Adverse Childhood Experiences & Teen Behavior Outcomes: The Role of Disability

Background and Purpose:

Children who have experienced adverse childhood experiences (ACEs) are more likely to have negative physical and behavioral health outcomes in later years. In addition, more recent literature points to the higher likelihood of youth with disabilities experiencing ACEs. However, the extent to which disability moderates the relationship between ACEs and poor outcomes is not well understood. One hypothesis is that the presence of disability complicates whatever difficulties the child may already experience related to ACEs, leading to poorer outcomes. Importantly, children with cognitive issues may fare even worse, with an “invisible” disability that may not be readily identified or accommodated. This study expands prior knowledge in this area by examining the association between adverse childhood experiences (ACEs) and teen behavior outcomes and whether the presence of disability moderates this relationship, leading to worse outcomes.

Methods:

We conducted a secondary data analysis data using existing population-based longitudinal public data from the Fragile Families and Child Wellbeing Study of more than 2,200 children in large US cities. We examined the associations of ACEs and caregiver-reported externalizing behaviors and youth-reported internalizing and delinquent behaviors at age 15, and whether disability moderates this relationship. A categorical ACE Index with 0, 1 ACE, or 2 or more ACEs, measured between ages 5 and 9, was the primary independent variable. Disability status by age 5 years included physical/ developmental/behavioral conditions as reported by the primary caregiver and cognitive disability, which was measured by a test of verbal ability, namely the Peabody Picture Vocabulary Test (PPVT). We estimated Ordinary Least Squares multiple regression models, controlling for a rich set of child and family characteristics. We then included interaction terms for low PPVT score and disability conditions with ACEs to assess potential moderator effects. 

Results:

Our analysis sample included 2,239 children with 14% meeting the cut-off criteria for cognitive disability and 24% of the sample reporting disability conditions. In this sample, 48% experienced ACEs, with 52% reporting no ACEs, 26% reporting 1 ACE, and 22% reporting 2 or more ACEs. Findings indicate that the presence of 2 or more ACEs leads to worse outcomes for all three behavior problems (externalizing, internalizing, and delinquent behaviors), and that cognitive disability compounds this relationship for externalizing behaviors, particularly for youth with 2 or more ACEs (B=.86, p<.001). We found no moderating effects for other behaviors or for disability conditions.

Conclusions and Implications:

Children experiencing more adverse childhood experiences have more externalizing, internalizing, and delinquent behavior problems in adolescence. Cognitive disability, but not physical or developmental disabilities, compounded this relationship for teen externalizing behaviors. The presence of cognitive disability may complicate whatever difficulties the child may already experience related to adverse childhood experiences, leading to worse outcomes in the teen years. These findings support the hypothesis that children with cognitive disabilities, which may be invisible, may experience worse outcomes, and highlight the importance of intervention and special attention for children with cognitive disability during critical school years.