: 3723: 3678: 3674: 3629: 3625: 3584:(1): e0226134. 3570: 3566: 3527: 3520: 3483:Obesity Reviews 3475: 3471: 3431: 3427: 3388: 3384: 3339: 3328: 3288: 3282: 3278: 3223: 3219: 3174: 3170: 3125: 3121: 3092:(10): 652–666. 3082: 3078: 3033: 3029: 2984: 2980: 2941: 2937: 2890: 2886: 2847: 2843: 2796: 2792: 2737: 2733: 2694: 2687: 2640: 2636: 2591: 2587: 2540: 2536: 2496: 2492: 2452: 2445: 2400: 2396: 2381: 2377: 2324: 2320: 2273: 2262: 2223: 2219: 2180: 2176: 2145: 2141: 2110: 2106: 2061: 2057: 2012: 2008: 1998: 1996: 1986: 1982: 1931: 1924: 1914: 1912: 1905: 1899: 1895: 1856: 1852: 1807: 1800: 1791: 1789: 1781: 1780: 1776: 1731: 1727: 1682: 1678: 1623: 1619: 1588: 1584: 1549: 1545: 1496: 1492: 1482:Wayback Machine 1472: 1468: 1460: 1454: 1450: 1403: 1399: 1356: 1354: 1347: 1338: 1336: 1327: 1326: 1322: 1314: 1308: 1301: 1248: 1246: 1242: 1197: 1193: 1142: 1138: 1112: 1111: 1107: 1048: 1044: 1001: 997: 954: 950: 895: 888: 883: 833: 828: 826: 823: 788: 679: 637:substance abuse 621:Emotional abuse 553: 516: 503: 483: 454:trauma-informed 443: 441:Social services 434:Trauma-informed 412: 384:trauma-informed 371: 369:School bullying 357: 322:trauma-informed 318: 309:trauma-informed 305: 300: 286: 270: 257: 255:Physical health 245:corpus callosum 228: 219: 181: 176: 152: 65: 28: 23: 22: 15: 12: 11: 5: 7108: 7098: 7097: 7092: 7087: 7082: 7077: 7072: 7067: 7053: 7052: 7047: 7041: 7033: 7032:External links 7030: 7029: 7028: 7021: 7018: 7015: 7014: 6988: 6966: 6948: 6925: 6903: 6885: 6856: 6822: 6773: 6751: 6708: 6688:978-9241594363 6687: 6664: 6630: 6603:(6): 665–680. 6587: 6552: 6534: 6517: 6499: 6481: 6447: 6425: 6401: 6359: 6312: 6269: 6232:BMC Psychiatry 6218: 6191: 6142: 6093: 6050: 5993: 5974:(5): 353–355. 5958: 5932: 5883: 5862: 5811: 5808:on 2014-09-03. 5782: 5763: 5744: 5724: 5675: 5641: 5624:on 2014-04-08. 5608: 5605:on 2016-01-27. 5582: 5563: 5549: 5520: 5501:(4): 301–315. 5485: 5470: 5443:(2): 327–341. 5424: 5405:(3): 205–217. 5384: 5363:(2): 253–261. 5336: 5274: 5234: 5184: 5154: 5133: 5114:(1): 163–176. 5097: 5079: 5057: 5038: 5019: 4997: 4970:(1): 137–146. 4951: 4933: 4919: 4900: 4848: 4819:(9): e022265. 4796: 4767:(2): 401–421. 4747: 4701: 4686: 4660: 4639:(3): 355–359. 4619: 4584: 4569: 4543: 4528: 4502: 4487: 4461: 4425: 4404:(4): 245–258. 4371: 4327: 4298:(2): 284–299. 4278: 4235: 4206:(4): 717–730. 4186: 4157:(4): 356–361. 4137: 4094: 4065:(1): 110–114. 4045: 4014: 3985:(5): 378–385. 3965: 3938:(6): 920–929. 3922: 3893:(8): e024609. 