Relationship Between Adverse Childhood Experiences and Missed School Days Among US Children, 2011-2012

Background: Adverse childhood experiences (ACEs) are associated with adverse health outcomes in adults and adolescents.  Using the 2011-2012 National Survey of Children’s Health (NSCH), we explored the relationship between ACEs and missed school days (MSD) secondary to illness or injury among US children.

Methods: Analyses were restricted to children age 6-17, enrolled in school, with recorded ACE responses (n=62,675).  NSCH addresses nine ACEs.  Parents reported the number of MSD in the previous year.  Linear regression was performed to adjust for individual, household, and neighborhood level covariates while accounting for the complex survey design. 

Results: Forty-eight percent of children experienced ≥1 ACE with the following weighted prevalence estimates: socioeconomic hardship (25.6%), parental divorce/separation (24.2%), household member with alcohol/drug problem (13.1%), victim/witness of neighborhood violence (11.3%), household member mentally ill/suicidal (10.0%), parent served jail time (8.1%), witness to domestic violence (8.8%), unfair treatment due to race/ethnicity (5.5%), and parent death (4.1%).  Compared to children with no ACEs [mean MSD=3.1 (95% CI 3.0 – 3.2)], the adjusted increase in mean MSD was 0.9 days (0.6 – 1.1), 1.3 days (1.0 – 1.6) and 2.2 days (1.9 – 2.5) for children with 1, 2, and ≥3 ACEs, respectively.  Exposure to mental illness [2.0 days (1.5 – 2.4)] and neighborhood violence [1.7 days (1.4 – 2.1)] were the individual ACEs with the largest unadjusted increase in mean MSD. 

Conclusion: While the primary prevention of ACEs is the ultimate goal, recognition that ACEs are associated with school absenteeism may help to guide and enhance intervention efforts to improve academic success for at-risk children.