Abstract
Positive childhood experiences (PCEs) have substantial potential to improve children’s mental health. We examined the prevalence of 26 specific PCEs, overall and by demographics, and the individual and cumulative effects of PCEs with current diagnosis of three mental health conditions using nationally representative, parent-reported data on U.S. children aged 6–17 years from the 2018–2019 National Survey of Children’s Health (n=35,583). The prevalence of each PCE varied, with a range between 22.6% (gets recommended amount of physical activity) to 92.1% (parent(s) have positive mental health). Accounting for demographics, there were associations between most specific PCEs and lower prevalence of current childhood anxiety (22 of 26 PCEs), depression (22 of 26 PCEs), and behavioral or conduct problems (21 of 26 PCEs). There was a dose-response relationship between children in higher cumulative PCE quartiles and lower proportions of anxiety, depression, and behavioral or conduct problems. Findings generally did not attenuate after further adjusting for adverse childhood experiences. PCEs are common among U.S. children, but vary substantially by type of PCE and subpopulation. This has critical implications for focusing prevention and intervention strategies to bolster PCEs in ways that could improve health equity and children’s mental health.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
Data from the National Survey of Children's Health are publicly available and can be accessed via the US Census Bureau (https://www.census.gov/programs-surveys/nsch/data/datasets.html) or the Data Resource Center for Child and Adolescent Health (https://www.childhealthdata.org/learn-about-the-nsch/NSCH).
References
Alsarrani, A., Hunter, R. F., Dunne, L., & Garcia, L. (2022). Association between friendship quality and subjective wellbeing among adolescents: a systematic review. BMC Public Health, 22, 2420. https://doi.org/10.1186/s12889-022-14776-4
Anderson, K. N., Johns, D., Holland, K. M., Chen, Y., Vivolo-Kantor, A. M., Trinh, E., Bitsko, R. H., Leeb, R. T., Radhakrishnan, L., Bacon, S., & Jones, C. M. (2023). Emergency department visits involving mental health conditions, suicide-related behaviors, and drug overdoses among adolescents–United States, January 2019–February 2023. MMWR Morbidity & Mortality Weekly Report, 72(19), 502–512. https://doi.org/10.15585/mmwr.mm7219a1
Anderson, K. N., Swedo, E. A., Trinh, E., Ray, C. M., Krause, K. H., Verlenden, J. V., Clayton, H. C., Villaveces, A., Massetti, G. M., & Holditch Niolon, P. (2022). Adverse childhood experiences during the COVID-19 pandemic and associations with poor mental health and suicidal behaviors among high school students – Adolescent Behaviors and Experiences Survey, United States, January–June 2021. MMWR Morbidity & Mortality Weekly Report, 71(41), 1301–1305. https://doi.org/10.15585/mmwr.mm7141a2
Austin, A. E., Naumann, R. B., Shiue, K. Y., Daniel, L., Singichetti, B., & Hays, C. N. (2022). An illustrative review of substance use-specific insights from the National Longitudinal Study of Adolescent to Adult Health. Journal of Adolescent Health, 71(S6), S6–S13. https://doi.org/10.1016/j.jadohealth.2022.08.025
Bailey, Z. D., Kriger, N., Agenor, M., Graves, J., Linos, N., & Bassett, M. T. (2017). Structural racism and health inequities in the USA: evidence and interventions. The Lancet, 389(10077), 1453–1463. https://doi.org/10.1016/S0140-6736(17)30569-X
Barry, C. M., Robinson, L. R., Kaminski, J. W., Danielson, M. L., Jones, C. L., & Lang, D. L. (2022). Behavioral and socioemotional outcomes of the Legacy for Children randomized control trial to promote healthy development of children living in poverty, 2 to 6 years postintervention. Journal of Developmental & Behavioral Pediatrics, 43(1), e39–e47. https://doi.org/10.1097/DBP.0000000000000962
Bethell, C., Jones, J., Gombojav, N., Linkenbach, J., & Sege, B. (2019). Positive childhood experiences and adult mental and relational health in a statewide sample: associations across adverse childhood experiences levels. JAMA Pediatrics, 173(11), e193007. https://doi.org/10.1001/jamapediatrics.2019.3007
