Girls who see or cope with violence, abuse, or neglect are more likely to begin puberty earlier than girls who have not had these types of adverse childhood experiences (ACEs) — but the same is not true for boys, a new Kaiser Permanente study shows.
The new study, published in the Journal of Adolescent Health, is among the first to look at the connection between ACEs and puberty. ACEs and age of a person’s first menstrual period were assessed using forms filled out at pediatric visits. The researchers used the children’s electronic medical records to learn when they started puberty.
“This study adds to what we know about the relationship between ACEs and health outcomes,” said lead author Ai Kubo, MPH, PhD, a research scientist at the Kaiser Permanente Northern California Division of Research. “The findings highlight the need for pediatricians who screen for these early traumas to think about earlier puberty as one of the potential negative health outcomes girls with many ACEs may experience.”
Screening for ACEs
Kaiser Permanente in Northern California began screening all children for ACEs in 2021. That’s because studies have shown that trauma can affect children’s health and emotional well-being or even change how their brains develop.
ACEs include sexual abuse as well as physical and emotional abuse or neglect. They also can include caregiver substance abuse, incarceration, or mental illness, witnessing domestic violence, and parental separation or divorce.
The study included more than 52,500 boys and girls in Northern California who were screened for ACEs. Most of the children — 75% — had no ACEs. Among the 25% of children who did, most had had 1 to 3 ACEs. The 3 most common ACEs were parental mental illness, parents’ separation or divorce, and witnessing domestic abuse.
This research found that the girls with ACEs were more likely to start their period before age 12 than the girls with no ACEs. Girls with 4 or more ACEs also were more likely to have earlier breast development.
The study found that for boys the number or types of ACEs did not affect the timing of puberty.
Earlier puberty affects health
Over the last 20 years, girls and boys started puberty at an earlier age. Earlier puberty can lead to several negative health outcomes, including earlier sexual activity, greater risk of abuse, and increased likelihood of emotional problems. Early puberty has also been tied to an increased risk of cancer and heart disease in adults.
The research team looked at both the number and specific types of ACEs children experienced. The type and number traumas can affect health in different ways.
- Girls with 7 to 10 ACEs were more likely to have earlier periods, breast development, and earlier pubic hair growth than girls with no ACEs.
- Girls who had an imprisoned parent were more likely to begin earlier breast development and have earlier periods.
- Girls who were sexually abused were more likely to have earlier breast development and earlier periods.
- And girls who experienced emotional neglect were more likely to have earlier breast development and earlier periods.
“Our findings confirm previous studies linking sexual abuse and father absence to early puberty,” Kubo said. “And like these other studies, we only saw this in girls.”
