Elsevier

Child Abuse & Neglect

Volume 98, December 2019, 104181
Child Abuse & Neglect

Research article
Adverse experiences in early childhood and their longitudinal impact on later behavioral problems of children living in poverty

https://doi.org/10.1016/j.chiabu.2019.104181Get rights and content

Abstract

Background

Adverse childhood experiences (ACEs) are an identified risk factor for the social and emotional development of children. What is less known is the long-term effects of ACEs when poverty and ACEs coincide.

Objective

Using longitudinal cohort-panel data, we examined whether exposure to ACEs by the age of three among poor children would longitudinally result in behavioral problems at ages three, five, nine, and 15, after controlling for mothers’ socioeconomic status and their children’s characteristics.

Participants and setting

We used a subsample of 2750 children and their parents living in urban poverty from the Fragile Families and Child Wellbeing study.

Methods

Logistic regression modeling was used to obtain adjusted odds ratios of ACE categories predicting behavioral problems after accounting for family socioeconomic position.

Results

Our findings indicate that experiencing ACEs in early childhood was significantly associated with later behavioral outcomes from childhood to adolescence. Exposure to multiple ACEs before the age of three was significantly associated with the top-risk behavior group at age five; the odd ratios were 2.0 (CI = 1.3–3.1) and 2.9 (CI = 1.8–4.6) for two ACEs and three or more ACEs, respectively. At both ages nine and 15, children experiencing two or more ACEs had 1.9 to 3.2 times higher odds to demonstrate more the top 10th percentile of behavioral problems. Among covariates, mothers’ race and education, and children’s gender and temperament were identified as significant factors to determine behavior problems.

Conclusions

The findings support policies and programs for families with children who have experienced economic disadvantages and early childhood adversity.

Introduction

Studies have found that adverse childhood experiences (ACEs)—defined as child maltreatment and family dysfunction—have negative impacts on the social and emotional development of children (Blodgett, 2012; Blodgett & Lanigan, 2018; Hillis et al., 2004). Although the association between ACEs and children’s social and emotional development is well established, prospective research focusing on poor children’s longitudinal outcomes remains sparse. In ACE studies, poverty has been considered as an underlying mechanism that accumulates and exacerbates adverse conditions by intensifying family stress and dysfunction, which can ultimately harm a child’s health and development (Steele et al., 2016). Children living in poverty are more than twice as likely as all other children to be exposed to three or more adverse childhood experiences (Anda et al., 2010; Child Trends, 2013). This is significant because exposure to three or more ACEs is twice to five times1 more likely to increase the risk of experiencing behavior problems (Clarkson Freeman, 2014).

Moreover, retrospective studies have found that cumulative ACEs in early childhood have adverse behavioral and economic consequences with respect to unemployment, poverty, and crime in the long term, into adulthood (Evans & Kim, 2013; Felitti et al., 1998; Hughes & Tucker, 2018; Metzler et al., 2017; Steele et al., 2016; Tomer, 2016; Ye & Reyes-Salvail, 2014). This is a public health concern that has effects beyond early childhood. In other words, retrospective evidence suggests that the impact of ACEs is likely to become more detrimental and last longer when poverty and ACEs coincide. As stated above, however, research focusing on early childhood ACEs and developmental outcomes during middle childhood and adolescent years have been understudied (Hunt et al., 2017). In the present study, we address this gap by testing, prospectively, whether and how exposure to ACEs in early childhood (age 3) affects children’s socioemotional and behavioral adjustment at ages three, five, nine, and 15, using a longitudinal cohort of mothers, fathers, and children from the Fragile Families and Child Wellbeing Study, selected based on the family’s poverty status during the first three years of the child’s life. Families that had never been poor during the children’s first three years were excluded.

It is well documented that children exposed to adverse experiences in early ages are more likely to develop long-term behavior problems (English et al., 2005; McCrae et al., 2010). Using a cumulative risk model, previous research has found that the magnitude of exposure was associated with both internalizing and externalizing behavioral problems. Given that children exposed to one ACE are more likely to experience additional ACEs (Dong et al., 2004), ACE exposure in the literature was often defined as the total number of adverse experiences or a categorical variable determined by whether children experienced none, one, or co-occurring adversities. Multiple ACEs including the co-occurrence of maltreatment and family dysfunction in early childhood were found to increase the risk of demonstrating externalizing and internalizing problems at the immediate and extended stages of development (Jaffee & Maikovich‐Fong, 2011; Pears & Fisher, 2005; Pears et al., 2008). Despite this evidence, retrospective investigations rely heavily on individual recall of former exposure to ACEs; therefore, potential information biases can be a major threat of causal inference.