Bethell, C. D., Carle, A., Hudziak, J., Gombojav, N., Powers, K., Wade, R., & Braverman, P. (2017). Methods to assess adverse childhood experiences of children and families: toward approaches to promote child well-being in policy and practice. Academic Pediatrics, 17(7), S51–S69. https://doi.org/10.1016/j.acap.2017.04.161
Bond, L., Butler, J., Thomas, L., Carlin, J. G. S., Bowes, G., & Patton, G. (2007). Social and school connectedness in early secondary school as predictors of late teenage substance use, mental health, and academic outcomes. Journal of Adolescent Health, 40(4), 357.e9–357.18. https://doi.org/10.1016/j.jadohealth.2006
Broadbent, E., Miller, J. R., Cheung, A., Rollins, E. M., Novilla, L. K. B., Downing, M. S., & Crandall, A. (2022). Concurrent childhood experiences impact underage substance use. Child Maltreatment, 27(4), 605–614. https://doi.org/10.1177/10775595211012480
Bunting, L., McCartan, C., Davidson, G., Grant, A., Mulholland, C., Schubotz, D., Hamill, R., McBride, O., Murphy, J., Nolan, E., & Shevlin, M. (2023). The influence of adverse and positive childhood experiences on young people’s mental health and experiences of self-harm and suicidal ideation. Child Abuse & Neglect, 140, 106159. https://doi.org/10.1016/j.chiabu.2023.106159
Center on the Developing Child (2010). The foundations of lifelong health are built in early childhood. Retrieved June 1, 2023, from: https://developingchild.harvard.edu/resources/the-foundations-of-lifelong-health-are-built-in-early-childhood/
Centers for Disease Control and Prevention. (2019a). Essentials for Childhood Framework: creating safe, stable, nurturing relationships and environments for all children. National Center for Injury Prevention and Control Retrieved January 4, 2024, from: cdc.gov/violenceprevention/pdf/essentials-for-childhood-framework508.pdf
Centers for Disease Control and Prevention. (2019b). Preventing adverse childhood experiences: leveraging the best available evidence. National Center for Injury Prevention and Control Retrieved January 4, 2024, from: cdc.gov/violenceprevention/pdf/ACEs-Prevention-Resource_508.pdf
Centers for Disease Control and Prevention. (2022). Adverse childhood experiences research priorities for equitable prevention, intervention, identification, and response. National Center for Injury Prevention and Control Retrieved June 1, 2023, from: https://www.cdc.gov/injury/researchpriorities
Chapman, R., Parkinson, M., & Halligan, S. (2016). How do parent-child interactions predict and maintain depression in childhood and adolescence: a critical review of the literature. Adolescent Psychiatry, 6(2), 100–115. https://doi.org/10.2174/2210676606666160822101450
Crandall, A., Broadbent, E., Stanfill, M., Magnusson, B. M., Novilla, L. B., Hanson, C. L., & Barnes, M. D. (2020). The influence of adverse and advantageous childhood experiences during adolescent on young adult health. Child Abuse & Neglect, 96, 104089. https://doi.org/10.1016/j.chiabu.2020.104644
Crosnoe, R., & Thorpe, J. (2022). Twenty-five years of national-level research on adolescent and young adult mental health in the United States. Journal of Adolescent Health, 71(S6), S40–S46. https://doi.org/10.1016/j.jadohealth.2022.08.008
Crouch, E., Probst, J., Shi, S., McLain, A., Eberth, J., Brown, M., Merrell, M., & Bennett, K. (2023). Examining the association between rurality and positive childhood experiences among a national sample. Journal of Rural Health, 39, 105–112. https://doi.org/10.1111/jrh.12708
Crouch, E., Radcliff, E., Bennett, K., Brown, M. J., & Hung, P. (2023). Child and adolescent health in the United States: The role of adverse and positive childhood experiences. Journal of Child and Adolescent Trauma, 1–9. https://doi.org/10.1007/s40653-023-00588-0
Crouch, E., Radcliff, E., Merrell, M. A., & Bennett, K. J. (2021). Rural-urban differences in positive childhood experiences across a national sample. Journal of Rural Health, 37(3), 495–503. https://doi.org/10.1111/jrh.12493
Crouch, E., Radcliff, E., Merrell, M. A., Brown, M. J., Ingram, L. A., & Probst, J. (2021). Racial/ethnic differences in positive childhood experiences across a national sample. Child Abuse & Neglect, 115, 105012. https://doi.org/10.1016/j.chiabu.2021.105012
