Role of adverse childhood experiences in traumatized youths' behavior problems

Background: Previous research has shown that adverse childhood experiences (ACE) such as physical abuse, sexual abuse, emotional abuse, neglect and parental risk factors (mental illness, domestic violence, incarceration, substance abuse) are associated with child behavior problems. Rarely have all of these factors been analyzed simultaneously in child samples. This study examined the associations between these ACEs and childhood behavior problems after several months of child psychotherapy.

Methods: Participants consisted of 7,222 children and adolescents treated by the National Child Traumatic Stress Network sites nationwide. Their average age was 10.0 years (S.D. 4.4 years), 51.2% were female and 62.0% received public medical insurance. Regression analyses were used to examine the associations between CBCL Total, Externalizing, and Internalizing scores after six months of treatment and ACE variables.

Results: Parental Mental Illness was associated with CBCL Total [β= 2.421 (95% CI 0.191, 4.651) p=0.031] and Externalizing [β=2.639 (95% CI 0.465, 4.813) p=0.016] T-scores. Age and CBCL T-scores at admission were also associated with CBCL T-scores six months into treatment; however, insurance status and the remaining ACEs were not associated with CBCL T-scores.

Conclusion: Surprisingly, few ACEs were associated with behavior problems; however, prior research has shown that characteristics of the ACE such as, duration, severity, and relationship to the perpetrator, are associated with child behavior problems but were not measured in this study. Future research should include detailed ACE characteristics including duration and severity, and potential moderating variables such as relationship with a stable caregiver.