Abstract
The purpose of this study was to examine whether the National Scientific Council on the Developing Child (NSCDC) resilience framework statistically predicted whether a child with 4 or more adverse childhood experiences (ACEs) ever had a mental health issue. The study also explored which NSCDC modifiable resilience factors had the strongest relationship with mental health issues among children with 4 or more ACEs. Utilizing the 2019 National Survey of Children’s Health, secondary data analysis was conducted using a sample of 1,225 children between 6 and 17 years old that had experienced 4 or more ACEs. Logistic regression examined whether the NSCDC framework was associated with a lower likelihood of mental health issues in school-aged children. Analysis found that the NSCDC framework predicted whether children with 4 or more ACEs ever had a mental health issue. Self-regulation had the strongest relationship with whether a child with 4 or more ACEs ever had a mental health issue. A supportive parent/caregiver relationship was also associated with a lower likelihood of ever having a mental health issue. The results demonstrate the promise of the NSCDC framework and modifiable protective factors to mitigate the impact of ACEs on mental health outcomes. Interventions that teach children skill-based self-regulation and parent/caregiver co-regulation while providing safe and supportive environments can build self-regulation to overcome ACEs. Promoting resilience-building parent–child relationships also have the potential to build resilience to mitigate ACEs.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Balistreri, K. S., & Alvira-Hammond, M. (2016). Adverse childhood experiences, family functioning and adolescent health and emotional well-being. Public health, 132, 72–78. https://doi.org/10.1016/j.puhe.2015.10.034
Bellis, M. A., Hughes, K., Ford, K., Hardcastle, K. A., Sharp, C. A., Wood, S., & Davies, A. (2018). Adverse childhood experiences and sources of childhood resilience: A retrospective study of their combined relationships with child health and educational attendance. BMC Public health, 18(1), 792. https://doi.org/10.1186/s12889-018-5699-8
Bethell, C., Davis, M. B., Gombojav, N., Stumbo, S., & Powers, K. (2017). A national and across-state profile on adverse childhood experiences among U.S. Children and possibilities to heal and thrive. Retrieved from http://www.cahmi.org/wp-content/uploads/2018/05/aces_brief_final.pdf
Bethell, C., Jones, J., Gombojav, N., Linkenbach, J., & Sege, R. (2019). Positive childhood experiences and adult mental and relational health in a statewide sample: Associations across adverse childhood experiences levels. JAMA Pediatr, e193007. https://doi.org/10.1001/jamapediatrics.2019.3007
Black, D. S., Grenard, J. L., Sussman, S., & Rohrbach, L. A. (2010). The influence of school-based natural mentoring relationships on school attachment and subsequent adolescent risk behaviors. Health education research, 25(5), 892–902. https://doi.org/10.1093/her/cyq040
Bomysoad, R. N., & Francis, L. A. (2020). Adverse childhood experiences and mental health conditions among adolescents. Journal of adolescent health, 67(6), 868–870. https://doi.org/10.1016/j.jadohealth.2020.04.013
Brown, D. W., Anda, R. F., Tiemeier, H., Felitti, V. J., Edwards, V. J., Croft, J. B., & Giles, W. H. (2009). Adverse childhood experiences and the risk of premature mortality. American journal of preventive medicine, 37(5), 389–396. https://doi.org/10.1016/j.amepre.2009.06.021
Burke, N. J., Hellman, J. L., Scott, B. G., Weems, C. F., & Carrion, V. G. (2011). The impact of adverse childhood experiences on an urban pediatric population. Child abuse and neglect, 35(6), 408–413. https://doi.org/10.1016/j.chiabu.2011.02.006
