Advertisement

Adverse Childhood Experiences and Mental Health, Chronic Medical Conditions, and Development in Young Children

      Abstract

      Objective

      To determine the relationships between adverse childhood experiences (ACEs) and mental health, chronic medical conditions, and social development among young children in the child welfare system.

      Methods

      This cross-sectional study used a nationally representative sample of children investigated by child welfare (National Survey of Child and Adolescent Well-Being II) from 2008 to 2009. Our analysis included caregiver interviews and caseworker reports about children aged 18 to 71 months who were not in out-of-home care (n = 912). We examined the associations between ACEs and mental health (measured by the Child Behavior Checklist [CBCL]), reported chronic medical conditions, and social development (measured by the Vineland Socialization Scale) in bivariate and multivariate analyses.

      Results

      Nearly all children (98.1%) were reported to have had an ACE in their lifetime; the average number of ACEs was 3.6. For every additional reported ACE, there was a 32% increased odds of having a problem score on the CBCL (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.14, 1.53) and a 21% increased odds of having a chronic medical condition (OR 1.21, 95% CI 1.05, 1.40). Among children aged 36 to 71 months, for every additional reported ACE, there was a 77% increased odds of a low Vineland Socialization score (OR 1.77, 95% CI 1.12, 2.78).

      Conclusions

      ACEs were associated with poor early childhood mental health and chronic medical conditions, and, among children aged 3 to 5, social development. Efforts are needed to examine whether providing early intervention to families with multiple stressors mitigates the impact of ACEs on children's outcomes.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Shonkoff J.P.
        • Garner A.S.
        • Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, Section on Developmental and Behavioral Pediatrics
        The lifelong effects of early childhood adversity and toxic stress.
        Pediatrics. 2012; 129: e232-e246
      1. National Scientific Council on the Developing Child. Excessive stress disrupts the architecture of the developing brain. Working Paper No. 3. Available at: http://developingchild.harvard.edu/resources/reports_and_working_papers/working_papers/wp3/. Accessed September 19, 2013.

      2. Centers for Disease Control and Prevention. Adverse childhood experiences (ACE) study. Available at: http://www.cdc.gov/violenceprevention/acestudy/. Accessed April 12, 2014.

        • Middlebrooks J.S.
        • Audage N.C.
        The Effects of Childhood Stress on Health Across the Lifespan.
        US Centers for Disease Control and Prevention; National Center for Injury Prevention and Control, Atlanta, Ga2008
        • McEwen B.S.
        • Seeman T.
        Protective and damaging effects of mediators of stress: elaborating and testing the concepts of allostasis and allostatic load.
        Ann NY Acad Sci. 1999; 896: 30-47
        • Heim C.
        • Nemeroff C.B.
        The role of childhood trauma in the neurobiology of mood and anxiety disorders: preclinical and clinical studies.
        Biol Psychiatry. 2001; 49: 1023-1039
        • Kaufman J.
        • Plotsky P.M.
        • Nemeroff C.B.
        • et al.
        Effects of early adverse experiences on brain structure and function: clinical implications.
        Biol Psychiatry. 2000; 48: 778-790
        • Felitti V.J.
        • Anda R.F.
        • Nordenberg D.
        • et al.
        Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) study.
        Am J Prev Med. 1998; 14: 245-258
        • Anda R.F.
        • Croft J.B.
        • Felitti V.J.
        • et al.
        Adverse childhood experiences and smoking during adolescence and adulthood.
        JAMA. 1999; 282: 1652-1658
        • Rothman E.F.
        • Edwards E.M.
        • Heeren T.
        • et al.
        Adverse childhood experiences predict earlier age of drinking onset: results from a representative US sample of current or former drinkers.
        Pediatrics. 2008; 122: e298-e304
        • Marie-Mitchell A.
        • O'Connor T.G.
        Adverse childhood experiences: translating knowledge into identification of children at risk for poor outcomes.
        Acad Pediatr. 2013; 13: 14-19
        • Burke N.J.
        • Hellman J.L.
        • Scott B.G.
        • et al.
        The impact of adverse childhood experiences on an urban pediatric population.
        Child Abuse Negl. 2011; 35: 408-413
        • Flaherty E.G.
        • Thompson R.
        • Litrownik A.J.
        • et al.
        Effect of early childhood adversity on child health.
        Arch Pediatr Adolesc Med. 2006; 160: 1232-1238
        • Flaherty E.G.
        • Thompson R.
        • Litrownik A.J.
        • et al.
        Adverse childhood exposures and reported child health at age 12.
        Acad Pediatr. 2009; 9: 150-156
        • Stambaugh L.F.
        • Ringeisen H.
        • Casanueva C.C.
        • et al.
        Adverse Childhood Experiences in NSCAW.
        Office of Planning, Research and Evaluation; Administration for Children and Families, US Dept of Health and Human Services, Washington, DC2013
        • Dowd K.
        • Dolan M.
        • Wallin J.
        • et al.
        National Survey of Child and Adolescent Well-Being II: Combined Waves 1–2 Data File User's Manual, Restricted Release Version.
        Cornell University; National Data Archive on Child Abuse and Neglect, Ithaca, NY2011
        • Stein R.E.K.
        • Hurlburt M.S.
        • Heneghan A.M.
        • et al.
        Chronic conditions among children investigated by child welfare: a national sample.
        Pediatrics. 2013; 131: 455-462
        • Straus M.A.
        • Hamby S.L.
        • Boney-McCoy S.
        • et al.
        The Revised Conflict Tactics Scales (CTS2): development and preliminary psychometric data.
        J Fam Issues. 1996; 17: 283-316
        • Reinert D.F.
        • Alen J.P.
        The Alcohol Use Disorder Identification Test (AUDIT): a review of recent research.
        Alcohol Clin Exp Res. 2002; 26: 272-279
        • Yudko E.
        • Lozhkina O.
        • Fouts A.
        A comprehensive review of the psychometric properties of the drug use screening test.
        J Subst Abuse Treat. 2007; 32: 189-198
        • Janca A.
        • Robins L.N.
        • Cottler L.B.
        • et al.
        Clinical observation of assessment using the Composite International Diagnostic Interview (CIDI). An analysis of the CIDI Field Trials—Wave II at the St Louis site.
        Br J Psychiatry. 1992; 160: 815-818
      3. Achenbach TM, Rescorla LA. Manual for the ASEBA preschool forms and profiles. Available at: http://www.aseba.org/ordering/ASEBA%20Reliability%20&%20Validity-Pre-school%20.pdf. Accessed September 3, 2013.

