Research Roundup: January 2021

Our monthly column highlights recent studies of Adverse Childhood Experiences (ACEs): causes, consequences, and the interventions that work.

If you have been reading our previous research roundups or have seen the many studies examining the health impacts of ACEs throughout one’s life, you likely already understand that the impact of ACEs extend far beyond childhood. Recently, there has been interest in understanding not only the individual impacts of ACEs, but how they might affect others—for example, the impact of a parent’s ACEs on their children. In this research roundup, we summarize key recent studies examining the intergenerational impacts of ACEs.

There are some methodological challenges to studying the intergenerational impacts of ACEs, which are worth noting as we summarize the literature below. First, it is of ten challenging to distinguish poor health that is genetically inherited from poor health that is the result of parenting or parental ACE exposure. Second, it is also difficult to distinguish whether parental ACEs lead to child ACEs and negative child health outcomes through a “cycle of abuse”, or whether parental ACE exposure results in parental socioeconomic disadvantage or stress in a way that places children in living circumstances that might adversely impact health. Further research is needed to establish the specific pathways through which parental ACEs may lead to negative outcomes for their offspring. Finally, it is important to note that while children born to parents who themselves experienced abuse and neglect are more likely to experience abuse and neglect, most people who have experienced abuse and neglect as children do not go on to abuse their own children.

Parental Adverse Childhood Experiences are linked to offspring health risks from early infancy to adolescence.

Researchers have examined a wide range of health outcomes in children whose parents were exposed to ACEs.

In separate studies, Zeynel and colleagues, McDonell and colleagues, and Doi and colleagues found that poor maternal mental health is linked to poor offspring mental health; however, they examined the importance of ACEs in this relationship in different ways.

Zeynel and colleagues studied the transmission of maladaptive schemas in 179 pairs of mothers and their adolescent children in Turkey. Maladaptive schemas are enduring negative or dysfunctional beliefs, cognitions, and attitudes about oneself or others. The authors found that maternal early maladaptive schemas in the disconnection and rejection domain were associated with maladaptive schemas in the same domain for their adolescent children. They also found that this relationship could be partially explained by offspring experience of ACEs; the authors’ model suggests that children whose mothers have early maladaptive schemas are at greater risk for adverse childhood experiences, which in turn lead to the development of early maladaptive schemas in their adolescent children.

McDonell and colleagues examined the impact of maternal ACEs on maternal perinatal depressive symptoms and offspring socioemotional symptoms in 398 pregnant women in the Midwestern United States. They found that mothers who had experienced a greater number of ACEs were at greater risk for perinatal depression. Maternal childhood maltreatment was also associated with maladaptive infant socioemotional functioning 6 months after birth. The authors’ model suggests that maternal ACEs may result in maladaptive infant socioemotional functioning due to the impact of maternal ACEs on maternal age at first pregnancy and birth weight.

Similar results were reported by Doi and colleagues in a study of 9,390 mother-child pairs in Kochi Prefecture, Japan. Children whose mothers reported more ACEs experienced more depressive symptoms and behavior problems compared to those whose mothers reported fewer ACEs. The authors found that maternal psychological distress and current socioeconomic status mediated the link between maternal ACEs and offspring mental health.

Finally, in a recent study, Lê-Scherban et al. studied a wide range of health outcomes, health behaviors, and healthcare access and use in 350 parent-offspring dyads in Philadelphia (80% mother-child dyads), including overall health, disease diagnoses, nutrition, and health behaviors. They found that parental ACEs were linked to 19% greater odds of poor offspring overall health status (95% confidence interval [1.07-1.32], 17% greater odds of offspring asthma (95% CI [1.05,1.30]), and 16% higher odds of excessive television watching [1.05,1.28]). Other outcomes, such as child obesity, diet, and physical activity, were not associated with parental ACEs.

Future directions

From this body of work, we can conclude that parental disadvantage and parental exposure to adverse childhood experiences are sticky; that is, they predict disadvantage and exposure to ACEs in offspring. However, we cannot establish how the intergenerational effects occur. Challenges in disentangling causes of poor health still apply to most of the studies reviewed. For example, we cannot rule out that children selectively adopt their parents’ attitudes and beliefs, regardless of ACE experience. The role of social and environmental factors shared by parents and children was also generally not accounted for, nor the potential role of genetic factors in the intergenerational transmission of poor health. Most studies also only examined the influence of one parent’s ACEs on children’s experience. It will be important for future research to take both parents’ experiences into account, and to examine pathways of transmission in greater depth. These lines of research will help to identify potential leverage points for intervention for both parents and children, as well as resilience and positive parenting factors that may mitigate the intergenerational transmission of ACEs and their adverse effects.

Works Cited

1Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245-258.
2Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., … & Dunne, M. P. (2017). The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. The Lancet Public Health, 2(8), e356-e366.
3Zeynel, Z., &Uzer, T. (2020). Adverse childhood experiences lead to trans-generational transmission of early maladaptive schemas. Child abuse & neglect, 99, 104235.
4McDonnell, C. G., & Valentino, K. (2016). Intergenerational effects of childhood trauma: evaluating pathways among maternal ACEs, perinatal depressive symptoms, and infant outcomes. Child maltreatment, 21(4), 317-326.
5Doi, S., Fujiwara, T., &Isumi, A. (2020). Association between maternal adverse childhood experiences and mental health problems in offspring: An intergenerational study. Dev. Psychopathol.
6Lê-Scherban, F., Wang, X., Boyle-Steed, K. H., &Pachter, L. M. (2018). Intergenerational associations of parent adverse childhood experiences and child health outcomes. Pediatrics, 141(6).

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Gloria Hu
Gloria Hu

Doctoral Student, Epidemiology, Mailman School of Public Health

Gloria is an incoming doctoral student in epidemiology at the Mailman School of Public Health. Her recent research includes work with the Global Violence Against Children and Youth Surveys (VACS) and qualitative research involving HIV-positive, formerly incarcerated individuals and the reentry process. She has also previously volunteered at youth correctional facilities in upstate New York.

Authors express their own opinions which do not necessarily reflect the opinions of the Stop Abuse Campaign.