• Summary: Current UK Government policy is concerned with the possible connections between childhood adversity, social exclusion and negative outcomes in adulthood. Understanding the impact of adverse childhood experiences on outcomes in adulthood is therefore key to informing effective policy and practice. In this article, the research on the impact of childhood adversity on outcomes in adulthood is reviewed in the broad categories of: mental health and social functioning; physical health; offending; service use; and economic impact. The literature on resilience that focuses on those who experience adversity, but do not have associated negative outcomes is also briefly considered. The strengths and limitations of the range of research methods used are then examined.
• Findings: Previous studies have tended to focus on specific forms of adversity, predominantly abuse and neglect, and either: specific populations and specific outcomes; specific populations and general outcomes; or general populations and specific outcomes. This means there may be incomplete understanding of the inputs (the range of adverse experiences in childhood), the processes (how these may affect people) and the outcomes (across domains in adulthood).
• Applications : It is concluded that it is important for social work researchers to engage in the current debate about how to prevent harmful childhood adversity and there is an important gap in the research for more interdisciplinary large-scale general population studies that consider the full range of childhood adversity and associated impacts across time and the possible processes involved.
Ammerson, R.T. and Hersen, M. ( 1990) Children at Risk: An Evaluation of Factors Contributing to Child Abuse and Neglect. New York: Plenum Press.
2.
Anda, R.F., Brown, D.W., Felitti, V.J., Dube, S.R. and Giles, W.H. ( 2008) ‘Adverse Childhood Experiences and Prescription Drug Use in a Cohort Study of Adult HMO Patients’, BMC Public Health8: 198. (Published online 4 June 2008 doi: 10.1186/1471-2458-8-198.)
3.
Anda, R.F., Felitti, V.J., Brown, D.W., Chapman, D., Dong, M., Dube, S.R., Edwards, V.J. and Giles, W.H. ( 2006) ‘Insights into Intimate Partner Violence from the Adverse Childhood Experiences (ACE) Study’, in P.R. Salber and E. Taliaferro (eds) The Physician’s Guide to Intimate Partner Violence and Abuse, pp. 77-88. Volcano, CA: Volcano Press.
4.
Banyard, V.L. and Williams, L.M. ( 2007) ‘Women’s Voices on Recovery: A Multi-method Study of the Complexity of Recovery from Child Sexual Abuse’, Child Abuse and Neglect31(3): 275-90.
5.
Bartley, M. ( 1994) ‘Unemployment and Ill Health: Understanding the Relationship’, Journal of Epidemiology and Community Health48(4): 333-7.
6.
Benard, B. ( 2006) ‘Using Strengths-based Practice to Tap the Resilience of Families’, in D. Saleebey (ed.) Strengths Perspective in Social Work Practice, pp. 197-220. Boston, MA: Allyn and Bacon.
7.
Blane, D. ( 2006) ‘The Life Course, the Social Gradient, and Health’ , in M. Marmot and R.G. Wilkinson (eds) Social Determinants of Health, 2nd edn, pp. 54-77. Oxford: Oxford University Press.
8.
Bonomi, A.E., Anderson, M.L., Rivara, F.P., Cannon, E.A., Fishman, P.A., Carrell, D., Reid, R.J. and Thompson, R.S. ( 2008b) ‘Health Care Utilization and Costs Associated with Childhood Abuse’, Journal of General Internal Medicine23(3): 294-9.
9.
Bonomi, A.E., Cannon, E.A., Anderson, M.L., Rivara, F.P. and Thompson, R.S. ( 2008a) ‘Association between Self-reported Health and Physical and/or Sexual Abuse Experienced before Age 18’, Child Abuse and Neglect32(7): 693-701.
10.
Bowlus, A., McKenna, K., Day, T. and Wright, D. ( 2003) The Economic Costs and Consequences of Child Abuse in Canada. Ottawa: Law Commission of Canada.
11.
Brezina, T. ( 1998) ‘Adolescent Maltreatment and Delinquency: The Question of Intervening Processes’, Journal of Research in Crime and Delinquency35(1): 71-99.
12.
Briere, J. ( 1992) ‘Methodological Issues in the Study of Sexual Abuse Effects’, Journal of Consulting and Clinical Psychology60(2): 196-203.
13.
Browne, A. and Finkelhor, D. ( 1986) ‘Impact of Child Sexual Abuse: A Review of the Research’ , Psychological Bulletin99(1): 66-77.
