Intergenerational Effects of Adverse Childhood Experiences: Examining Relationships Among Parental ACEs, Familial Sleep Problems, and Children's Internalizing and Externalizing Behaviors

Background: Adverse childhood experiences (ACEs) have profound effects on the health and well-being of individuals across the lifespan (Felitti et al., 1998). Critical to this research are data from studies showing that parental ACEs may have intergenerational effects on offspring outcomes; parental ACEs are predictive of higher levels of child socio-emotional problems (McDonnell & Valentino, 2016; Narayan et al., 2017). Despite emergent research on ACEs and the intergenerational transmission of adversity, we lack an advanced understanding of the factors that may modify the relationship between parental ACEs and child outcomes.

One potential factor linking parental adversity and children’s behavioral outcomes is poor sleep. Sleep is a critical determinant of health and well-being, and families exposed to greater adversity are at heightened risk for sleep problems (Greenfield et al., 2011). Furthermore, parent-child sleep is dynamic, such that when one has sleep problems, the other will often be impacted (Meltzer & Montgomery-Downs, 2012). This in turn is predictive of negative daytime functioning in both parents and children (Meltzer & Mindell, 2007; Touchette et al., 2009). Yet, few studies have examined the role of sleep as a factor contributing to negative behavioral outcomes in children from high-risk families. This study investigated the role of sleep in the intergenerational transmission of risk in low-income families.

Methods: Data were collected as part of an ongoing study of “toxic stress”; 104 Early Head Start children were recruited (6-45 months, M=25 months; 58% male). Primary caregivers (98% mothers) were majority (67%) Latina. Most families (75%) lived at-or-below the poverty line. At baseline, parental ACEs, familial sleep problems (8-items), and child internalizing and externalizing behaviors (BITSEA/CBCL T-scores) were collected via interview. Parental ACEs were subsequently categorized into maltreatment versus household dysfunction. Multiple regression analyses were conducted to examine the effects of parental ACEs and sleep problems and their interaction on children’s internalizing and externalizing behaviors, controlling for demographics.

Results: On average, parents reported exposure to 2.50 ACEs. In the models with maltreatment, main-effects-analyses indicated (a) no significant relationships between parental maltreatment and internalizing and externalizing problems and (b) children of parents who reported more familial sleep problems were at elevated risk for internalizing (b=1.96, SE=.68, p<.01) and externalizing (b=2.50, SE=.77, p<.01) problems. However, the interaction between parental history of maltreatment and sleep problems was significant, such that experiencing familial sleep problems exacerbated the risk of parental maltreatment on children’s externalizing problems (b=2.88, SE=1.00, p<.01). In the models with household dysfunction, main-effects-analyses indicated (a) parental household dysfunction was associated with children’s internalizing (b=1.89, SE=.77, p<.05) and externalizing (b=2.24, SE=.86, p<.05) problems and (b) poor familial sleep was associated with internalizing (b=1.86, SE=.67, p<.01) and externalizing (b=2.38, SE=.75, p<.01) problems. However, there was no significant household dysfunction x sleep interaction.

Conclusions: Findings provide a more nuanced understanding of specific categories of parental ACEs that may be associated with intergenerational transmission of risk. Furthermore, screening of sleep problems in families with adversity may provide more precise targets for intervention to promote healthy development in children and disrupt cycles of risk.