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Research Article

Association of adverse childhood experiences with functional identity and impulsivity among adults: a cross-sectional study

[version 1; peer review: 1 approved, 1 not approved]
PUBLISHED 08 Nov 2017
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This article is included in the Developmental Psychology and Cognition gateway.

Abstract

Introduction: The present study explores the association of adverse childhood experiences with impulsivity and functional identity among Pakistani adults.
Methods: In this cross-sectional study, 260 Pakistani medical students aged 18 and above were approached. A consent form, a questionnaire on sociodemographic characteristics, and an English versions of the Adverse Childhood Experiences (ACE) scale, Functions of Identity scale (FIS) and Barratt’s Impulsiveness Scale (BIS-11) was employed in this study. All data were analyzed in SPSS v. 20.
Results: A total of 122 (52.6%) of respondents had experienced at least one adverse childhood experience. According to linear regression analysis, ACE scores were significantly associated with increasing age, increasing order in birth, lower scores on functional identity structure and non-planning impulsivity, and higher scores on future (functional identity) and motor impulsivity.
Conclusions: A high proportion of Pakistani medical students reported adverse childhood experiences, which lead to impulsive behaviors and poor functional identities.

Keywords

adverse childhood, impulsivity, identity, Pakistan, abuse

Introduction

The Centers for Disease Control and Prevention (CDC) report a high prevalence of physical (28%) and sexual abuse (21%) associated with an unstable living environment among the American youth1. Previous studies demonstrate a significant relationship between experience of abuse and physical, behavioral and social problems among the youth1. Although there is abundant data exploring the prevalence of adverse childhood experiences in higher income countries, in low and middle income countries (LAMI) data is more scarce2 Moreover, a paucity of data has been identified in the LAMI, necessitating the need to transculturally translate the impact of adverse childhood events (ACEs) on social, cognitive and emotional impairment and adoption of high risk behaviors3.

Childhood emotional mistreatment; particularly emotionally abusive acts, has been found to be associated with increased odds of lifetime diagnoses of several mental disorders4. The early, prolonged, and severe trauma can also increase impulsivity, diminishing the capacity of the brain to regulate emotions. Neurobiological studies show that childhood mistreatment leads to failure of inhibitory processes ruled by the frontal cortex over a fear-motivated hyper-responsive limbic system5. Therefore, impulsivity is a double edged sword, presenting itself as sequela of trauma as well as a risk factor for the development of a pathological response to trauma6. Many psychiatric disorders feature impulsivity, including substance-abuse disorders, attention deficit hyperactivity disorder, borderline personality disorder, conduct disorder and mood disorders. Impulsivity has also been associated with suicidal behaviors within various psychiatric populations exhibiting low serotonergic activity7. In mental health disorders especially substance use disorders, superimposition of the behavioral aftermaths of ACEs on impulsivity potentiate the risk of alcohol abuse by many folds8.

Similarly, previous studies have also established an association between ACEs and development of identity in adolescence. Development of a stable identity is a major developmental task, with its changing facets responsible for shaping the attachment styles and self-esteem in adolescence9,10. Serafini and Adams describe the importance of identity in providing structure for higher self-esteem and positive self-image; providing the goals necessary for self-direction11. This provides a sense of free will; harmony for social and academic adjustment; and future orientation that manifests as achievements in academia, aspirations and determination11. To address the gaps in scientific literature, the present study explores the association of adverse childhood experiences with subsequent impulsivity and functional identity among Pakistani adults.

Methods

This study was designed as a cross-sectional study, where 260 medical students aged 18 and above and currently enrolled in King Edward Medical University and CMH Lahore Medical College & Institute of Dentistry, both in Lahore, were conveniently interviewed from April to May, 2017. Institutional review board approval was sought and obtained from the Ethical Review Board of CMH Lahore Medical College, Pakistan (approval number: 21/ERC/CMHLMC). A consent form, an anonymous questionnaire on sociodemographic characteristics, and English versions of the Adverse Childhood Experiences (ACE) scale, Functions of Identity scale (FIS) and Barratt’s Impulsiveness Scale (BIS-11) were employed in this study. Participation in this study was voluntary and written informed consent was obtained from all participants. The participants were ensured anonymity and that only group findings would be reported.

The Adverse Childhood Experiences (ACE) questionnaire is an important assessment tool that measures multiple types of abuse and adverse experiences that one may have encountered as a child1. Increasing scores correspond to a higher number of ACEs.

