About this paper symposium

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Panel information
Panel 9. Family Context & Processes

Paper #1
Adverse Childhood Experiences: A Meta-Analysis of Prevalence in Child Population Samples
Author information	Role
Raela Thiemann, Department of Psychology, University of Calgary, Canada	Presenting author
Audrey-Ann Deneault, PhD, Department of Psychology, University of Montreal, Canada	Non-presenting author
R.M. Pasco Fearon, PhD, Centre for Family Research, University of Cambridge, United Kingdom	Non-presenting author
Nicole Racine, PhD, School of Psychology, Faculty of Social Sciences, University of Ottawa, Canada	Non-presenting author
Julianna Park, Queen's University, Canada	Non-presenting author
Carole A. Lunney, MA, Department of Psychology, University of Calgary, Canada	Non-presenting author
Gina Dimitropoulos, PhD, Faculty of Social Work, University of Calgary, Canada	Non-presenting author
Serena Jenkins, PhD, Alberta Children’s Hospital Research Institute, Canada	Non-presenting author
Tyler Williamson, PhD, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Canada	Non-presenting author
Ross D. Neville, PhD, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland	Non-presenting author
Sheri Madigan, PhD, Department of Psychology, University of Calgary, Canada	Non-presenting author
Abstract
Introduction. Adverse childhood experiences (ACEs), which include abuse, neglect, and family dysfunction, are strongly associated with adverse physical and mental health outcomes, including depression, substance use, chronic diseases, and obesity. Children experiencing ACEs may also encounter cognitive, social, and emotional challenges. These challenges over result in the adoption of risky health behaviors, thereby exacerbating personal health issues and increasing the risk of premature death. In the current literature, there is a conspicuous absence of robust estimates of the distribution of ACEs in samples of children 18 years or younger. Objectives. The 1st objective was to conduct a systematic review and meta-analysis to estimate the distribution of ACEs (i.e., 0, 1, 2, 3, 4+ ACEs) from published samples of children ≤18 years old at the time of ACEs assessment. Given the considerable variation in ACE prevalence across the rapidly expanding literature, the 2nd objective was to conduct moderation analyses to determine if the distribution of ACEs varies among samples with differing individual and household characteristics. Methods. Studies published between January 1, 1998 and February 19, 2024 were sourced from MEDLINE, PsycINFO, CINHAL, and Embase. This study was pre-registered on PROSPERO (CRD42022348429). Inclusion criteria required studies to report the prevalence of ACEs using an 8- or 10-item ACEs questionnaire (±2 items), include population samples of children <18yrs, and be published in English. This study was pre-registered in PROSPERO. Data from 65 studies, representing 490,423 children from 18 countries, were extracted and synthesized using a multicategory prevalence meta-analysis. Results. The mean age of children across studies was 11.9 years (SD, 4.3 years; range 0-18yrs; across samples, 50.5% were female). The estimated mean prevalences were 42.3% for 0 ACEs (95%CI, 25.3-52.7%), 22.0% for 1 ACE (9.9-32.7%), 12.7% for 2 ACEs (3.8-22.3%), 8.1% for 3 ACEs (1.4-16.8%), and 14.8% for 4+ ACEs (5.1-24.8%). As detailed in Table 1 and 2, the prevalence of 4+ ACEs was higher among adolescents versus children (15.5% vs 11.3%; prevalence ratio, 1.16; 95%CI, 1.04-1.30), children in residential care (32.0%; prevalence ratio, 1.26; 1.10-1.43), with a history of juvenile offending (39.0%; prevalence ratio, 1.29; 1.24-1.34), and in Indigenous peoples (76.3%; prevalence ratio, 1.63; 1.28-2.08), as well as in studies where file review vs questionnaire was the primary assessment method (40.4% vs 8.1%; prevalence ratio, 1.29; 1.23-1.34). Conclusions. ACEs are prevalent among children, with notable disparities across subject demographic characteristics and contexts. As principal antecedent threats to child and adolescent well-being that can affect later life prospects, ACEs represent a pressing global social issue. Effective early identification and prevention strategies, including targeted co-designed community interventions, can reduce the prevalence of ACEs and mitigate their severe effects, thereby minimizing the harmful health consequences of childhood adversity in future generations.