Crouch, E., Radcliff, E., Srivastav, A., & McRell, A. S. (2022). Examining racial/ethnic differences in positive childhood experiences among respondents in a southern state. Journal of Child and Adolescent Trauma, 15, 1191–1198 10.1007/s40653-022-00453-6
Crush, E., Arseneault, L., Jaffee, S. R., Danese, A., & Fisher, H. L. (2018). Protective factors for psychotic symptoms in poly-victimized children. Schizophrenia Bulletin, 44(3), 691–700. https://doi.org/10.1093/schbul/sbx111
Donahue, J. M., Cole, E. S., James, C. V., Jarlenski, M., Michener, J. D., & Roberts, E. T. (2022). The US Medicaid program: coverage, financing, reforms, and implications for health equity. JAMA, 328(11), 1085–1099. https://doi.org/10.1001/jama.2022.14791
Foy, J. M., Green, C. M., Earls, M. F., & the Committee on Psychological Aspects of Child and Family Health, Mental Health Leadership Work Group. (2019). Mental health competencies for pediatric practice. Pediatrics, 144(5), e20192757. https://doi.org/10.1542/peds.2019-2757
Gaylor, E. M., Krause, K. H., Welder, L. E., Cooper, A. C., Ashley, C., Mack, K. A., Crosby, A. E., Trinh, A., Ivey-Stephenson, A. Z., & Whittle, L. (2023). Suicidal thoughts and behaviors among high school students–Youth Risk Behavior Survey, United States, 2021. MMWR Supplements, 72(Suppl-1), 45–54. https://doi.org/10.15585/mmwr.su7201a6
Ghandour, R. M., Jones, J. R., Lebrun–Harris, L. A., Minnaert, J., Blumberg, S. J., Fields, J., Bethell, C., & Kogan, M. D. (2018). The design and implementation of the 2016 National Survey of Children’s Health. Maternal Child Health Journal, 22(8), 1093–1102. https://doi.org/10.1007/s10995-018-2526-x
Gorostiaga, A., Aliri, J., Balluerka, N., & Lameirinhas, J. (2019). Parenting styles and internalizing symptoms in adolescence: a systematic literature review. International Journal of Environmental Research in Public Health, 16(17), 3192. https://doi.org/10.3390/ijerph16173192
Graupensberger, S., Kilmer, J. R., Olson, D. C., & Linkenbach, J. W. (2023). Associations between positive childhood experiences and adult smoking and alcohol use behaviors in a large statewide sample. Journal of Community Health, 48, 260–268. https://doi.org/10.1007/s10900-022-01155-8
Grossman, J. B., & Tierney, J. P. (1998). Does mentoring work? An impact study of the Big Brothers Big Sisters Program. Evaluation Review, 22(3), 403–426. https://doi.org/10.1177/0193841X980220030
Han, D., Dieujuste, N., Doom, J. R., & Narayan, A. J. (2023). A systematic review of the positive childhood experiences and adult outcomes: Promotive and protective processes for resilience in the context of childhood adversity. Child Abuse & Neglect, 144, 106356. https://doi.org/10.1016/j.chiabu.2023.106346
Homel, J., Thompson, K., & Leadbeater, B. (2020). Changes in positive and negative peer influences and depressive symptoms from adolescence to young adulthood. Journal of Adolescence, 84, 113–122. https://doi.org/10.1016/j.adolescence.2020.08.009
Hutchins, H. J., Barry, C. M., Wanga, V., Bacon, S., Njai, R., Classen, A. H., Ghandour, R. M., Lebrun-Harris, L. A., Perkins, K., & Robinson, L. R. (2022). Perceived racial/ethnic discrimination, physical and mental health conditions in childhood, and the relative role of other adverse experiences. Adversity and Resilience Science, 3(2), 181–194. https://doi.org/10.1007/s42844-022-00063-z
Kauhanen, L., Wan Mohd Yunus, W. M. A., Lempinen, L., Peltonen, K., Gyllenberg, D., Mishina, K., Gilbert, S., Bastola, K., Brown, J. S., & Sourander, A. (2023). A systematic review of the mental health changes of children and youth people before and during the COVID-19 pandemic. European Child & Adolescent Psychiatry, 32, 995–1013. https://doi.org/10.1007/s00787-022-02060-0
King, C. A., Gipson, P. Y., Arango, A., Lernihan, D., Clark, M., Foster, C. E., Caldwell, C., Ghaziuddin, N., & Stone, D. (2021). LET’s CONNECT community mentorship program for adolescents with peer social problems: a randomized intervention trial. American Journal of Community Psychology, 68(3-4), 310–322. https://doi.org/10.1002/ajcp.12528
Laursen, B., & Collins, W. A. (2009). Parent-child relationships during adolescence. In R. M. Lerner & L. Steinberg (Eds.), Handbook of Adolescent Psychology (3rd ed., pp. 3–42). John Wiley & Sons.