The Functions of Identity Scale (FIS) is a valid and reliable 5-point Likert scale, comprising 15 questions that assess five domains of psychological functions that identity serves for an individual: structure, goals, personal control, harmony and future11. Higher scores on these subscales correspond to a stronger sense of identity.

Barratt’s Impulsiveness Scale (BIS-11) is a 30-item self-report Likert scale, with seven subscales; attention, motor, self-control, cognitive complexity, perseverance, and cognitive instability12. Higher scores on the scale or its subscales correspond to worsening impulsivity. All of these scales were found to be reliable in the present sample with following Cronbach’s α; ACE (0.71), FIS (0.86) and BIS-11 (0.78).

All data were analyzed in SPSS v. 21. Descriptive statistics were computed for the whole data. Frequencies were calculated and reported for ten domains of ACE, impulsivity and functions of identity. Multiple regression analysis was run to assess the association of impulsivity and functions of identity with ACEs, gender, age and socioeconomic status.

Results

A total of 232 medical students (232/260= 89.2%) responded to the surveys. The majority of them were females (n=188, 81%), with a mean age of 21.22 ± 1.31 years, mean number of siblings 3 ± 1.46, mean order of birth 1.94 ± 0.78 and a mean income greater than 30,000 PKR (n=208, 89.7%). Mean scores on subscales of Functional Identity Scale and Barratt’s Impulsiveness Scale are given in Table 1.

Table 1. Mean scores on subscales of the Functional Identity Scale.

Subscale MeanStd. Deviation
Functional Identity
Scale
Structure11.142.5
Harmony12.272.3
Goals11.592.6
Future11.003.0
Personal Control11.782.1
Barrat’s Impulsiveness
Scale
Attention 11.462.9
Cognitive instability7.472.1
Motor16.503.9
Perseverance7.572.0
Self-control13.133.4
Cognitive complexity12.142.6
Attention18.933.9
Motor24.084.8
Non-planning25.274.9

A total of 122 (52.6%) respondents had experienced at least one ACE. Verbal, physical, sexual adverse events and poor support and affection from family were the most reported adverse events. Detailed statistics are presented in Table 2.

Table 2. Adverse childhood experiences reported by respondents.

Adverse childhood experiencesResponseCountColumn
N %
Did a parent or other adult in the household often? Swear at you, insult you, put you down,
or humiliate you? or Act in a way that made you afraid that you might be physically hurt?
No15265.5%
Yes8034.5%
Did a parent or other adult in the household often: Push, grab, slap, or throw something at
you? or Ever hit you so hard that you had marks or were injured?
No18178.0%
Yes5122.0%
Did an adult or person at least 5 years older than you ever: Touch or fondle you or have
you touch their body in a sexual way? or Try to or actually have oral, anal, or vaginal sex
with you?
No19684.5%
Yes3615.5%
Did you often feel that no one in your family loved you or thought you were important or
special? or Your family didn’t look out for each other, feel close to each other, or support
each other?
No18881.0%
Yes4419.0%
Did you often feel that you didn’t have enough to eat, had to wear dirty clothes, and had no
one to protect you? or Your parents were too drunk or high to take care of you or take you
to the doctor if you needed it?
No20990.1%
Yes239.9%
Were your parents ever separated or divorcedNo22195.3%
Yes114.7%
Was your mother or stepmother: Often pushed, grabbed, slapped, or had something
thrown at her? or Sometimes or often kicked, bitten, hit with a fist, or hit with something
hard? or Ever repeatedly hit over at least a few minutes, or threatened?
No20688.8%
Yes2611.2%
Did you live with anyone who was a problem drinker or alcoholic or who used street drugsNo22396.1%
Yes93.9%
Was a household member depressed or mentally ill or did a household member attempt
suicide?
No20688.8%
Yes2611.2%
Did a household member go to prison?No22195.3%
Yes114.7%

According to multiple regression analyses (backward method), the predictors explained 14.2% of the variance in ACE scores (R2= 16.8%, adjusted R2= 14.2%, ANOVA F=6.435, P < 0.001). ACE scores were significantly associated with increasing age, increasing order in birth, lower scores on functional identity structure and non-planning impulsivity, and higher scores on future (functional identity) and motor impulsivity. Detailed statistics are presented in Table 3.

Table 3. Association of score on ACE scale with characteristics of respondents and domains of functional identity and impulsivity.