14.
Brunner, E. and Marmot, M. ( 2006) ‘Social Organization, Stress, and Health’ , in M. Marmot and R.G. Wilkinson (eds) Social Determinants of Health, 2nd edn, pp. 6-30. Oxford: Oxford University Press.
15.
Bryman, A. ( 2004) Social Research Methods, 2nd edn. Oxford: Oxford University Press.
16.
Buckingham, A. and Saunders, P. ( 2004) The Survey Methods Workbook. Cambridge : Polity Press.
17.
Busch, N.B., Bell, H., DiNitto, D. and Neff, J.A. ( 2003) A Health Survey of Texans: A Focus on Sexual Assault - Final Report. Austin: Institute on Domestic Violence and Sexual Assault, The University of Texas at Austin .
18.
Bywater, P., McLeod, E. and Napier, L. ( 2009) Social Work and Global Health Inequalities - Practice and Policy Developments. Bristol: Policy Press.
19.
Cicchetti, D. and Valentino, K. ( 2006) ‘Toward the Application of a Multiple-levels-of-analysis Perspective to Research in Development and Psychopathology’, in A. Masten (ed.) Minnesota Symposia on Child Psychology, Vol. 34, pp. 243-83. Mahwah, NJ: Erlbaum.
20.
Collishaw, S., Pickles, A., Messer, J., Rutter, M., Shearer, C. and Maughan, B. ( 2007) ‘Resilience to Adult Psychopathology Following Childhood Maltreatment: Evidence from a Community Sample’, Childhood Abuse and Neglect31(3): 211-29.
21.
Commission to Inquire into Child Abuse (2009 ) Report of the Commission to Inquire into Child Abuse (the Ryan Report). Dublin: Irish Government .
22.
Corso, P.S. and Lutzker, J.R. ( 2006) ‘The Need for Economic Analysis in Research on Child Maltreatment’, Child Abuse and Neglect30(7): 727-38.
23.
Currie, J. and Tekin, E. ( 2006) Does Child Abuse Cause Crime?Cambridge, MA: National Bureau of Economic Research.
24.
Department of Health, Social Services and Public Safety ( 2009) Families Matter: Supporting Families in Northern Ireland . Belfast: DHSSPS.
25.
De Vaus, D.A. ( 2002) Surveys in Social Research, 5th edn. London: Routledge.
26.
Dex, S. and Joshi, H. (eds) (2004) Millennium Cohort Study First Survey: A User’s Guide to Initial Findings. London : Centre for Longitudinal Studies.
27.
Dube, S.R., Felitti, V.J., Dong, M., Giles, W.H. and Anda, R.F. ( 2003) ‘The Impact of Adverse Childhood Experiences on Health Problems: Evidence from Four Birth Cohorts Dating Back to 1900’ , Preventive Medicine37: 268-77.
28.
DuMont, K.A., Widom, C.S. and Czaja, S.J. ( 2007) ‘Predictors of Resilience in Abused and Neglected Children Grown-up: The Role of Individual and Neighborhood Characteristics’ , Childhood Abuse and Neglect31(3): 255-74.
29.
Ellsberg, M., Heise, L., Pena, R., Agurto, S. and Winkvist, A. ( 2001) ‘Researching Domestic Violence against Women: Methodological and Ethical Considerations’, Studies in Family Planning32(1): 1-17.
30.
Elmer, E. and Gregg, G.S. ( 1967) ‘Developmental Characteristics of Abused Children’ , Pediatrics40(4): 596-602.
31.
Farrington, D.P. ( 2007) ‘Childhood Risk Factors and Risk-Focused Prevention’ , in M. Maguire, R. Morgan and R. Reiner (eds) The Oxford Handbook of Criminology, pp. 602-40. Oxford: Oxford University Press.
32.
Faugier, J. and Sargeant, M. ( 1997) ‘Sampling Hard-to-reach Populations’, Journal of Advanced Nursing26(4): 790-7.
33.
Feinstein, L. and Sabates, R. ( 2006) Predicting Adult Life Outcomes from Earlier Signals: Identifying Those at Risk. London: Institute of Education, University of London.
34.
Felitti, V.J. and Anda, R.F. (in press) ‘The Relationship of Adverse Childhood Experiences to Adult Health, Well-being, Social Function, and Healthcare’, in R. Lanius and E. Vermetten (eds) The Hidden Epidemic: The Impact of Early Life Trauma on Health and Disease. Cambridge: Cambridge University Press.