An emerging body of prospective research has focused on proximal behavior outcomes using longitudinal data. A recent study with a sample of families involved with the Child Protective Services examined the association between children’s exposure to ACEs from birth to six years and their later behavioral outcomes at five to eight years after the close of the investigation (Clarkson Freeman, 2014). In her study, two thirds of the sampled children (69%) were found to have had three or more ACEs by the age of six. Results suggested a dose-response effect displaying the association between the cumulative number of ACEs and the risk of experiencing various behavior problems. For example, children who had three ACEs were two to four times more likely to have an increased risk of demonstrating externalizing, internalizing, and total behavioral problems while those who had four or more ACEs had four to five times higher risk of behavior problems. These odds ratios were adjusted after controlling for the effect of caregivers’ marital status, education, and poverty status and the child’s race and sex. A longitudinal study using the Fragile Families and Child Wellbeing (FFCW) data investigated the proximal associations between ACEs children had been exposed to by the age of five and behavioral outcomes at the age of nine (Hunt et al., 2017). This study found a strong association between exposure to childhood adversity and the frequency of internalizing and externalizing problematic behaviors. The findings also suggest that there is a stronger association between ACEs and externalizing behaviors than internalizing behaviors. Another FFCW sampled study using teacher-reported outcomes for kindergarteners found that experiencing three or more ACEs was associated with attention problems, social problems, and aggression at the age of five after adjusting for potential confounders (Jimenez et al., 2016). In this study, exposures to ACEs was also found to be negatively related to children’s academic skills and emergent literacy skills.

A notable strength of the aforementioned prospective investigations is that the researchers examined the proximal association between ACE exposure and child behavioral problems in early or middle childhood after controlling for a rich set of demographic variables and socioeconomic status (see Finkelhor et al., 2016). The current study extends the previous research by examining the longitudinal relationships between ACEs children have been exposed to by the age of three and their behavioral problems over time from early childhood to middle childhood, and to early adolescence, at the ages of three, five, nine, and 15. With a focus on poor families, we hypothesized that exposure to ACEs by the age of three among poor children would longitudinally result in significant behavioral problems at ages three, five, nine, and 15, after controlling for mothers’ socioeconomic status and their children’s characteristics.

This study was guided by a social-ecological perspective that posits that child development is shaped by the immediate home environment as well as caregivers’ characteristics and functioning (Bronfenbrenner, 1979); and that stressful environment and events (e.g., child maltreatment) in childhood negatively influence the development transition from childhood to adolescence and young adulthood (Belsky et al., 1991). We were also informed by several theoretical models that highlight socioeconomic and psychosocial factors contributing to child health and development. From a social causation perspective (Adler et al., 1994; Marmot et al., 1991), socioeconomic status (SES) based on race, gender, educational attainment, and income level creates vulnerability. Socioeconomically disadvantaged children are at great risk for developmental problems due to the lack of access to the support and resources needed for optimal development (Brooks-Gunn & Duncan, 1997; McLoyd, 1998). Poverty and economic hardship appear to aggravate health disparities and have poor developmental consequences (Parker et al., 1988). In particular, low SES is significantly associated with externalizing problems and delinquent behaviors in early and middle childhood (Achenbach et al., 1990; McLoyd, 1997). On the other hand, a psychosocial theory seeks to explain how stressors (e.g., negative life events and stressful living circumstances) influence children’s healthy development (McMahon et al., 2003; Schneiderman et al., 2005). Evidence indicates that early life adversities, such as abuse, neglect, violence, and family dysfunction, have a detrimental impact on adolescents and young adults (Kilpatrick et al., 2003; Widom, 2000). The literature has identified consistent patterns showing that negative life events often co-occur (Edwards & Holden, 2003; Finkelhor et al., 2007). Exposure to a negative event leads to a greater risk of exposure to multiple stressful experiences, which are in turn associated with impaired health and developmental outcomes (Dube et al., 2001; Dube et al., 2003; Schilling et al., 2007). Due to the lack of resources, stressful life events for low-SES families and their children tend to be uncontrollable. Poor children are more likely to be exposed to family dysfunction and environmental hazards (Bradley et al., 1997; Gad & Johnson, 1980). These theoretical perspectives undergird our conceptual model that examines the longitudinal effects of the accumulation of ACEs on poor children’s later behavioral problems during early and middle childhood and adolescence, after accounting for family socioeconomic position and personal characteristics.

Section snippets

Study samples

We used a subsampled dataset of 2750 children and their parents from the Fragile Families and Child Wellbeing (FFCW) study conducted by Princeton University’s Center for Research on Child Wellbeing and the Columbia Population Research Center. Intentionally recruiting non-marital families, the FFCW study has been following a cohort of 4898 children born in large U.S. cities between 1998 and 2000. Approximately three quarters of the sampled children were born to unmarried parents; and the term of

Results

A matrix summary of the correlations, means, standard deviations, skewness, and kurtosis is shown in Table 3. Notably, the correlational analyses revealed that ACEs were highly and positively correlated with behavioral problems at all time points (coefficient r ranged from .15 to .26). The mothers’ age, education, and marital status and the child’s gender were also significantly correlated with child outcomes. As shown in Table 4, the prevalence of the top 10th percentile of behavioral problems

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