Associations between Adverse Childhood Experiences and Functioning in Young Children

Introduction: Although a large body of research points to the relation between adverse childhood experiences (ACEs) and health outcomes in adulthood, a major limitation is that this research has focused on adults who provide retrospective accounts of their childhood experiences. This limits the ability to gain an accurate understanding of children’s experiences and to identify intermediate outcomes of ACEs that lead to long-term health problems. Understanding intermediate outcomes of ACEs in childhood will provide information necessary to implement effective prevention and intervention programs. It was hypothesized that rates of ACEs would be higher among children who received neurodevelopmental diagnoses compared to children who did not. It was also hypothesized that there would be a dose-response relation between ACEs and clinically significant symptoms of internalizing and externalizing problems and physical health problems.

Method: Participants were 208 children between the ages of 2 and 11 who received a first-time evaluation through the Division of Developmental and Behavioral Pediatrics in a children’s hospital. Parents reported on their child’s adverse childhood experiences, including family dysfunction such as domestic violence and substance use in the home. Neurodevelopmental diagnosis, emotional and behavioral functioning (measured by the Child Behavioral Checklist), and physical health (e.g., respiratory problems such as asthma, endocrinal problems, sleep disturbance, feeding problems) were gathered from the electronic health record.

Results: Rates of ACEs were high, with 60% experiencing at least one ACE. Twenty-three percent experienced two to three ACEs, and 4% experienced four or more ACEs. The rates of ACEs will be compared across neurodevelopmental diagnostic category (no diagnosis, global developmental delay, autism spectrum disorder, attention-deficit/hyperactivity disorder, speech/language disorder). Logistic regressions will be conducted to determine the extent to which there is a dose-response relationship between ACEs and clinically significant internalizing and externalizing symptoms as well as physical health conditions.

Conclusion: Studies of adverse childhood experiences in early and middle childhood are necessary to understand the mechanisms through which dysfunction in the family context and other adversity leads to major causes of morbidity and mortality. This may be particularly important to understand in vulnerable populations, such as children with developmental delays. Compared to population-based studies of children, this study suggests that rates of ACEs are significantly higher among children who were referred for neurodevelopmental evaluations compared to compared to typically developing children. This study provides an important step in understanding short-term associations between adverse childhood experiences and internalizing, externalizing, and physical health problems.