35.
Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P. and Marks, J.S. ( 1998) ‘Relationship of Adult Health Status to Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults’, American Journal of Preventive Medicine14(4): 245-58.
36.
Fergusson, D.M., Boden, J.M. and Horwood, L.J. ( 2008) ‘Exposure to Childhood Sexual and Physical Abuse and Adjustment in Early Adulthood’, Child Abuse and Neglect32(6): 607-19.
37.
Fleming, J.M. ( 1997) ‘Prevalence of Childhood Sexual Abuse in a Community Sample ofAustralian Women’, Medical Journal of Australia166: 65-8.
38.
Frederick, J. and Goddard, C. ( 2007) ‘Exploring the Relationship between Poverty, Childhood Adversity and Child Abuse from the Perspective of Adulthood’, Child Abuse Review16(5): 323-41.
39.
Gilligan, P. ( 2009) ‘Considering Religion and Beliefs in Child Protection and Safeguarding Work: Is Any Consensus Emerging?’, Child Abuse Review18(2): 94-110.
40.
Gilligan, P. with Akhtar, S. ( 2006) ‘Cultural Barriers to the Disclosure of Child Sexual Abuse in Asian Communities: Listening to What Women Say’, British Journal of Social Work36(8): 1361-77.
41.
Goodman, L., Thompson, K., Weinfurt, K., Corl, S., Acker, P., Mueser, K. and Rosenberg, S.D. ( 1999) ‘Reliability of Reports of Violent Victimization and Posttraumatic Stress Disorder among Men and Women with Serious Mental Illness’, Journal of Traumatic Stress12(4): 587-99.
Gorey, K.M. and Leslie, D.R. ( 1997) ‘The Prevalence of Child Sexual Abuse: Integrative Review Adjustment for Potential Response and Measurement Biases’, Child Abuse & Neglect21(4): 391-8.
44.
Greene, J. and Caracelli, V. ( 1997) Advances in Mixed Method Evaluation: The Challenges and Benefits of Integrating Diverse ParadigmsNew Directions for Evaluation, No.74. San Francisco, CA: Jossey-Bass.
45.
Griggs, J., Whitworth, A., Walker, R., McLennan, D. and Noble, M. ( 2008) Person or Place-based Policies to Tackle Disadvantage? Not Knowing what Works. York: Joseph Rowntree Foundation.
46.
Harkonmaki, K., Korkelia, K., Vahtera, J., Kivimaki, M., Suominen, S., Sillanmaki, L. and Koskenvuo, M. ( 2007) ‘Childhood Adversities as a Predictor of Disability Retirement’, Journal of Epidemiology and Community Health61(6): 479-84.
47.
Heckman, J. ( 2006) ‘Investing in Disadvantaged Young Children is an Economically Efficient Policy’, paper presented at the Committee for Economic Development Forum ‘Building the Economic Case for Investments in Preschool’, New York, 10 January.
48.
Heller, S.S., Larrieu, J.A., D’Imperio, R. and Boris, N.W. ( 1999) ‘Research on Resilience to Child Maltreatment: Empirical Considerations’, Child Abuse and Neglect23(4): 321-38.
49.
Herman, J. and Schatzow, E. ( 1987) ‘Recovery and Verification of Childhood Sexual Trauma’ , Psychoanalytic Psychology4(1): 1-14.
50.
HM Government (2004) Every Child Matters. London: Department for Education and Skills.
51.
Horwitz, A.V., Spatz Widom, C., McLaughlin, J. and Raskin White, H. ( 2001) ‘The Impact of Childhood Abuse and Neglect on Adult Mental Health: A Prospective Study’, Journal of Health and Social Behavior42(2): 184-201.
52.
James, A. and James, A.L. ( 2004) Constructing Childhood: Theory, Policy and Social Practice . Basingstoke: Palgrave Macmillan .
53.
Johnson, R.J., Ross, M.W., Taylor, W.C., Williams, M.L., Carvajal, R.I. and Peters, R.J. ( 2006) ‘Prevalence of Childhood Sexual Abuse among Incarcerated Males in County Jail’, Child Abuse and Neglect30(1): 75-86.
54.
Kessler, R.C., Davis, C.G. and Kendler, K.S. ( 1997) ‘Childhood Adversity and Adult Psychiatric Disorder in the US National Comorbidity Survey’, Psychological Medicine27(5): 1101-19.