Paper #2
The Legacy of Adversity: A Meta-Analysis of Caregiver and Child Adverse Childhood Experiences
Author information	Role
Jenney Zhu, University of Calgary, Canada	Presenting author
Audrey-Ann Deneault, PhD, Université de Montréal, Canada	Non-presenting author
Jessica Turgeon, PhD, Université du Québec en Outaouais, Canada	Non-presenting author
Sheri Madigan, PhD, Department of Psychology, University of Calgary, Canada	Non-presenting author
Abstract
Introduction. Adverse childhood experiences (ACEs) include abuse, neglect, and household dysfunction experienced prior to age 18. ACEs are common, with a recent meta-analysis of 206 studies showing that 60% of individuals in general population adult samples reported at least one ACE and 16% reported 4 or more ACEs. This is of particular concern, given there is robust support for the association between ACEs and negative mental, physical, and relational health outcomes across the life course. More recently, research has begun to examine whether caregiver ACEs have implications for subsequent generations; however, the extent to which caregiver ACEs is associated with their child’s ACEs score is unclear. Some studies have found very strong associations between caregiver and child ACEs scores, while others have reported a small or no significant association. Given these mixed findings, and that this body of literature is growing, it is both critical and timely to synthesize this work to determine the overall magnitude of associations. Thus, the purpose of this study was to meta-analytically examine the association between caregiver and child ACEs score. It was hypothesized that caregiver ACEs would demonstrate a significant positive association with child ACEs. Potential moderators, including caregiver and child race and/or ethnicity, age, sex, and the informant of ACEs (i.e., caregiver-report, self-report, records), were also explored. Due to the exploratory nature of the moderator analyses, specific hypotheses were not made. Methods. Systematic searches were conducted using MEDLINE, Embase, PsycINFO, and CINHAL from 1998 to February 19, 2024. Inclusion criteria were that the ACEs questionnaire was completed for both caregiver and child, an effect size was available, and the study was published in English. Variables extracted included sample size and magnitude of the association between caregiver ACEs and child ACEs, mean caregiver and child age, sex (% female), race and/or ethnicity, and informant of ACEs. This study was pre-registered in PROSPERO. Seventeen samples (4,872 caregiver-child dyads) met inclusion criterion. Results: Results revealed a large pooled effect size between caregiver and child ACEs, r = .33, (95% CI: .25, .41), p < .001; see Figure 1). As detailed in Table 1, the association was stronger among studies with younger caregivers, b = -.02, (CI: -.04, -.001), p = .045 and caregiver-report compared to child self-report of ACEs, b = -0.22, (CI: -0.37, -0.08), p = .002. Conclusions. This study demonstrated that caregiver ACEs scores were significantly associated with increased ACEs scores among their children. In order to break this cycle, it is critical to intervene at multiple levels. Efforts must be deployed to limit exposure to ACEs in the first generation, thereby benefitting the second. The findings suggest that prevention and intervention efforts targeted towards caregivers should be trauma-informed and focus on bolstering factors that may mitigate the intergenerational transmission of ACEs in subsequent generations.

Paper #3
The role of IPV in the association between ACEs and internalizing psychopathology: A mediation meta-analysis
Author information	Role
Mrs. Julia Martini, University of Toronto, Canada	Presenting author
Audrey-Ann Deneault, PhD, Department of Psychology, Université de Montréal, Canada	Non-presenting author
Sheri Madigan, Department of Psychology, University of Calgary, Canada	Non-presenting author
Pasco Fearon, University of Cambridge, United Kingdom	Non-presenting author
Jennifer Jenkins, Department of Applied Psychology and Human Development, University of Toronto, Canada	Non-presenting author
Abstract
Introduction: Approximately half of all adults have experienced adversity in childhood—defined as exposure to abuse, neglect, or household chaos (e.g., parental psychopathology) before the age of 18. It is estimated that a third of all mental health problems in adulthood can be attributed to adverse childhood experiences (ACEs). Recent meta-analyses have found links between ACEs and internalizing psychopathology (e.g., bipolar disorder, anxiety, depression). However, little is known about the underlying mechanisms that explain why ACEs have such pervasive implications for internalizing problems in adulthood. Exposure to intimate partner violence (IPV)—physical, sexual, and/or emotional abuse inflicted by a romantic partner—has been hypothesized to be a potential transdiagnostic risk factor that may, in part, explain why ACEs are associated with internalizing psychopathology in adulthood. IPV is a pressing public health issue that disproportionately impacts women. Meta-analytic evidence reveals that exposure to ACEs is associated with an increased risk of IPV perpetration and victimization. Consequently, IPV is thought to, in turn, contribute to internalizing psychopathology. However, aggregating all findings is necessary to reliably establish whether IPV mediates the association between ACES and internalizing psychopathology in women. Therefore, the primary aim of this study was to examine the associations between ACEs, IPV, and internalizing psychopathology using meta-analytic structural equational modelling (MASEM). This novel and powerful statistical technique integrates meta-analytic and structural equational modelling approaches, allowing researchers to amalgamate the strength of an indirect effect across all available studies and assess potential moderators. Hypotheses & Methods: We hypothesized that IPV would partially mediate the association between ACEs and internalizing psychopathology in women. We also hypothesized that the strength of the indirect effect would be moderated by various sociodemographic (e.g., SES, single status, minority status) and study-level variables (e.g., psychopathology informant, psychopathology assessment method, IPV type). A systematic search method, consistent with PRISMA guidelines, was used to carry out the meta-analysis. Articles were screened and effect sizes (k = 24; N = 30,497) were extracted by expert coders. The metaSEM package (version 1.4.0) in R was used to conduct the MASEM. Results: All pathways were positively associated in the MASEM model. IPV significantly mediated the association between ACEs and internalizing psychopathology, accounting for 16% of the variance in the total effect. The strength of the indirect effect was stronger for self-reports compared to clinician reports and multiple informants and for questionnaires (versus diagnostic interviews and multiple assessment methods). Implications: Understanding the underlying processes that explain the relationship between ACEs and internalizing psychopathology is critical to inform targets for prevention and intervention. The robust findings highlight a need for clinicians, policymakers, and researchers to prioritize IPV as an important risk factor for internalizing problems in females exposed to ACEs.