3873: 3844:(3): e045167. 3824: 3778: 3741:(3): 701–714. 3721: 3692:(1): 1720336. 3672: 3643:(4): 723–752. 3623: 3564: 3518: 3469: 3442:(3): 360–372. 3425: 3398:(1): 155–162. 3382: 3326: 3299:(3): 339–349. 3276: 3237:(12): e03003. 3217: 3168: 3119: 3076: 3047:(2): 196–203. 3027: 2998:(3): 241–266. 2978: 2935: 2884: 2841: 2790: 2731: 2685: 2634: 2605:(2): e053915. 2585: 2534: 2490: 2463:(5): 768–779. 2443: 2394: 2375: 2318: 2260: 2217: 2190:(5): 833–844. 2174: 2139: 2120:(1): 469–494. 2104: 2055: 2006: 1980: 1922: 1893: 1850: 1821:(3): 174–186. 1798: 1774: 1725: 1676: 1617: 1598:(3): 265–270. 1582: 1569:10.2307/350477 1563:(4): 721–735. 1543: 1490: 1466: 1448: 1397: 1345: 1320: 1299: 1240: 1191: 1156:(8): 457–465. 1136: 1117:. 2022-06-08. 1105: 1042: 1015:(4): 951–959. 995: 948: 885: 884: 882: 879: 878: 877: 872: 867: 866: 865: 860: 850: 845: 839: 838: 822: 819: 787: 784: 732: 731: 716: 712: 678: 675: 641:mental illness 631:, Exposure to 613:Physical abuse 552: 549: 515: 512: 502: 499: 482: 479: 457:whole family. 446:Social service 442: 439: 411: 408: 356: 353: 317: 314: 304: 301: 288:Additionally, 285: 282: 269: 266: 256: 253: 227: 224: 218: 215: 180: 177: 175: 172: 151: 148: 144: 143: 136: 130: 124: 109: 103: 97: 91: 85: 79: 76:Physical abuse 64: 61: 26: 9: 6: 4: 3: 2: 7107: 7096: 7095:Public health 7093: 7091: 7088: 7086: 7083: 7081: 7078: 7076: 7073: 7071: 7068: 7066: 7063: 7062: 7060: 7051: 7050:Veto Violence 7048: 7045: 7042: 7039: 7036: 7035: 7027: 7024: 7023: 6999: 6992: 6976: 6970: 6959: 6952: 6936: 6929: 6913: 6907: 6896: 6889: 6878: 6874: 6867: 6860: 6852: 6848: 6844: 6840: 6836: 6829: 6827: 6818: 6814: 6810: 6806: 6801: 6796: 6792: 6788: 6784: 6777: 6769: 6765: 6761: 6755: 6747: 6743: 6739: 6735: 6731: 6727: 6723: 6719: 6712: 6704: 6698: 6690: 6684: 6677: 6676: 6668: 6654:on 2016-02-05 6650: 6643: 6642: 6634: 6626: 6622: 6618: 6614: 6610: 6606: 6602: 6598: 6591: 6575: 6571: 6567: 6561: 6559: 6557: 6548: 6544: 6538: 6527: 6521: 6513: 6509: 6503: 6495: 6491: 6485: 6470: 6463: 6456: 6454: 6452: 6443: 6439: 6435: 6429: 6421: 6417: 6410: 6408: 6406: 6397: 6393: 6389: 6385: 6381: 6377: 6373: 6366: 6364: 6355: 6351: 6347: 6343: 6339: 6335: 6331: 6327: 6323: 6316: 6308: 6304: 6300: 6296: 6292: 6288: 6284: 6280: 6273: 6265: 6261: 6256: 6251: 6246: 6241: 6237: 6233: 6229: 6222: 6214: 6210: 6206: 6202: 6195: 6187: 6183: 6178: 6173: 6169: 6165: 6161: 6157: 6153: 6146: 6138: 6134: 6129: 6124: 6120: 6116: 6112: 6108: 6104: 6097: 6089: 6085: 6081: 