VariableBStd. ErrorBetat-statisticP-value
(Constant)-1.0232.111-0.4850.628
age0.1980.0810.1502.4500.015
Order in birth0.3320.1400.1502.3680.019
Functional Structure-0.1750.059-0.256-2.9710.003
Functional Harmony-0.1210.067-0.160-1.8230.070
Functional Future0.1080.0440.1862.4560.015
Motor Impulsivity0.0550.0220.1532.4680.014
Non-planning Impulsivity-0.0620.025-0.174-2.5140.013
Dataset 1.Impulsivity and adverse childhood events.
The dataset contains all variables pertaining to demographics, responses to Functional Identity Scale and Barrat’s Impulsiveness Scale.

Discussion

In our study, adverse childhood experiences were significantly negatively associated with structure and positively with future subscales of the functional identity scale. Providing structure is a major function of one’s identity, deprivation of this results in poor self-esteem and negative self-image11. However, the negative association of adverse childhood experiences with the function of “future” was surprising. These adverse experiences may provide a better orientation in adulthood to fulfill one’s potential in academics and career in adulthood11.

Individuals reporting higher episodes of ACEs reported higher impulsivity, translating to a greater motor impulsiveness and a disrupted executive functioning among these individuals. However, these experiences were negatively associated with non-planning impulsiveness, representing an improved ability of forethought and planning for future12.

The results of this study should be generalized with caution. The cross-sectional nature of this study does not establish causality and temporality, therefore, future studies should employ a longitudinal study design.

Data availability

Dataset 1: Impulsivity and adverse childhood events. The dataset contains all variables pertaining to demographics, responses to Functional Identity Scale and Barrat’s Impulsiveness Scale. DOI, 10.5256/f1000research.13007.d18267013.

Consent

Participation in this study was voluntary and written informed consent was obtained from all participants. The participants were ensured anonymity and that only group findings would be reported.

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Haaris Sheikh M, Naveed S, Waqas A and Tahir Jaura I. Association of adverse childhood experiences with functional identity and impulsivity among adults: a cross-sectional study [version 1; peer review: 1 approved, 1 not approved]. F1000Research 2017, 6:1978 (https://doi.org/10.12688/f1000research.13007.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 1
VERSION 1
PUBLISHED 08 Nov 2017
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Reviewer Report 19 Mar 2018
Syeda Fariha Iram Rizvi, Govt, M A O College, Lahore, Pakistan 
Not Approved
VIEWS 34
Childhood abuse is under recognized phenomena in Pakistan. This research is good effort to link childhood adverse experiences with impulsivity and identity. but there are few confusions/questions. Some detail of ACE questionnaire should be mentioned. Explain sub-variables in ACE in ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Iram Rizvi SF. Reviewer Report For: Association of adverse childhood experiences with functional identity and impulsivity among adults: a cross-sectional study [version 1; peer review: 1 approved, 1 not approved]. F1000Research 2017, 6:1978 (https://doi.org/10.5256/f1000research.14105.r31204)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
  • Author Response 18 May 2018
    Ahmed Waqas, CMH Lahore Medical College & Institute of Dentistry, Lahore Cantt, Pakistan
    18 May 2018
    Author Response
    Response to Reviewer:
    Dear Ms. Rizvi,
                                We are grateful to you for providing such a valuable feedback to our short report exploring the association of adverse childhood experiences with ... Continue reading
COMMENTS ON THIS REPORT
  • Author Response 18 May 2018
    Ahmed Waqas, CMH Lahore Medical College & Institute of Dentistry, Lahore Cantt, Pakistan
    18 May 2018
    Author Response
    Response to Reviewer:
    Dear Ms. Rizvi,
                                We are grateful to you for providing such a valuable feedback to our short report exploring the association of adverse childhood experiences with ... Continue reading
Views
31
Cite
Reviewer Report 12 Dec 2017
Usman Ali, Fauji Foundation Hospital, Rawalpindi, Pakistan 
Approved
VIEWS 31
In Pakistan, the researchers often have to deal with scarcity of existent data on virtually any subject. This article gives insight about adverse childhood experiences and its impact in terms of functional identity and impulsivity. However, there are a few points to ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Ali U. Reviewer Report For: Association of adverse childhood experiences with functional identity and impulsivity among adults: a cross-sectional study [version 1; peer review: 1 approved, 1 not approved]. F1000Research 2017, 6:1978 (https://doi.org/10.5256/f1000research.14105.r28427)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.

Comments on this article Comments (0)

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Comment
Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
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