55.
Kiser, L.J., Nurse, W., Lucksted, A. and Collins, S. ( 2008) ‘Understanding the Impact of Trauma on Family Life From the Viewpoint of Female Caregivers Living in Urban Poverty’, Traumatology14(3): 77-90.
56.
Kish, L. ( 1995) Survey Sampling. New York: Wiley.
57.
Lee, R. ( 1993) Doing Research on Sensitive Topics. London: SAGE.
58.
Lee, R. and Renzetti, C. ( 1990) ‘The Problems of Researching Sensitive Topics’ , American Behavioural Scientist33(5): 510-28.
59.
Lister, R. ( 2003) ‘Investing in the Citizen-workers of the Future: Transformations in Citizenship and the State under New Labour’, Social Policy & Administration37(5): 427-43.
60.
MacKellar, D., Valleroy, L., Karon, J. et al. (1996) ‘The Young Men’s Survey: Methods for Estimating HIV Sero-prevalence and Risk Factors among Young Men Who Have Sex with Men’, Public Health Reports111 (Suppl. 1): 138-44.
61.
Marmot, M. and Wilkinson, R.G. ( 2006) Social Determinants of Health, 2nd edn. Oxford: Oxford University Press.
62.
Mason, P., Morris, K. and Smith, P. ( 2005) ‘A Complex Solution to a Complicated Problem? Early Messages from the National Evaluation of the Children’s Fund Prevention Programme’, Children & Society19(2): 131-43.
63.
McCord, J. ( 1983) ‘A 40-year Perspective on Effects of Child Abuse and Neglect’, Child Abuse and Neglect7(3): 265-70.
64.
Melchior, M., Moffitt, T.E., Milne, B.J., Poulton, R. and Caspi, A. ( 2007) ‘Why Do Children from Socioeconomically Disadvantaged Families Suffer from Poor Health When They Reach Adulthood? A Life-Course Study’, American Journal of Epidemiology166(8): 966-74.
65.
Merkel-Hoguin, L., Kaplan, C. and Kwak, A. ( 2006) National Study on Differential Response in Child Welfare . Denver, CO: American Humane Society .
66.
Min, M., Farkas, K., Minnes, S. and Singer, L.T. ( 2007) ‘Impact of Childhood Abuse and Neglect on Substance Abuse and Psychological Distress in Adulthood’, Journal of Traumatic Stress20(5): 833-44.
67.
Mullan, P.E., Martin, J.L., Anderson, J.C., Romans, S.E. and Herbison, G.P. ( 1996) ‘The Long-term Impact of the Physical, Emotional and Sexual Abuse of Children: A Community Study’, Child Abuse and Neglect20(1): 7-21.
68.
Nicholson, J.M. and Rempel, L.A. ( 2004) ‘Australian and New Zealand Birth Cohort Studies: Breadth, Quality and Contributions’, Journal of Paediatrics & Child Health40(3): 87-95.
69.
Osgood, D.W., Foster, E.M., Flanagan, C. and Ruth, G.R. ( 2005) ‘Why Focus on the Transition to Adulthood for Vulnerable Populations?’, in D.W. Osgood, E.M. Foster, C. Flanagan and G.R. Ruth (eds) On Your Own Without a Safety Net: The Transition to Adulthood for Vulnerable Populations, pp. 1-16. Chicago, IL: The Chicago University Press.
70.
Östlin, P., Schrecker, T., Sadana, R., Bonnefoy, J., Gilson, L., Hertzman, C., Kelly, M.P., Kjellström, Labonté, R., Lundberg, O., Muntaner, C., Popay, J., Sen, G. and Vaghri, Z. (2009) Priorities for Research on Equity and Health: Implications for Global and National Priority Setting and the Role of WHO to Take the Health Equity Research Agenda Forward. Geneva: World Health Organization.
71.
Perrott, K., Morris, E., Martin, J. and Romans, S. ( 1998) ‘Cognitive Coping Styles of Women Sexually Abused in Childhood: A Qualitative Study’, Child Abuse and Neglect22(11): 1135-49.
72.
Perry, B.D. ( 2002) ‘Childhood Experience and the Expression of Genetic Potential: What Childhood Neglect Tells Us About Nature and Nurture’ , Brain and Mind3(1): 79-100.
73.