6077: 6073: 6069: 6065: 6061: 6054: 6046: 6042: 6038: 6034: 6029: 6024: 6020: 6016: 6012: 6008: 6004: 5997: 5989: 5985: 5981: 5977: 5973: 5969: 5962: 5951: 5947: 5943: 5936: 5928: 5924: 5920: 5916: 5911: 5906: 5902: 5898: 5894: 5887: 5879: 5875: 5869: 5867: 5858: 5854: 5849: 5844: 5839: 5834: 5830: 5826: 5822: 5815: 5804: 5800: 5793: 5786: 5778: 5777:ACEs Too High 5774: 5767: 5759: 5755: 5748: 5737: 5736: 5728: 5720: 5716: 5711: 5706: 5702: 5698: 5694: 5690: 5686: 5679: 5671: 5667: 5663: 5659: 5655: 5654:NIHR Evidence 5651: 5645: 5637: 5631: 5623: 5619: 5612: 5604: 5600: 5596: 5589: 5587: 5578: 5577:ACEs Too High 5574: 5567: 5559: 5553: 5545: 5541: 5540:Common Ground 5534: 5527: 5525: 5516: 5512: 5508: 5504: 5500: 5496: 5489: 5481: 5474: 5466: 5462: 5458: 5454: 5450: 5446: 5442: 5438: 5431: 5429: 5420: 5416: 5412: 5408: 5404: 5400: 5393: 5391: 5389: 5380: 5376: 5371: 5366: 5362: 5358: 5354: 5347: 5345: 5343: 5341: 5332: 5328: 5324: 5320: 5315: 5310: 5306: 5302: 5298: 5294: 5290: 5283: 5281: 5279: 5270: 5264: 5248: 5247: 5238: 5230: 5226: 5221: 5216: 5212: 5208: 5204: 5197: 5195: 5193: 5191: 5189: 5172: 5168: 5164: 5158: 5143: 5137: 5129: 5125: 5121: 5117: 5113: 5109: 5101: 5090: 5083: 5075: 5068: 5061: 5053: 5052:ACEs Too High 5049: 5042: 5034: 5033:ACEs Too High 5030: 5023: 5015: 5011: 5004: 5002: 4993: 4989: 4985: 4981: 4977: 4973: 4969: 4965: 4958: 4956: 4947: 4946:ACEs Too High 4944: 4937: 4929: 4923: 4915: 4911: 4904: 4896: 4892: 4887: 4882: 4878: 4874: 4870: 4866: 4862: 4855: 4853: 4844: 4840: 4835: 4830: 4826: 4822: 4818: 4814: 4810: 4803: 4801: 4792: 4788: 4783: 4778: 4774: 4770: 4766: 4762: 4758: 4751: 4743: 4739: 4734: 4729: 4725: 4721: 4717: 4713: 4705: 4697: 4693: 4689: 4683: 4679: 4675: 4671: 4664: 4656: 4652: 4647: 4642: 4638: 4634: 4630: 4623: 4615: 4611: 4607: 4603: 4599: 4595: 4588: 4580: 4576: 4572: 4566: 4562: 4558: 4554: 4547: 4539: 4535: 4531: 4525: 4521: 4517: 4513: 4506: 4498: 4494: 4490: 4484: 4480: 4476: 4472: 4465: 4449: 4444: 4440: 4436: 4429: 4421: 4417: 4412: 4407: 4403: 4399: 4395: 4388: 4386: 4384: 4382: 4380: 4378: 4376: 4367: 4363: 4359: 4355: 4351: 4347: 4343: 4339: 4331: 4323: 4319: 4314: 4309: 4305: 4301: 4297: 4293: 4289: 4282: 4274: 4270: 4266: 4262: 4258: 4254: 4250: 4246: 4239: 4231: 4227: 4223: 4219: 4214: 4209: 4205: 4201: 4197: 4190: 4182: 4178: 4173: 4168: 4164: 4160: 4156: 4152: 4148: 4141: 4133: 4129: 4125: 4121: 4117: 4113: 4109: 4105: 4098: 4090: 4086: 4081: 4076: 4072: 4068: 4064: 4060: 4056: 4049: 4041: 4037: 4034:(4): 89–101. 