Centers for Disease Control and Prevention. (2013). Essentials for childhood: Creating safe, stable, nurturing relationships and environment for all children. Retrieved from https://www.cdc.gov/violenceprevention/pdf/essentials-for-childhood-framework508.pdf
Centers for Disease Control and Prevention. (2020). Adverse childhood experiences prevention strategy. Retrieved from https://stacks.cdc.gov/view/cdc/108183/cdc_108183_DS1.pdf
Choi, J. K., Wang, D., & Jackson, A. P. (2019). Adverse experiences in early childhood and their longitudinal impact on later behavioral problems of children living in poverty. Child abuse and neglect, 98, 104181. https://doi.org/10.1016/j.chiabu.2019.104181
Clements-Nolle, K., & Waddington, R. (2019). Adverse childhood experiences and psychological distress in juvenile offenders: The protective influence of resilience and youth assets. Journal of adolescent health, 64(1), 49–55. https://doi.org/10.1016/j.jadohealth.2018.09.025
Cohrdes, C., & Mauz, E. (2020). Self-efficacy and emotional stability buffer negative effects of adverse childhood experiences on young adult health-related quality of life. Journal of adolescent health, 67(1), 93–100. https://doi.org/10.1016/j.jadohealth.2020.01.005
Copeland, W. E., Wolke, D., Shanahan, L., & Costello, E. J. (2015). Adult functional outcomes of common childhood psychiatric problems: A prospective, longitudinal study. JAMA Psychiatry, 72(9), 892–899. https://doi.org/10.1001/jamapsychiatry.2015.0730
Crandall, A., Broadbent, E., Stanfill, M., Magnusson, B. M., Novilla, M. L. B., Hanson, C. L., & Barnes, M. D. (2020). The influence of adverse and advantageous childhood experiences during adolescence on young adult health. Child abuse and neglect, 108, 104644. https://doi.org/10.1016/j.chiabu.2020.104644
Crouch, E., Radcliff, E., Hung, P., & Bennett, K. (2019a). Challenges to school success and the role of adverse childhood experiences. Academic pediatric, 19(8), 899–907. https://doi.org/10.1016/j.acap.2019.08.006
Crouch, E., Radcliff, E., Strompolis, M., & Srivastav, A. (2019b). Safe, stable, and nurtured: Protective factors against poor physical and mental health outcomes following exposure to adverse childhood experiences (ACEs). Journal of child & adolescent trauma, 12(2), 165–173. https://doi.org/10.1007/s40653-018-0217-9
Dube, S. R., Miller, J. W., Brown, D. W., Giles, W. H., Felitti, V. J., Dong, M., & Anda, R. F. (2006). Adverse childhood experiences and the association with ever using alcohol and initiating alcohol use during adolescence. Journal of adolescent health, 38(4), 444.e441-444.e410. https://doi.org/10.1016/j.jadohealth.2005.06.006
Elmore, A. L., & Crouch, E. (2020). The association of adverse childhood experiences with anxiety and depression for children and youth, 8 to 17 years of age. Academic pediatric, 20(5), 600–608. https://doi.org/10.1016/j.acap.2020.02.012
Elmore, A. L., Crouch, E., & Kabir Chowdhury, M. A. (2020). The interaction of adverse childhood experiences and resiliency on the outcome of depression among children and youth, 8–17 year olds. Child abuse and neglect, 107, 104616. https://doi.org/10.1016/j.chiabu.2020.104616
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American journal of preventive medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8
Finkelhor, D., Shattuck, A., Turner, H., & Hamby, S. (2013). Improving the adverse childhood experiences study scale. JAMA Pediatrics, 167(1), 70–75. https://doi.org/10.1001/jamapediatrics.2013.420
Foster, B. A., & Weinstein, K. (2019). Moderating effects of components of resilience on obesity across income strata in the national survey of children’s health. Academic pediatric, 19(1), 58–66. https://doi.org/10.1016/j.acap.2018.08.012
Heard-Garris, N., Davis, M. M., Szilagyi, M., & Kan, K. (2018). Childhood adversity and parent perceptions of child resilience. BMC Pediatrics, 18(1), 204. https://doi.org/10.1186/s12887-018-1170-3
