Adverse Childhood Experiences and Behavioral Trajectories from Early Childhood to Adolescence

Background and Purpose: Research has shown that adverse childhood experiences (ACEs) increase the risk of poor adult health and well-being, yet less is known about the pathways through which these later-life outcomes emerge. For instance, there is a lack of prospective, longitudinal research into the link between ACEs and maladaptive behavioral trajectories. Moreover, no longitudinal study has investigated whether children’s behavioral problems also increase their risk of adverse experiences over time. Therefore, the purpose of this study is to explore the bidirectional relationships between adverse experiences and behavioral trajectories in a sample of low-income children.

Methods: This study is a secondary data analysis of the Fragile Families and Child Wellbeing Study (FFCWS) dataset. The FFCWS is a birth cohort study of 4,898 children born between 1998 and 2000. FFCWS families were interviewed soon after their child’s birth and again when the child was about 1, 3, 5, 9 and 15 years old. For the current study, data on the focal child’s ACEs and behavioral problems were primarily obtained through telephone and in-home interviews with the child’s primary caregiver at years 3, 5, 9 and 15.

Eight ACEs were measured in this study, including four types of maltreatment (physical abuse, emotional abuse, neglect, sexual abuse) and four types of household dysfunction (domestic violence, mental illness, substance abuse, incarceration). At each time point, ACEs were dichotomized and summed to produce an aggregate score ranging from 0 to 8. Caregiver ratings on the Child Behavior Checklist (CBCL) were used to measure children’s behavioral problems at year 3, 5, 9 and 15. Total scores of four problem subscales of the CBCL were included in this study: anxious/depressed, withdrawn, aggression, and destructive/delinquent. A cross-lagged panel model was fit to examine reciprocal relations between ACEs and child behavioral problems while controlling for child gender and disability status as well as maternal race/ethnicity, education, income, and age at childbirth.

Results: Descriptive analyses showed that roughly half of children were exposed to an ACE at each measurement time point. Estimates of cumulative incidence indicated that 85% of children endured at least one ACE from ages 3 to 15 years. The cross-lagged panel model indicated that earlier ACEs significantly contributed to later anxious/depressed, withdrawn, aggressive, and destructive/delinquent problem trajectories. For instance, year 3 ACE scores were associated with year 5 anxious/depressed problems (β=0.110, SE=0.032, p=0.001). Also, year 5 ACE scores predicted year 9 anxious/depressed problems (β=0.081, SE=0.028, p=0.003). Similarly, year 9 ACE scores were associated with year 15 anxious/depressed problems (β=0.055, SE=0.025, p=0.027). However, earlier behavioral problems did not predict later increase of ACEs reported at later time points.

Conclusions and Implications: ACEs are known to be prevalent and consequential. We found that ACE rates were particularly high in this low-income sample, and that they precipitated behavior problems from early childhood through adolescence. Maladaptive behaviors did not predict ACE exposure, however. The findings have implications for understanding the etiology and consequences of adversity as well as the design of prevention and intervention strategies.