4033: 4029: 4025: 4018: 4010: 4006: 4001: 3996: 3992: 3988: 3984: 3980: 3976: 3969: 3961: 3957: 3953: 3949: 3945: 3941: 3937: 3933: 3926: 3918: 3914: 3909: 3904: 3900: 3896: 3892: 3888: 3884: 3877: 3869: 3865: 3860: 3855: 3851: 3847: 3843: 3839: 3835: 3828: 3820: 3816: 3812: 3808: 3804: 3800: 3796: 3792: 3785: 3783: 3774: 3770: 3766: 3762: 3757: 3752: 3748: 3744: 3740: 3736: 3732: 3725: 3717: 3713: 3708: 3703: 3699: 3695: 3691: 3687: 3683: 3676: 3668: 3664: 3659: 3654: 3650: 3646: 3642: 3638: 3634: 3627: 3619: 3615: 3610: 3605: 3600: 3595: 3591: 3587: 3583: 3579: 3575: 3568: 3560: 3556: 3552: 3548: 3544: 3540: 3536: 3532: 3525: 3523: 3514: 3510: 3505: 3500: 3496: 3492: 3489:(7): e13204. 3488: 3484: 3480: 3473: 3465: 3461: 3457: 3453: 3449: 3445: 3441: 3437: 3429: 3421: 3417: 3413: 3409: 3405: 3401: 3397: 3393: 3386: 3378: 3374: 3370: 3366: 3361: 3356: 3352: 3348: 3344: 3337: 3335: 3333: 3331: 3322: 3318: 3314: 3310: 3306: 3302: 3298: 3294: 3287: 3280: 3272: 3268: 3263: 3258: 3253: 3248: 3244: 3240: 3236: 3232: 3228: 3221: 3213: 3209: 3204: 3199: 3195: 3191: 3187: 3183: 3179: 3172: 3164: 3160: 3155: 3150: 3146: 3142: 3138: 3134: 3130: 3123: 3115: 3111: 3107: 3103: 3099: 3095: 3091: 3087: 3080: 3072: 3068: 3063: 3058: 3054: 3050: 3046: 3042: 3038: 3031: 3023: 3019: 3014: 3009: 3005: 3001: 2997: 2993: 2989: 2982: 2974: 2970: 2966: 2962: 2958: 2954: 2950: 2946: 2939: 2931: 2927: 2922: 2917: 2912: 2907: 2903: 2899: 2895: 2888: 2880: 2876: 2872: 2868: 2864: 2860: 2856: 2852: 2845: 2837: 2833: 2828: 2823: 2818: 2813: 2809: 2805: 2801: 2794: 2786: 2782: 2777: 2772: 2767: 2762: 2758: 2754: 2750: 2746: 2742: 2735: 2727: 2723: 2719: 2715: 2711: 2707: 2703: 2699: 2692: 2690: 2681: 2677: 2672: 2667: 2662: 2657: 2653: 2649: 2645: 2638: 2630: 2626: 2621: 2616: 2612: 2608: 2604: 2600: 2596: 2589: 2581: 2577: 2572: 2567: 2562: 2557: 2553: 2549: 2545: 2538: 2530: 2526: 2522: 2518: 2514: 2510: 2506: 2502: 2494: 2486: 2482: 2478: 2474: 2470: 2466: 2462: 2458: 2450: 2448: 2439: 2435: 2431: 2427: 2422: 2417: 2413: 2409: 2405: 2398: 2390: 2386: 2379: 2371: 2367: 2363: 2359: 2354: 2349: 2345: 2341: 2337: 2333: 2329: 2322: 2314: 2310: 2305: 2300: 2295: 2290: 2286: 2282: 2278: 2271: 2269: 2267: 2265: 2256: 2252: 2248: 2244: 2240: 2236: 2232: 2228: 2221: 2213: 2209: 2205: 2201: 2197: 2193: 2189: 2185: 2178: 2170: 2166: 2162: 2158: 2154: 2150: 2143: 2135: 2131: 2127: 2123: 2119: 2115: 2108: 2100: 2096: 2091: 2086: 2082: 2078: 2074: 2070: 2066: 2059: 2051: 2047: 2042: 2037: 2033: 2029: 2025: 2021: 2017: 2010: 1995: 1991: 1984: 1976: 1972: 1968: 1964: 1960: 1956: 1952: 1948: 1945:(1): 93–100. 