Lebrun-Harris, L. A., Ghandour, R. M., Kogan, M. D., & Warren, M. D. (2022). Five-year trends in US children’s health and well-being, 2016–2020. JAMA Pediatrics, 176(7), e220056. https://doi.org/10.1001/jamapediatrics.2022.0056
Lerner, R. M., Lerner, J. V., Bowers, E. P., & Geldhof, J. (2015). Positive youth development and relational-developmental-systems. In R. M. Lerner (Ed.), Handbook of Child Psychology and Developmental Science (7th ed.). John Wiley & Sons.
Lyu, W., & Wehby, G. L. (2023). Child flourishing, school engagement, physical activity, and screen time during the Coronavirus Disease 2019 pandemic in 2020. Academic Pediatrics, 22, S187602859(22)00643-X. https://doi.org/10.1016/j.acap.2022.12.016
Mak, H. W., & Iacovou, M. (2018). Dimensions of the parent-child relationship: effects on substance use in adolescence and adulthood. Substance Use & Misuse, 54(5), 724–736. https://doi.org/10.1080/10826084.2018.1536718
Marraccini, M. E., & Brier, Z. M. F. (2017). School connectedness and suicidal thoughts and behaviors: a systematic meta-analysis. School Psychology Quarterly, 32(1), 5–21. https://doi.org/10.1037/spq0000192
Masten, A. S., Lucke, C. M., Nelson, K. M., & Stallworthy, I. C. (2021). Resilience in development and psychopathology: Multisystem perspectives. Annual Review of Clinical Psychology, 17, 521–549. https://doi.org/10.1146/annurev-clinpsy-081219-120307
Metzler, M., Merrick, M. T., Klevens, J., Ports, K. A., & Ford, D. C. (2017). Adverse childhood experiences and life opportunities: shifting the narrative. Children & Youth Services Review, 72, 141–149. https://doi.org/10.1016/j.childyouth.2016.10.021
Morris, A. S., Criss, M. M., Silk, J. S., & Houltberg, B. J. (2017). The impact of parenting on emotion regulation during childhood and adolescence. Child Development Perspectives, 11(4), 233–238. https://doi.org/10.1111/cdep.12238
Narayan, A. J., Rivera, L. M., Bernstein, R. E., Harris, W. W., & Lieberman, E. F. (2018). Positive childhood experiences predict less psychopathology and stress in pregnant women with childhood adversity: a pilotstudy of the benevolent childhood experiences (BCEs) scale. Child Abuse & Neglect, 78, 19–30. https://doi.org/10.1016/j.chiabu.2017.09.022
National Academies of Sciences, Engineering, and Medicine. (2019). Fostering healthy mental, emotional, and behavioral development in children and youth: a national agenda. The National Academies Press Retrieved January 4, 2024, from: https://nap.nationalacademies.org/catalog/25201/fostering-healthy-mental-emotional-and-behavioral-development-in-children-and-youth
Neal, J. W., & Veenstra, R. (2021). Network selection and influence effects on children’s and adolescent’s internalizing behaviors and peer victimization: a systematic review. Developmental Review, 59, 100944. https://doi.org/10.1016/j.dr.2020.100944
Parks, M. J., Roesler, J., Menanteau, B., Raguet, M., & Eisenberg, M. E. (2022). The intersection of depressive symptoms, adverse childhood experiences, and protective factors among adolescents: epidemiological evidence from Minnesota. Adversity & Resilience Science, 3(1), 21–36. https://doi.org/10.1007/s42844-022-00052-2
Perrin, J. M., Lu, M. C., Geller, A., & Devoe, J. E. (2020). Vibrant and healthy kids: aligning science, practice and policy to advance health equity. Academic Pediatrics, 20, 160–162. https://doi.org/10.1016/j.acap.2019.11.019
Peterson, C., Aslam, M. V., Niolon, P. H., Bacon, S., Bellis, M. A., Mercy, J. A., & Florence, C. (2023). Economic burden of health conditions associated with adverse childhood experiences among US adults. JAMA Network Open, 6(12), e2346323. https://doi.org/10.1001/jamanetworkopen.2023.46323