Hornor, G. (2017). Resilience. Journal of pediatric health care, 31(3), 384–390. https://doi.org/10.1016/j.pedhc.2016.09.005
Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., & Dunne, M. P. (2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The lancet public health, 2(8), e356–e366. https://doi.org/10.1016/s2468-2667(17)30118-4
Infurna, F. J., Rivers, C. T., Reich, J., & Zautra, A. J. (2015). Childhood trauma and personal mastery: Their influence on emotional reactivity to everyday events in a community sample of middle-aged adults. PLoS ONE, 10(4), e0121840. https://doi.org/10.1371/journal.pone.0121840
Jimenez, M. E., Wade, R., Jr., Lin, Y., Morrow, L. M., & Reichman, N. E. (2016). Adverse experiences in early childhood and kindergarten outcomes. Pediatrics, 137(2), e20151839. https://doi.org/10.1542/peds.2015-1839
Lenz, A. S. (2021). Evidence for relationships between hope, resilience, and mental health among youth. Journal of counseling & development, 99(1), 96–103. https://doi.org/10.1002/jcad.12357
Masten, A. S. (2018). Resilience theory and research on children and families: Past, present, and promise. Journal of Family Theory & Review, 10(1), 12–31. https://doi.org/10.1111/jftr.12255
Maternal and Child Health Bureau. (2019). National Survey of Children's Health (NSCH). Retrieved from: https://www.census.gov/data/datasets/2019/demo/nsch/nsch2019.html
Munoz, R. T., Hanks, H., & Hellman, C. M. (2020). Hope and resilience as distinct contributors to psychological flourishing among childhood trauma survivors. Traumatology, 26(2), 177. https://doi.org/10.1037/trm0000224
Murray, D. W., Rosanbalm, K., & Christopoulos, C. (2016). Self-regulation and toxic stress report 3: A comprehensive reviewof self-regulation interventions from birth through young adulthood. (OPRE Report #2016–34). Retrieved from Washington, D.C.: https://www.acf.hhs.gov/sites/default/files/documents/acf_report_3_approved_fromword_b508_0.pdf
Murray, D. W., Rosanbalm, K., Christopoulos, C., & Meyer, A. L. (2019). An applied contextual model for promoting self-regulation enactment across development: Implications for prevention, public health and future research. The Journal of Primary Prevention, 40(4), 367–403. https://doi.org/10.1007/s10935-019-00556-1
Narayan, A. J., Rivera, L. M., Bernstein, R. E., Harris, W. W., & Lieberman, A. F. (2018). Positive childhood experiences predict less psychopathology and stress in pregnant women with childhood adversity: A pilot study of the benevolent childhood experiences (BCEs) scale. Child Abuse & Neglect, 78, 19–30. https://doi.org/10.1016/j.chiabu.2017.09.022
National Scientific Council on the Developing Child. (2015). Supportive relationships and active skill-building strengthen the foundations of resilience. Retrieved from https://developingchild.harvard.edu/resources/supportive-relationships-and-active-skill-building-strengthen-the-foundations-of-resilience
Ortiz, R. (2019). Building resilience against the sequelae of adverse childhood experiences: Rise up, change your life, and reform health care. American Journal of Lifestyle Medicine, 13(5), 470–479. https://doi.org/10.1177/1559827619839997
Petruccelli, K., Davis, J., & Berman, T. (2019). Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis. Child Abuse and Neglect. https://doi.org/10.1016/j.chiabu.2019.104127
Porche, M. V., Costello, D. M., & Rosen-Reynoso, M. (2016). Adverse family experiences, child mental health, and educational outcomes for a national sample of students. School Ment Health, 8(1), 44–60. https://doi.org/10.1007/s12310-016-9174-3
Robles, A., Gjelsvik, A., Hirway, P., Vivier, P. M., & High, P. (2019). Adverse childhood experiences and protective factors with school engagement. Pediatrics, 144(2). https://doi.org/10.1542/peds.2018-2945
