Abstract
We examined parent-reported adverse childhood experiences (ACEs) and associated outcomes among American Indian and Alaska Native (AI/AN) children aged 0–17 years from the 2011-2012 National Survey of Children's Health. Bivariate and multivariable analyses of cross-sectional data on 1,453 AI/AN children and 61,381 non-Hispanic White (NHW) children assessed race-based differences in ACEs prevalence and differences in provider-diagnosed chronic emotional and developmental conditions, health characteristics, reported child behaviors, and health services received as a function of having multiple ACEs. AI/AN children were more likely to have experienced 2+ ACEs (40.3% versus 21%), 3+ ACEs (26.8% versus 11.5%), 4+ ACEs (16.8% versus 6.2%), and 5+ ACEs (9.9% versus 3.3%) compared to NHW children. Prevalence rates for depression, anxiety, and ADHD were higher among AI/AN children with 3+ ACEs (14.4%, 7.7%, and 12.5%) compared to AI/ANs with fewer than 2 ACEs (0.4%, 1.8%, and 5.5%). School problems, grade failures, and need for medication and counseling were 2-3 times higher among AI/ANs with 3+ ACEs versus the same comparison group. Adjusted odds ratio for emotional, developmental, and behavioral difficulties among AI/AN children with 2+ ACEs was 10.3 (95% CI = 3.6–29.3). Race-based differences were largely accounted for by social and economic-related factors.
Highlights
A variety of deleterious child health and well-being outcomes have connections with adverse or traumatic experiences in childhood
It has been stated that American Indians and Alaska Natives (AI/ANs) are disproportionally affected by childhood trauma, including abuse, neglect, and family violence, with pronounced disparities between White and AI/AN youth, sometimes attributed to cultural degradation resulting from multigenerational historical colonization and trauma [9]
AI/AN families were more concentrated in nonmetropolitan statistical areas (40.3% versus 20.1%) and more likely to live in Alaska, the Northern Plains, and the Southwest compared to their non-Hispanic White (NHW) counterparts
Summary
A variety of deleterious child health and well-being outcomes have connections with adverse or traumatic experiences in childhood. Multiple experiences of food insufficiency and hunger are associated with behavioral, emotional, and academic problems and children exposed to family substance abuse and domestic violence show higher levels of aggression, delinquency, hyperactivity, impulsivity, anxiety, negative affectivity, and posttraumatic stress disorder compared to children without such histories [1,2,3,4,5]. One study of Native American adolescents and young adults from the Northern Plains states indicated that approximately half of the sample had been exposed to one or more severe traumatic events [10]. Many AI/AN studies of outcomes for traumatized children have been conducted with nonrepresentative samples of adults or adolescents reporting on past experiences and examining narrowly defined health outcomes [10,11,12,13]. None have examined difficulties across a range of developmental, emotional, and behavioral problems experienced by younger children of varying ages
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