      4. Sparrow SS, Carter AS, Cicchetti DV. Vineland Screener. 1993. Available at: http://www.unc.edu/depts/sph/longscan/pages/measures/Ages12to14/writeups/Age%2012%20and%2014%20Vineland%20Screener%20FINAL%20(Public%20Site).pdf. Accessed July 1, 2015.

        • van Duijn G.
        • Dijkxhoorn Y.
        • Noens I.
        • et al.
        Vineland Screener 0–12 years research version (NL). Constructing a screening instrument to assess adaptive behaviour.
        Int J Methods Psychiatr Res. 2009; 18: 110-117
        • Goldsmith D.F.
        • Oppenheim D.
        • Wanlass J.
        Separation and reunification: using attachment theory and research to inform decisions affecting the placements of children in foster care.
        Juvenile Fam Court J. 2004; 55: 1-13
        • Bierhaus A.
        • Wolf J.
        • Andrassy M.
        • et al.
        A mechanism converting psychosocial stress into mononuclear cell activation.
        Proc Natl Acad Sci U S A. 2003; 100: 1920-1925
        • Danese A.
        • Pariante C.M.
        • Caspi A.
        • et al.
        Childhood maltreatment predicts adult inflammation in a life-course study.
        Proc Natl Acad Sci U S A. 2007; 104: 1319-1324
        • Miller G.E.
        • Chen E.
        Harsh family climate in early life presages the emergence of a proinflammatory phenotype in adolescence.
        Psychol Sci. 2010; 21: 848-856
        • Berasain C.
        • Perugorria M.J.
        • Latasa M.U.
        • et al.
        The epidermal growth factor receptor: a link between inflammation and liver cancer.
        Exp Biol Med. 2009; 234: 713-725
        • Chen E.
        • Miller G.E.
        Stress and inflammation in exacerbations of asthma.
        Brain Behav Immun. 2007; 21: 993-999
        • Danese A.
        • Moffitt T.E.
        • Pariante C.M.
        • et al.
        Elevated inflammation levels in depressed adults with a history of childhood maltreatment.
        Arch Gen Psychiatry. 2008; 65: 409-415
        • Bramlett M.D.
        • Radel L.F.
        Adverse family experiences among children in nonparental care, 2011–2012.
        Natl Health Stat Report. 2014; 74: 1-8
        • Briggs-Gowan M.J.
        • Carter A.S.
        • Skuban E.M.
        • et al.
        Prevalence of social–emotional and behavioral problems in a community sample of 1- and 2-year-old children.
        J Am Acad Child Adolesc Psychiatry. 2001; 40: 811-819
        • Bethell C.D.
        • Read D.
        • Blumberg S.J.
        • et al.
        What is the prevalence of children with special health care needs? Toward an understanding of variations in findings and methods across three national surveys.
        Matern Child Health J. 2008; 12: 1-14
        • Sukhodolsky D.G.
        • Scahill L.
        • Zhang H.
        • et al.
        Disruptive behavior in children with Tourette's syndrome: association with ADHD comorbidity, TIC severity, and functional impairment.
        J Am Acad Child Adolesc Psychiatry. 2003; 42: 98-105
        • Evans G.W.
        A multimethodological analysis of cumulative risk and allostatic load among rural children.
        Dev Psychol. 2003; 39: 924-933
        • Rogosch F.A.
        • Dackis M.N.
        • Cicchetti D.
        Child maltreatment and allostatic load: consequences for physical and mental health in children from low-income families.
        Dev Psychopathol. 2011; 23: 1107-1124
        • Sherrod K.B.
        • O'Connor S.
        • Vietze P.M.
        • et al.
        Child health and maltreatment.
        Child Dev. 1984; 55: 1174-1183
        • Wertlieb D.
        Converging trends in family research and pediatrics: recent findings for the American Academy of Pediatrics Task Force on the Family.
        Pediatrics. 2003; 111: 1572-1587
        • Earls M.F.
        • Committee on Psychosocial Aspects of Child and Family Health; American Academy of Pediatrics
        Incorporating recognition and management of perinatal and postpartum depression into pediatric practice.
        Pediatrics. 2010; 126: 1032-1039
        • Garner A.S.
        • Shonkoff J.P.
        • Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, Section on Developmental and Behavioral Pediatrics
        Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health.
        Pediatrics. 2012; 129: e224-e231