1944: 1940: 1936: 1929: 1927: 1911: 1904: 1897: 1889: 1885: 1881: 1877: 1873: 1869: 1865: 1861: 1854: 1846: 1842: 1837: 1832: 1828: 1824: 1820: 1816: 1812: 1805: 1803: 1788: 1784: 1778: 1770: 1766: 1761: 1756: 1752: 1748: 1744: 1740: 1736: 1729: 1721: 1717: 1713: 1709: 1704: 1699: 1695: 1691: 1687: 1680: 1672: 1668: 1663: 1658: 1653: 1648: 1644: 1640: 1637:(7): e01900. 1636: 1632: 1628: 1621: 1613: 1609: 1605: 1601: 1597: 1593: 1586: 1578: 1574: 1570: 1566: 1562: 1558: 1554: 1547: 1539: 1535: 1531: 1527: 1523: 1519: 1514: 1509: 1506:(2): 79–101. 1505: 1501: 1494: 1487: 1483: 1479: 1476: 1473:Krug et al., 1470: 1459: 1452: 1444: 1440: 1435: 1430: 1425: 1420: 1416: 1412: 1408: 1401: 1393: 1389: 1385: 1381: 1377: 1373: 1369: 1363: 1362:public domain 1352: 1350: 1334: 1330: 1324: 1313: 1306: 1304: 1295: 1291: 1286: 1281: 1277: 1273: 1269: 1265: 1261: 1255: 1254:public domain 1244: 1236: 1232: 1228: 1224: 1219: 1214: 1210: 1206: 1202: 1195: 1187: 1183: 1179: 1175: 1171: 1167: 1163: 1159: 1155: 1151: 1147: 1140: 1132: 1128: 1124: 1120: 1116: 1115:NIHR Evidence 1109: 1101: 1097: 1093: 1089: 1085: 1081: 1077: 1073: 1069: 1065: 1061: 1057: 1053: 1046: 1038: 1034: 1030: 1026: 1022: 1018: 1014: 1010: 1006: 999: 991: 987: 983: 979: 975: 971: 967: 963: 959: 952: 944: 940: 935: 930: 926: 922: 917: 912: 908: 904: 900: 893: 891: 886: 876: 873: 871: 868: 864: 861: 859: 856: 855: 854: 851: 849: 846: 844: 841: 840: 836: 825: 818: 816: 812: 803: 799: 797: 792: 783: 781: 780:United States 777: 773: 769: 765: 761: 756: 754: 750: 746: 742: 738: 737:heart disease 729: 725: 721: 717: 713: 710: 705: 704: 703: 701: 693: 689: 683: 674: 673: 671: 667: 662: 656: 654: 650: 646: 642: 638: 634: 630: 626: 622: 618: 614: 610: 606: 601: 599: 595: 591: 587: 582: 581:losing weight 578: 574: 570: 566: 561: 557: 548: 546: 541: 536: 533: 529: 525: 520: 511: 508: 501:Public health 498: 496: 491: 489: 478: 474: 472: 467: 462: 458: 455: 451: 447: 438: 435: 431: 427: 423: 421: 416: 407: 405: 401: 395: 393: 388: 385: 375: 370: 366: 362: 352: 349: 344: 340: 338: 334: 329: 325: 323: 313: 310: 299: 294: 291: 281: 277: 274: 268:Mental health 265: 263: 252: 250: 246: 242: 238: 234: 223: 214: 212: 208: 207:externalizing 204: 203:internalizing 199: 195: 191: 187: 171: 167: 163: 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