The Comorbidity of Physical, Mental, and Developmental Conditions Associated with Childhood Adversity: A Population Based Study
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Objective Adverse childhood experiences (ACEs) are associated with myriad health conditions and risk behaviors in both adolescents and adults. In this study we examine the association between ACEs and specific physical, mental, and developmental conditions, as well as their comorbidity, in a nationally representative sample of children 0–17 years. Methods Data from the 2011–2012 National Survey for Child Health (NSCH) were used. A total of 95,677 random-digit-dial interviews with parents of children 0–17 years were conducted across all 50 states and the District of Columbia. Outcomes included singular condition domains (physical, mental, and developmental) as well as combinations of condition domains (e.g., physical plus mental, mental plus developmental, etc.). Results Twenty-three percent of parents reported that their child experienced 1 ACE; 9.2 % experienced 2 ACEs, and 10.3 % experienced three or more. Across all three condition domains and combinations of domains, children who experienced at least one ACE were more likely than children who experienced 0 ACEs to have at least one condition. Additionally, greater ACEs was associated with increased likelihood of at least one condition in each domain and in multiple domains. Conclusions for practice These findings support the extension of existing family environment screening tools in pediatric practices as well as the establishment of a system for monitoring ACEs in families with multiple or complex conditions.
KeywordsAdverse childhood experiences Pediatrics Comorbidity Public health
Administration for children and families
National Center for Chronic Disease Prevention and Health Promotion
American Academy of Pediatrics
Adverse childhood experiences
Federal poverty level
National Study of Children’s Health
Child and adolescent measurement initiative
The corresponding author (MB) had full access to all of the data under a data use agreement between CAHMI’s Data Resource Center and Melanie Sberna Hinojosa. The authors take responsibility for the integrity of the data and the accuracy of the data analysis. None of the authors have potential conflicts of interest to declare. The manuscript uses publicly available data and subsequently did not require ethical approval from the Institutional Review Board.
Compliance with Ethical Standards
Conflict of interest
The authors have no conflicts of interest to declare.
- 1.Child and Adolescent Health Measurement Initiative (CAHMI). 2011–2012 indicator data set. Retrieved from http://www.childhealthdata.org.
- 4.Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., & Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 256(3), 174–186. doi: 10.1007/s00406-005-0624-4.CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Brehaut, J. C., Garner, R. E., Miller, A. R., Lach, L. M., Klassen, A. F., Rosenbaum, P. L., & Kohen, D. E. (2011). Changes over time in the health of caregivers of children with health problems: Growth-curve findings from a 10-year Canadian population-based study. American Journal of Public Health, 101(12), 2308–2316. doi: 10.2105/AJPH.2011.300298.CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Brown, D. W., Anda, R. F., Felitti, V. J., Edwards, V. J., Malarcher, A. M., Croft, J. B., & Giles, W. H. (2010). Adverse childhood experiences are associated with the risk of lung cancer: A prospective cohort study. BMC Public Health, 10, 20. doi: 10.1186/1471-2458-10-20.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Centers for Disease Control and Prevention, National Center for Health Statistics, State and Local Area Integrated Telephone Survey. 2011–2012 National Survey of Children’s Health Frequently Asked Questions. Retrieved from http://www.cdc.gov/nchs/slaits/nsch.htm.
- 13.Deater-Deckard, K., Mullineaux, P. Y., Beekman, C., Petrill, S. A., Schatschneider, C., & Thompson, L. A. (2009). Conduct problems, IQ, and household chaos: A longitudinal multi-informant study. Journal of Child Psychology and Psychiatry, 50(10), 1301–1308. doi: 10.1111/j.1469-7610.2009.02108.x.CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Dong, M., Giles, W. H., Felitti, V. J., Dube, S. R., Williams, J. E., Chapman, D. P., & Anda, R. F. (2004). Insights into causal pathways for ischemic heart disease: Adverse childhood experiences study. Circulation, 110(13), 1761–1766. doi: 10.1161/01.CIR.0000143074.54995.7F.CrossRefPubMedGoogle Scholar
- 20.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.CrossRefPubMedGoogle Scholar
- 24.Garner, A. S., Shonkoff, J. P., Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, & Section on Developmental and Behavioral Pediatrics. (2012). Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics, 129(1), e224–e231. doi: 10.1542/peds.2011-2662.CrossRefPubMedGoogle Scholar
- 25.Hinojosa, M. S., Hinojosa, R., Fernandez-Baca, D., Knapp, C., & Thompson, L. A. (2012). Parental strain, parental health, and community characteristics among children with attention deficit-hyperactivity disorder. Academic Pediatric, 12(6), 502–508. doi: 10.1016/j.acap.2012.06.009.CrossRefGoogle Scholar
- 27.Johnson, A. D., Martin, A., Brooks-Gunn, J., & Petrill, S. A. (2008). Order in the house! associations among household chaos, the home literacy environment, maternal reading ability, and children’s early reading. Merrill Palmer Q (Wayne State Univ Press), 54(4), 445–472. doi: 10.1353/mpq.0.0009.CrossRefGoogle Scholar
- 39.Shonkoff, J. P., Garner, A. S., Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, & Section on Developmental and Behavioral Pediatrics. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246. doi: 10.1542/peds.2011-2663.CrossRefPubMedGoogle Scholar
- 40.Straus, M. A., Gelles, R. J., & Smith, C. (1990). Physical violence in American families: risk factors and adaptations to violence in 8145 families. New Brunswick, NJ: Transaction Publishers.Google Scholar
- 44.Vostanis, P., Graves, A., Meltzer, H., Goodman, R., Jenkins, R., & Brugha, T. (2006). Relationship between parental psychopathology, parenting strategies and child mental health: Findings from the GB national study. Social Psychiatry and Psychiatric Epidemiology, 41(7), 509–514. doi: 10.1007/s00127-006-0061-3.CrossRefPubMedGoogle Scholar