Comparison of Adverse Child Experiences in a Population of ...

Comparison of Adverse Child Experiences in a Population of ...

Adverse Childhood Experiences and Functional Outcome in Young
Children
Natasha N. Clark, B.S.1, Sonja Johnson-Brooks, Ph.D.1, Corinna J. Moore 2, Harolyn M.E. Belcher 1-4, M.D., M.H.S., The
1
2
3
Family Center and Child Neurology and Developmental Medicine , The Kennedy Krieger Institute; Pediatrics , The Johns
4
Hopkins School of Medicine; Mental Health , The Johns Hopkins Bloomberg School of Public Health, Baltimore MD
Introduction

Abstract
Adverse childhood experiences (ACE), including child maltreatment,
parental mental illness, substance abuse, incarceration and exposure to
domestic violence, has been associated with adverse adult physical and
mental health outcomes. The present study examined the relationship
between ACE and functional outcome among young children following
mental health treatment by administering the Preschool and Early Childhood
Functional Assessment Scale (PECFAS). PECFAS assesses functional
impairment across seven domains. This study defines functional impairment
to be a total PECFAS > 40. Descriptive analysis and logistic regression
were used to examine the data. The cohort included 354, four to seven year
olds, in treatment at an urban community mental health center. Participants
were primarily African American (74%), with a mean age of 5.3 years (SD
= 1.0). Parental risk factors (incarceration, substance abuse, alcohol abuse,
and mental health disorders) and entry ACE were used to predict most recent
PECFAS score following adjustment for race, gender, age at treatment entry,
and length of treatment. Children with a history of parental incarceration
were twice as likely to demonstrate functional impairment (OR= 2.00; 95%
CI: 1.03-3.81). Functional impairment was also significantly associated with
increased exposure to ACE at treatment entry (OR = 1.6, 1.02 2.49). The
results suggest that history of parental incarceration and exposure to ACE at
entry are important risk factors for poor functional outcomes for young
children.

Methods

Medical Record Review Instrument
Study Participants
354 children ages 4 to
7 years old who
received treatment at
an urban communitybased mental health
treatment center

PECFAS

Measure of functional
impairment in children
across seven domains

School Role
Home Role
Community Role
Thinking
Behavior Towards Others
Mood/Emotions
Self-Harmful Behaviors

Total PECFAS > 40
defines functional
impairment

Introduction

The present study examined the associations among total
adverse childhood experiences (ACE), parental risk
factors, and child functional outcomes following mental
health treatment.

Parental risk factors associated with adverse child
outcome:

Parental Incarceration

(Phillips et al, 2002)

Externalizing
behaviors
Conduct disorders
Involvement with
criminal justice system
Parental Mental Health

ACE includes:
Physical abuse
Sexual abuse
Emotional abuse
Exposure to
Domestic violence
Mental health disorders
Incarceration
Substance abuse

(Lewinsohn et al., 2005; Weissman et al.,
2005)

2006)

Depression (Steinhausen et. al.,
1984)

Aggression (Edwards et al.,
2006)

Suicide
Depression
Anxiety
Neglect

Felitti, V.J. et al. (2006). The enduring effects of abuse and related adverse experiences in childhood. Eur Arch
Psychiatry Clin Nueurosci (256), 12.

Parental Alcoholism
Alcoholism & drug use
in offspring (Chandler et al.,

Parental Substance Abuse
Illicit drug use in
offspring (Simcha-Fagan et al.,
1986)

Child abuse and
neglect (Regan et al., 1987)

Introduction

Study Hypotheses

ACE is associated with adverse adult
physical and mental health outcomes

Obesity
Stroke
Sexual Risks Behaviors
Substance Abuse
Depression
Alcoholism
Cancer
Felitti, V.J. et al. (2006). The enduring effects of abuse and related adverse experiences in childhood. Eur Arch Psychiatry
Clin Nueurosci (256), 12.

Conclusions

Results

Results

Results

Table 1. Characteristics of Child Participants (N=354)

Table 2. Parental Risk Factors (N=354)

Table 3. Logistic Regression Analysis of Functional Impairment Adjusted
for Age at Entry, Gender, Race, and Length of Treatment (N = 354)

Characteristics

% (N)

Age at program entry (years)*

5.3 (1.0)

Length of Stay at 2nd PECFAS
(months)*

9.3 (7.3)

Gender (Male)

53.4 (189)

Race (African American)

74.0 (262)

Living with biological parent

45.8 (162)

Intrauterine Drug Exposure

10.7(38)

Fetal Alcohol Exposure

* Mean (SD)

1.4(5)

Parental Risk Factors
Alcohol Abuse

Mother % (N)
7.3 (26)

Father % (N)

30.2 (107)

12.7 (45)

Mental Illness

9 (32)

4 (14)

Incarceration

4.5 (16)

Adjusted Odds Ratio

95% Confidence Interval

Total ACE at entry*

1.60

1.02 2.49

Parental Incarceration*

2.00

1.03 3.81

Parental Alcohol Abuse

1.45

0.69 3.05

Parental Drug Abuse

0.83

0.52 1.32

Parental Mental Health
Disorder

1.60

0.80 3.17

3.7 (13)

Drug Abuse

Children exposed to ACE will have impaired
functional outcomes.
Parental substance abuse will result in impaired
child functional outcomes.
Parental history of incarceration will be associated
with impaired child functional outcomes.
Parental mental health disorders will be associated
with impaired child functional outcomes.

8.5 (30)

*p<0.05 The odds of functional impairment increased by 60% per ACE. Of the parental risk factors studied in this group of young children, parental incarceration was significantly associated with child functional impairment. Children with history of parental incarceration are twice as likely to demonstrate functional impairment relative to children without a history of parental incarceration.

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