Adverse childhood experiences: towards a clear conceptual meaning

Aim To report an analysis of the concept of adverse childhood experiences. Background Adverse childhood experiences have been associated with negative physical and psychological health outcomes, but this phenomenon lacks the clear, consistent meaning necessary for use in nursing research, theory development and practice. Design Concept clarification. Data Sources The literature search was not limited a priori by date and included publications with abstracts in English from PubMed, CINAHL , Psych INFO and Social Abstracts. The search retrieved 128 articles published from 1970–2013. The search term ‘adverse childhood experiences’ was used, with similar terms permitted. A snowball approach was used to expand the search to relevant literature. Methods The articles were read and analysed following Norris's five steps for concept clarification to refine, elucidate and operationally define the concept and the context in which it occurred. Results Adverse childhood experiences were defined operationally as childhood events, varying in severity and often chronic, occurring in a child's family or social environment that cause harm or distress, thereby disrupting the child's physical or psychological health and development. Conclusion This concept clarification should raise awareness and understanding of the diverse nature and shared characteristics of adverse childhood experiences that are believed to influence the health of individuals as they age. This clarified concept will help expand research on health consequences of adverse childhood experiences and interventions to improve health. We recommend promoting a model of primary care that pays attention to the social and familial influences on the health of individuals worldwide.