The Relationship between Cumulative Adverse Childhood Experiences (ACEs) and Temperament in Children

Background and Purpose: Adverse Childhood Experiences (ACEs) are potentially traumatic events that can negatively affect a child’s overall well-being. Previous research has linked ACEs to long-term emotional and behavioral challenges, which may result in difficulties regulating temperament in children. However, studies that examine children's temperament in the context of childhood adversities using nationally representative data are limited. Therefore, this study investigates the prevalence and association between exposure to ACEs and children’s temperament in the U.S.

Methods: This study obtained data from the 2023 National Survey of Children’s Health (n=11,803; children under 18 years old). Children’s temperament, which served as the dependent variable, was assessed by asking their parents, "How often does this child lose their temper?" This was coded dichotomously as “easy-tempered” or “difficult-tempered.” The independent variables were ACEs, which captured nine lifetime experiences: financial hardship, parental divorce/separation, parental incarceration, parental death, witnessing domestic violence, being a victim/witnessing neighborhood violence, co-residing with an adult in the household who suffers from mental illness or substance use, and experiencing discrimination (no/yes). The nine binary responses were summed for a total score, creating a measure indicating whether the child experienced: 0 ACE, 1 ACE, and =>2 ACEs. Prevalence estimates were obtained using chi-square tests. Logistic regression models (unadjusted and adjusted) determined the significant association between independent and dependent variables while adjusting for sex, age, race, health status, parental education, marital status, and neighborhood safety conditions. Data analysis was performed using SPSS vs. 29 (p < 0.05).

Results: Out of 11,126 children, 16.7% (n=1,968) were reported by their parents as having a difficult temperament. Among these children (n=1,968; 16.7%), those exposed to two or more ACEs (30.2%) and those exposed to one ACE (22.5%) had higher rates of difficult temperament compared to children without ACE exposure (13.7%). Similarly, both before and after adjusting for other factors in the regression models, children with at least one ACE (OR=1.83, 95% CI=1.62–2.07, p<.001; aOR=1.61, 95% CI=1.40–1.86, p<.001) and those exposed to two or more ACEs (OR=2.73, 95% CI=2.36–3.16, p<.001; aOR=2.19, 95% CI=1.84–2.61, p<.001) were significantly associated with higher odds of exhibiting difficult temperament compared to those without ACE exposure.

Conclusion and Implications: This study has demonstrated that exposure to ACEs increases the risk of developing a difficult temperament in children. Understanding the link between ACEs and children's temperament can help shape early intervention and prevention strategies. Thus, this study underscores the importance of prioritizing early screening for ACEs and implementing trauma-informed interventions to support children's emotional and behavioral regulation. This can be achieved through cross-sector collaboration with schools, community mental health services, and healthcare agencies, fostering a supportive environment that promotes resilience and positive coping skills in children.