Schurer, S., Trajkovski, K., & Hariharan, T. (2019). Understanding the mechanisms through which adverse childhood experiences affect lifetime economic outcomes. Labour Economics. https://doi.org/10.1016/j.labeco.2019.06.007
Sciaraffa, M. A., Zeanah, P. D., & Zeanah, C. H. (2017). Understanding and promoting resilience in the context of adverse childhood experiences. Early Childhood Education Journal, 46(3), 343–353. https://doi.org/10.1007/s10643-017-0869-3
Sege, R. D., & Harper Browne, C. (2017). Responding to ACEs with hope: Health outcomes from positive experiences. Academic Pediatric, 17(7S), S79–S85. https://doi.org/10.1016/j.acap.2017.03.007
Soleimanpour, S., Geierstanger, S., & Brindis, C. D. (2017). Adverse childhood experiences and resilience: Addressing the unique needs of adolescents. Academic Pediatrics, 17(7S), S108–S114. https://doi.org/10.1016/j.acap.2017.01.008
Song, W., & Qian, X. (2020). Adverse childhood experiences and teen sexual behaviors: The role of self-regulation and school-related factors. Journal of school health, 90(11), 830–841. https://doi.org/10.1111/josh.12947
Stempel, H., Cox-Martin, M., Bronsert, M., Dickinson, L. M., & Allison, M. A. (2017). Chronic school absenteeism and the role of adverse childhood experiences. Academic pediatric, 17(8), 837–843. https://doi.org/10.1016/j.acap.2017.09.013
Thomas, M. S., Crosby, S., & Vanderhaar, J. (2019). Trauma-informed practices in schools across two decades: An interdisciplinary review of research. Review of research in education, 43(1), 422–452. https://doi.org/10.3102/0091732x18821123
Uddin, J., Alharbi, N., Uddin, H., Hossain, M. B., Hatipoglu, S. S., Long, D. L., & Carson, A. P. (2020). Parenting stress and family resilience affect the association of adverse childhood experiences with children’s mental health and attention-deficit/hyperactivity disorder. Journal of affective disorders, 272, 104–109. https://doi.org/10.1016/j.jad.2020.03.132
United States Census Bureau. (2020). 2019 National Survey of Children’s Health: Methodology report. Retrieved from https://www.childhealthdata.org/learn-about-the-nsch/methods
Wade, R., Jr., Shea, J. A., Rubin, D., & Wood, J. (2014). Adverse childhood experiences of low-income urban youth. Pediatrics, 134(1), e13–20. https://doi.org/10.1542/peds.2013-2475
Woodward, L. J., Lu, Z., Morris, A. R., & Healey, D. M. (2017). Preschool self regulation predicts later mental health and educational achievement in very preterm and typically developing children. The clinical neuropsychologist, 31(2), 404–422. https://doi.org/10.1080/13854046.2016.1251614
Zins, J. E., & Elias, M. J. (2007). Social and emotional learning: Promoting the development of all students. Journal of educational and psychological consultation, 17(2–3), 233–255.
Funding
No funding was received in order to conduct this study.
Author information
Authors and Affiliations
Contributions
K. K. formulated the initial study, completed the data analysis, and drafted the manuscript; R. E. contributed to the development of the manuscript, assisted in conceptualizing the study, and assisted in the drafting of the manuscript. Both authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethical Approval
Data utilized in this study was de-identified, secondary data from the 2019 National Survey of Children’s Health that was determined to be not human subjects research based upon review by the University of Alabama at Birmingham Institutional Review Board.
Conflict of Interest
The authors declare that they have no conflicts of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Keane, K., Evans, R.R. Exploring the Relationship Between Modifiable Protective Factors and Mental Health Issues Among Children Experiencing Adverse Childhood Experiences Using a Resilience Framework. Journ Child Adol Trauma 15, 987–998 (2022). https://doi.org/10.1007/s40653-022-00471-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40653-022-00471-4