Radhakrishnan, L., Leeb, R. T., Bitsko, R. H., et al. (2022). Pediatric emergency department visits associated with mental health conditions before and during the COVID-19 pandemic–United States, January 2019–January 2022. MMWR Morbidity & Mortality Weekly Report, 71(8), 319–324. https://doi.org/10.15585/mmwr.mm7108e2
Raghunathan, R. S., Sosnowski, D. W., Musci, J. J., & Johnson, S. B. (2024). A scoping review of positive childhood experiences: Measurement and evidence. Adversity and Resilience Science, 1–8. https://doi.org/10.1007/s42844-023-00125-w
Rodriguez-Ruiz, J., Zych, I., Ribeaud, D., Steinhoff, A., Eisner, M., Quednow, B. B., & Shanahan, L. (2023). The influence of different dimensions of the parent-child relationship in childhood as longitudinal predictors of substance use in late adolescence: the mediating role of self-control. International Journal of Mental Health & Addiction, 1–18. https://doi.org/10.1007/s11469-023-01036-8
Rose, I. D., Lesesne, C. A., Sun, J., Johns, M. M., Zhang, X., & Hertz, M. (2022). The relationship of school connectedness to adolescents’ engagement in co-occurring health risks: a meta-analytic review. Journal of School Nursing, 40(1), 58–73. https://doi.org/10.1177/10598405221096802
Search Institute. (2024). The Developmental Assets Framework. Retrieved April 2, 2024, from https://www.search-institute.org/our-research/development-assets/developmental-assets-framework/
Sege, R. D., & Browne, C. H. (2017). Responding to ACEs with HOPE: Healthy Outcomes from Positive Experiences. Academic Pediatrics, 17, S79–S85. https://doi.org/10.1016/j.acap.2017.03.007
Sosnowski, D. W., Musci, R. J., & Johnson, S. B. (2021). Positive functioning moderates the association between classes of adverse childhood experiences and adolescent depression symptoms. Adversity & Resilience Science, 2(3), 157–168. https://doi.org/10.1007/s42844-021-00033-x
U.S. Census Bureau (2023a). National Survey of Children’s Health data. Retrieved January 31, 2023, from: https://www.census.gov/programs-surveys/nsch.html.
U.S. Census Bureau (2023b). 2018 National Survey of Children’s Health (NSCH): Methodology Report. Retrieved January 31, 2023, from: https://www2.census.gov/programs–surveys/nsch/technical–documentation/methodology/2018–NSCH–Methodology–Report.pdf.
U.S. Census Bureau (2023c). 2019 National Survey of Children’s Health (NSCH): Methodology Report. Accessed January 31, 2023, from: https://www2.census.gov/programs–surveys/nsch/technical–documentation/methodology/2019–NSCH–Methodology–Report.pdf.
Ziker, J. P., & Snopkowski, K. (2020). Life-history factors in influence teenagers’ suicidal ideation: a model selection analysis of the Candian National Longitudinal Survey of Children and Youth. Evolutionary Psychology, 18(3), 1474704920939521. https://doi.org/10.1177/1474704920939521
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclaimer
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Health Resources and Services Administration.
Conflicts of Interest
The authors have no conflicts of interest or financial disclosures to report.
Supplementary Information
ESM 1
(DOCX 61 kb)
Rights and permissions
About this article
Cite this article
Anderson, K.N., Okwori, G., Hutchins, H.J. et al. Prevalence of Positive Childhood Experiences and Associations with Current Anxiety, Depression, and Behavioral or Conduct Problems among U.S. Children Aged 6–17 Years. ADV RES SCI 5, 447–464 (2024). https://doi.org/10.1007/s42844-024-00138-z
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1007/s42844-024-00138-z