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 accessOne-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 PediatricsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The lifelong effects of early childhood adversity and toxic stress.Pediatrics. 2012; 129: e232-e246
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.
Centers for Disease Control and Prevention. Adverse childhood experiences (ACE) study. Available at: http://www.cdc.gov/violenceprevention/acestudy/. Accessed April 12, 2014.
- 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
- 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
- The role of childhood trauma in the neurobiology of mood and anxiety disorders: preclinical and clinical studies.Biol Psychiatry. 2001; 49: 1023-1039
- Effects of early adverse experiences on brain structure and function: clinical implications.Biol Psychiatry. 2000; 48: 778-790
- 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
- Adverse childhood experiences and smoking during adolescence and adulthood.JAMA. 1999; 282: 1652-1658
- 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
- Adverse childhood experiences: translating knowledge into identification of children at risk for poor outcomes.Acad Pediatr. 2013; 13: 14-19
- The impact of adverse childhood experiences on an urban pediatric population.Child Abuse Negl. 2011; 35: 408-413
- Effect of early childhood adversity on child health.Arch Pediatr Adolesc Med. 2006; 160: 1232-1238
- Adverse childhood exposures and reported child health at age 12.Acad Pediatr. 2009; 9: 150-156
- 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
- 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
- Chronic conditions among children investigated by child welfare: a national sample.Pediatrics. 2013; 131: 455-462
- The Revised Conflict Tactics Scales (CTS2): development and preliminary psychometric data.J Fam Issues. 1996; 17: 283-316
- The Alcohol Use Disorder Identification Test (AUDIT): a review of recent research.Alcohol Clin Exp Res. 2002; 26: 272-279
- A comprehensive review of the psychometric properties of the drug use screening test.J Subst Abuse Treat. 2007; 32: 189-198
- 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
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.
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.
- 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
- 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
- A mechanism converting psychosocial stress into mononuclear cell activation.Proc Natl Acad Sci U S A. 2003; 100: 1920-1925
- Childhood maltreatment predicts adult inflammation in a life-course study.Proc Natl Acad Sci U S A. 2007; 104: 1319-1324
- Harsh family climate in early life presages the emergence of a proinflammatory phenotype in adolescence.Psychol Sci. 2010; 21: 848-856
- The epidermal growth factor receptor: a link between inflammation and liver cancer.Exp Biol Med. 2009; 234: 713-725
- Stress and inflammation in exacerbations of asthma.Brain Behav Immun. 2007; 21: 993-999
- Elevated inflammation levels in depressed adults with a history of childhood maltreatment.Arch Gen Psychiatry. 2008; 65: 409-415
- Adverse family experiences among children in nonparental care, 2011–2012.Natl Health Stat Report. 2014; 74: 1-8
- 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
- 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
- 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
- A multimethodological analysis of cumulative risk and allostatic load among rural children.Dev Psychol. 2003; 39: 924-933
- Child maltreatment and allostatic load: consequences for physical and mental health in children from low-income families.Dev Psychopathol. 2011; 23: 1107-1124
- Child health and maltreatment.Child Dev. 1984; 55: 1174-1183
- 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
- Incorporating recognition and management of perinatal and postpartum depression into pediatric practice.Pediatrics. 2010; 126: 1032-1039
- Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health.Pediatrics. 2012; 129: e224-e231
Article info
Publication history
Published online: July 13, 2015
Accepted:
May 15,
2015
Received:
October 9,
2014
Footnotes
The authors declare that they have no conflict of interest.
Identification
Copyright
© 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