Paper #4
Developing a Knowledge Hub for Synthesis and Dissemination of Research on Adverse Childhood Experiences (ACEs)
Author information	Role
Carole A. Lunney, University of Calgary, Canada	Presenting author
Sheri Madigan, PhD, Department of Psychology, University of Calgary, Canada	Non-presenting author
Pasco Fearon, PhD, University of Cambridge, United Kingdom	Non-presenting author
Serena Jenkins, PhD, Alberta Children’s Hospital Research Institute, Canada	Non-presenting author
Anh Ly, MA, Department of Psychology, University of Calgary, Canada	Non-presenting author
Gina Dimitropolous, PhD, Faculty of Social Work, University of Calgary, Canada	Non-presenting author
Tyler Williamson, PhD, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Canada	Non-presenting author
Abstract
Exposure to Adverse Childhood Experiences (ACEs), including abuse and family dysfunction is a major contributor to the global burden of disease and disability. Approximately 60% of individuals experience at least one ACE, and 16% experience four or more ACEs. Thousands of studies conducted globally show that the greater the number of ACEs experienced prior age 18, the higher the likelihood of illness and disease across the lifespan. In addition to the individual toll of ACEs, there are substantial health and financial costs – estimated to be 6% of a country’s annual gross domestic product. Accordingly, calls have been issued to increase knowledge and applied understanding of ACEs. A barrier to this endeavor, however, is that with a large and increasing number of studies4, collating and synthesizing knowledge to build an understanding of ACEs is challenging. To address this, our team developed the ACEs Catalogue, a comprehensive inventory and data repository of all empirical studies utilizing the ACEs questionnaire. The goals of this presentation are to (1) describe the creation of data catalogues in developmental science to streamline systematic reviews, and (2) demonstrate the use of open science methods to share these catalogues via the creation of an online data platform on ACEs. A librarian executed the search strategy across MEDLINE, Embase, CINAHL, and PsycINFO. The search spanned from January 1, 1998, when the original ACEs study was published, to February 19, 2024. Text fields were searched using terms such as “adverse childhood experience” and “ACEs.” The search strategy is updated every 12-18 months to keep the catalogue current. Studies are included if they report an 8- or 10-item ACEs measure (± 2 items), assess domains of maltreatment and household dysfunction, and report prevalence or effect size statistics. Two trained coders independently enter all included studies into the catalogue. To date, over 20,000 studies have been screened, over 8000 full-text articles reviewed, and over 4,000 articles have met inclusion criteria. For each included study, codes are generated to capture information on prevalence, demographics, and outcomes related to ACEs. We will provide an overview of the data catalogue creation process, which can be replicated by others on topics related to child development, and also showcase the results of a number of systematic reviews conducted to date using data from the ACEs Data Catalogue. We will also introduce ACEs Hub (https://www.aceshub.org/catalogue/), an open-science platform that makes data from the ACEs Catalogue publicly available. ACEs Hub was developed by an advisory committee of diverse stakeholders, including people with lived experiences of ACEs, policymakers, practitioners, and trainees. ACEs Hub features a user-friendly interface allowing users to filter and select studies from the catalogue. We will demonstrate how the catalogue can be used for literature reviews and systematic reviews to inform research, evidence-based clinical practice, and policy decisions. Ultimately, by making data on ACEs widely accessible, ACEs Hub hopes to facilitate the development of policy and practice initiatives that reduce the risk of future generations experiencing ACEs and their toxic effects.

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