Read, J., Agar, K., Argyle, N. and Aderhold, V. ( 2003) ‘Sexual and Physical Abuse during Childhood and Adulthood as Predictors of Hallucinations, Delusions and Thought Disorder’ , Psychology and Psychotherapy: Theory, Research and Practice76(1): 1-22.
74.
Read, J., van Os, J., Morrison, A.P. and Ross, C.A. ( 2005) ‘Childhood Trauma, Psychosis and Schizophrenia: A Literature Review with Theoretical and Clinical Implications’, Acta Psychiatrica Scandinavia112(5): 330-50.
75.
Rutter, M. ( 2007) ‘Resilience, Competence and Coping’, Child Abuse and Neglect31(3): 205-9.
76.
Scott, D.A. ( 2009) ‘The Landscape of Child Maltreatment’, The Lancet373(9658): 101-02.
77.
Scottish Executive (2007) Getting It Right for Every Child. Edinburgh: Scottish Executive.
78.
Semaan, S., Lauby, J. and Liebman J. ( 2002) ‘Street and Network Sampling in Evaluation Studies of HIV Risk-reduction Interventions’, AIDS Review4(4): 213-23.
79.
Shulruf, B., Morton, S., Goodyear-Smith, F., O’Loughlin, C. and Dixon, R. ( 2007) ‘Designing Multidisciplinary Longitudinal Studies of Human Development: Analyzing Past Research to Inform Methodology’ , Evaluation and the Health Professions30: 207.
80.
Silva, P.A. and Stanton, W.R. (eds) (1996) From Child to Adult: The Dunedin Multidisciplinary Health and Development Study. Oxford: Oxford University Press.
81.
Socolar, R.R.S., Runyan, D.K. and Amaya-Jackson, L. ( 1995) ‘Methodological and Ethical Issues Related to Studying Child Maltreatment’, Journal of Family Issues16(5): 565-86.
82.
Spratt, T. ( 2009) ‘Identifying Families with Multiple Problems: Possible Responses from Child and Family Social Work to Current Policy Developments’ , British Journal of Social Work39(3): 435-50.
83.
Stewart, A., Livingston, M. and Dennison, S. ( 2008) ‘Transitions and Turning Points: Examining the Links between Child Maltreatment and Juvenile Offending’, Child Abuse and Neglect32(1): 51-66.
84.
Tang, B., Jamieson, E., Boyle, M., Libby, A., Gafni, A. and MacMillan, H. ( 2006) ‘The Influence of Child Abuse on the Pattern of Expenditures in Women’s Adult Mental Health Service Utilization in Ontario, Canada’, Social Science & Medicine63(7): 1711-9.
85.
Ungar, M. ( 2008) ‘Resilience across Cultures’, British Journal of Social Work38: 218-35.
86.
Walker, E.A., Unutzer, J., Rutter, C., Gelfand, A., Saunders, K., VonKorff, M., Koss, M.P. and Katon, W. ( 1999) ‘Costs of Health Care Use by Women HMO Members With a History of Childhood Abuse and Neglect’, Archives of General Psychiatry56(7): 609-13.
87.
Wang, C. and Holton, J.K. ( 2007) ‘Total Estimated Cost of Child Abuse and Neglect in the United States. Prevent Child Abuse America’, available at: [www.preventchildabuse.org], accessed 5 November 2008.
88.
Watters, J.K. and Biernacki, P. ( 1989) ‘Targeted Sampling: Options for the Study of Hidden Populations’, Social Probability36(4): 416-30.
89.
Whiffen, V.E., Thompson, J.M. and Aube, J.A. ( 2000) ‘Mediators of the Link between Childhood Sexual Abuse and Adult Depressive Symptoms’, Journal of Interpersonal Violence15(10): 1100-20.
90.
Widom, C.S. ( 1989) ‘The Cycle of Violence’, Science244(4901): 160-6.
91.
Wilkinson, R.G. ( 2006) ‘Ourselves and Others - for Better or Worse: Social Vulnerability and Inequality’, in M. Marmot and R.G. Wilkinson (eds) Social Determinants of Health, 2nd edn, pp. 339-58. Oxford: Oxford University Press.
92.
Wilkinson, R.G. and Pickett, K. ( 2009) The Spirit Level: Why More Equal Societies Almost Always Do Better. London: Allen Lane.
93.
World Health Organization (2008) Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Geneva: World Health Organization.
