Associations of Adverse Childhood Experiences with Individual-Level Factors Related to Resilience in a Nationally Representative Sample of Adolescents in the United States

Introduction: Adverse childhood experiences (ACEs) have detrimental health consequences, such as major depressive disorder, suicide, and substance use. Toxic stress resulted from ACEs has harmful effects on children’s optimal brain development, highlighting the importance of prevention and early intervention efforts. Previous research has focused on measuring ACEs and its effects among adults. We assessed prevalence of ACEs and associations of ACEs with resilience-related factors, which could work as a buffer against toxic stress among adolescents at a population level.

Methods: We used cross-sectional, nationally representative data from the National Comorbidity Survey: Adolescent Supplement (n=10,148, age 13-18 years). We examined the associations of ACEs (10 items: 1) household dysfunction: substance use, mental disorders, witnessed interpersonal violence, divorce, prison; 2) abuse: psychological, physical, sexual; 3) neglect: emotional, physical) and four individual-level factors related to resilience (1) coping: problem solving, avoidance, distraction; 2) social competence; 3) locus of control; 4) self-esteem). We performed multiple regression analyses, controlling for age, sex, race/ethnicity, and family income.

Results: 72% of adolescents reported to have ACEs score of at least one; 20% of adolescents reported to have ACEs score of four and above. Adolescents who were older, non-Hispanic Black or Hispanic, and with lower family income reported higher ACEs scores (all p<0.01). Higher ACEs scores were associated with increased engagement in avoidance (β=0.58) and distraction (β=0.09) coping and decreased engagement in problem solving (β=-0.13; all p<0.001). Higher ACEs scores were all negatively associated with social competency (β=-0.55), internal locus of control (β=-0.42), and self-esteem (β=-0.35; all p<0.001). Each ACEs−avoidance coping and ACEs−self-esteem association was stronger among girls than boys (all p<0.001).

Conclusions: Our study showed that ACEs are common among adolescents. We found that Adolescents with higher ACEs reported increase use of maladaptive coping (avoidance and distraction) and decreased use of adaptive coping (problem solving) and reported lower social competency, locus of control, and self-esteem. More girls than boys with higher ACEs scores may be at a higher risk for engaging in avoidance coping and having lower self-esteem, suggesting that intervention strategies that help decrease engagement in avoidance coping and increase and sustain positive self-esteem may be particularly beneficial to girls with ACEs. Our findings support the need to develop intervention approaches to promote resilience for adolescents, especially those with ACEs in efforts to prevent negative mental and physical health consequences.