Intergenerational transmission and prevention of adverse childhood experiences (ACEs)

Childhood multiple risk factor exposure exceeds the adverse developmental impacts of singular exposures. Multiple risk factor exposure may also explain why sociodemographic variables (e.g., poverty) can have adverse consequences. Most research on multiple risk factor exposure has relied upon cumulative risk (CR) as the measure of multiple risk. CR is constructed by dichotomizing each risk factor exposure (0 = no risk; 1 = risk) and then summing the dichotomous scores. Despite its widespread use in developmental psychology and elsewhere, CR has several shortcomings: Risk is designated arbitrarily; data on risk intensity are lost; and the index is additive, precluding the possibility of statistical interactions between risk factors. On the other hand, theoretically more compelling multiple risk metrics prove untenable because of low statistical power, extreme higher order interaction terms, low robustness, and collinearity among risk factors. CR multiple risk metrics are parsimonious, are statistically sensitive even with small samples, and make no assumptions about the relative strengths of multiple risk factors or their collinearity. CR also fits well with underlying theoretical models (e.g., Bronfenbrenner's, 1979, bioecological model; McEwen's, 1998, allostasis model of chronic stress; and Ellis, Figueredo, Brumbach, & Schlomer's, 2009, developmental evolutionary theory) concerning why multiple risk factor exposure is more harmful than singular risk exposure. We review the child CR literature, comparing CR to alternative multiple risk measurement models. We also discuss strengths and weaknesses of developmental CR research, offering analytic and theoretical suggestions to strengthen this growing area of scholarship. Finally, we highlight intervention and policy implications of CR and child development research and theory. © 2013 American Psychological Association

Advances in a wide range of biological, behavioral, and social sciences are expanding our understanding of how early environmental influences (the ecology) and genetic predispositions (the biologic program) affect learning capacities, adaptive behaviors, lifelong physical and mental health, and adult productivity. A supporting technical report from the American Academy of Pediatrics (AAP) presents an integrated ecobiodevelopmental framework to assist in translating these dramatic advances in developmental science into improved health across the life span. Pediatricians are now armed with new information about the adverse effects of toxic stress on brain development, as well as a deeper understanding of the early life origins of many adult diseases. As trusted authorities in child health and development, pediatric providers must now complement the early identification of developmental concerns with a greater focus on those interventions and community investments that reduce external threats to healthy brain growth. To this end, AAP endorses a developing leadership role for the entire pediatric community-one that mobilizes the scientific expertise of both basic and clinical researchers, the family-centered care of the pediatric medical home, and the public influence of AAP and its state chapters-to catalyze fundamental change in early childhood policy and services. AAP is committed to leveraging science to inform the development of innovative strategies to reduce the precipitants of toxic stress in young children and to mitigate their negative effects on the course of development and health across the life span.