Family and Environmental Influences on Child Behavioral Health: The Role of Neighborhood Disorder and Adverse Childhood Experiences

Background

The seminal Adverse Childhood Experiences (ACEs) study has demonstrated the ways in which childhood experience affects adult’s physical and behavioral health outcomes.  Newer research is examining the more immediate impact on child health, and the impact of neighborhood environment on the likelihood of experiencing ACEs. What remains unclear is the extent to which all of these aspects of the child context fit together.  The current study seeks to fill this gap using a comprehensive model to examine the ways in which neighborhood disorder and ACEs increase the likelihood of poor behavioral health outcomes for children.

Methods

The data were obtained from 3,001 mother participants in the Fragile Families and Child Wellbeing Study. The key dependent variable was children’s 5-year behavioral health problems, including aggression, depression/anxiety, withdrawal and attention problems.  The key independent variable was mother’s perception of neighborhood disorder when the child was 3.  The mediator was the child’s ACE score at age 3 created by summing 9 dichotomized categories of ACEs, including three types of child maltreatment; child witnessing domestic violence; parents’ separation; household financial hardship; parental mental health problems; parental substance abuse problems; parental involvement with criminal justice system.

Path analysis was conducted in Mplus 7 to explore the process by which neighborhood disorder influences the child’s behavior problems through the family level ACEs.  Key covariates were the sex of the child, the race, age and education of the mother, and the number of children in the household.

Results

The average level of behavior problems on a 0-2 scale was 0.54 for aggression, 0.26 for attention problems, 0.24 for depression/anxiety, and 0.23 for withdrawal.  Eleven percent of mothers reported no ACEs for the child, 21.4% reported 1 ACE, 21.3% 2 ACEs, 20.3% 3 ACEs, and 25.8% reported 4 and above ACEs.  The most common ACEs were witnessing domestic violence and child emotional abuse.

The pathway model showed a good fit: RMSEA=.07, CFI=.98, SRMR =.02. After controlling for covariates, we found the level of neighborhood disorder was positively and directly associated with the child’s problems of aggression, depression/anxiety, withdrawal, and attention (β =.15, .13, .10, .10, all p<.05).  Meanwhile, the association between neighborhood disorder and the child’s behavioral problems was partially mediated by the ACEs: the indirect effects through ACEs were found for all behavioral problems (β=.07, .05, .04, .06, all p<.05). 

Conclusions and implications

Guided by the social disorganization theory and empirical studies on ACEs, this study found that neighborhood disorder was associated with higher levels of ACEs and higher levels of ACEs were associated with increased behavioral health problems.  The relationship between neighborhood disorder and behavioral health problems was partially explained by ACEs. This information underscores the importance of implementing ACEs screening for children living in the disadvantaged neighborhood as a preventive strategy. The development of early childhood intervention programs should focus on reducing both neighborhood and family disadvantages to boost the healthy development of children.