Abstract
Objective: Adverse childhood experiences (ACEs) can have a significant but variable effect on childhood neurodevelopment. The purpose of this study was to quantify and compare the associations between “household challenge” ACEs and common childhood neurodevelopmental and behavioral health conditions, using nationally representative U.S. data. Method: This study used data from the 2016–2019 National Survey of Children’s Health, a nationwide, population-based, cross-sectional survey. Seven household challenge ACEs (not including child maltreatment) were reported by parents/guardians: parental death, incarceration, divorce/separation, family violence, mental illness, substance abuse, and poverty. Logistic regression with sample weights was used to estimate the odds ratio (OR) for 15 parent-reported neurodevelopmental and behavioral health conditions, by the number of reported ACEs. A dose-response relationship was examined by applying tests of orthogonal polynomial contrasts to fitted logistic regression models. Results: Down syndrome, Tourette syndrome and cerebral palsy were not associated with household challenge ACEs, whereas behavior/conduct problems, depression, and substance abuse were strongly associated, with adjusted ORs ranging from 6.36 (95% confidence interval (CI) 5.53, 7.32) to 9.19 (95% CI 7.79, 10.84). Other neurodevelopmental conditions not traditionally associated with childhood adversity showed moderate yet robust associations with ACEs, including autism (adjusted OR 2.15, 95% CI 1.64, 2.81), learning disability (adjusted OR 3.26, 95% CI 2.80, 3.80), and attention deficit hyperactivity disorder (adjusted OR 3.95, 95% CI 3.44, 4.53). The ORs increased with the number of ACEs, showing significant positive linear trends. Conclusion: We found significant dose-dependent or cumulative associations between ACEs and multiple neurodevelopmental and behavioral conditions.
Highlights
Adverse childhood experiences (ACEs) are defined as traumatic experiences in a person’s life occurring before the age of 18 years, which are recalled by the person in adulthood
The current study examines associations between seven parent-reported ACEs not related to child maltreatment—referred to as household challenge ACEs—and 15 common neurodevelopmental and behavioral health conditions in children, using the most up-todate, nationally representative data available through the National Survey of Children’s Health (NSCH)
For all ACE levels, after adjusting for potential confounding, there was a significant increase in odds of each of the following neurodevelopmental and behavioral health conditions: epilepsy, speech disorder, autism spectrum disorder (ASD), intellectual disability (ID), headaches/migraine, developmental delay, learning disability, attention deficit hyperactivity disorder (ADHD), anxiety problems, behavior/conduct problems, depression, and substance use disorder (Table 3)
Summary
Adverse childhood experiences (ACEs) are defined as traumatic experiences in a person’s life occurring before the age of 18 years, which are recalled by the person in adulthood. ACE exposure has been associated with a number of neurodevelopmental and behavioral health conditions, including learning disability [6], anxiety [7,8,9,10], substance use disorders [1,8,9,10,11,12,13,14,15], depression [2,8,9,10,16], post-traumatic stress disorder (PTSD) [17,18], high-risk sexual behavior [1,19], and suicide attempts [5,20,21]. This is consistent with the idea that “toxic stress” or conditions of deprivation may lead to altered activation of the glucocorticoid stress response system, cortisol production, and disruption of neuroendocrine and immune systems, which remodel neurological pathways in brain regions such as the hippocampus, amygdala, and prefrontal cortex [22]
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