Overview
This study is, to our knowledge, the largest retrospective source of Early Life Adversity (ELA) derived from a population-based study of youth development. An exploratory factor analysis (EFA) yielded a 6-factor solution corresponding to distinct domains of ELA, including:
- Physical and sexual violence
- Parental psychopathology
- Neighborhood threat
- Prenatal substance exposure
- Scarcity
- Household dysfunction
Our findings reveal that ELA prevalence among 9- and 10-year-old youth is largely driven by the incidence of parental psychopathology. The lifetime prevalence of any adult psychiatric disorder per DSM-IV diagnostic criteria has been estimated at 46.4% [24]. Our sample’s greater proportion (81.4%) may in part be attributable to a different measure being used to capture psychopathology and that the measure was not just completed by the youth’s biological parent but by the primary caregiver, which was not always the same. Therefore, parental psychopathology as an exposure may reflect both genetic and behavioral influences on our clinical outcomes and does not always equate with behavioral exposure in the instances where youth do not have contact with their biological parent(s) at baseline (n (%) = 443, 3.8%). Lastly, biological parental psychopathology reported by the caregiver is not equivalent to a clinical diagnosis.
Sociodemographic characteristics significantly differed between youth with adversity exposure and controls, specifically, sex, race/ethnicity of youth, primary caregiver’s education and family income. These findings are supported by previous research showing a higher incidence of ELA among racial and ethnic minorities, and among individuals identifying with low SES [4], the latter also associated with an increased risk for mental and physical health problems [25]. Adversity exposure was significantly associated with greater problematic behaviors, specifically, parental psychopathology, household dysfunction and neighborhood threat.
Exploratory factor analysis
A 6-factor solution corresponding to 6 domains of ELA were derived from an EFA performed on 47 variables both youth and caregiver-reported across 14 measures. Seventeen variables were not included in the final EFA due to sparse endorsement of the variables which can in part be explained by the sensitive self-identifying nature of the questions, which were primarily caregiver-reported, as well as narrow time constraints referenced in the question, i.e., within the past 6 months. While the 6 domains of ELA are similar to the original Adverse Childhood Experiences (ACEs), our domains differ in two prominent areas: incarceration of household member and neighborhood threat. We hypothesized that adversity domains derived from the EFA would overall align with and complement the domains established by the CDC-Kaiser ACE’s Study given that the original categorizations of exposure were broad yet discrete in nature. At baseline, the ABCD Study did not capture information on youth, caregiver, or household member incarceration. Given that one in three Americans will have an encounter with the criminal justice system, with racial and ethnic minorities carrying a significantly greater risk [26], capturing incidences of arrest, detainment, juvenile confinement, and adult incarceration are necessary to comprehensively catalog exposures that impact youth development. Not only does incarceration of a caregiver or family member constitute the removal of a source of support, a youth’s direct involvement with the justice system is associated with significant disadvantages (e.g., educational, economic, social, emotional, general health and wellbeing) throughout the lifespan [27]. Our study was, however, able to capture both youth and caregiver reported neighborhood threat. National survey data indicate that adolescent exposure to community violence is on par with adversity exposure within the home [28]. Irrespective of direct harm, community violence exposure constitutes a pervasive threat that accelerates biological aging and contributes to detrimental quality of life outcomes [29]. Despite not being captured in the original ACEs Study, more recent studies examining ELA are including measures of neighborhood or community threat and or violence [30]. Our findings support the literature detailing the increased incidence of problematic behaviors following neighborhood threat and community violence exposure [31]. Lastly, our EFA resulted in the combination of physical and sexual violence exposure into one domain versus two discrete categories of exposure. This may in part be explained by the minimal endorsement of these exposure types as well as that the same questionnaire (i.e., Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5)) was used to measure physical and sexual violence exposure.
Relationship between adversity and behavioral outcomes
Our findings that youth with ELA endorsed more internalizing, externalizing, and total problematic behaviors, which is associated with psychopathology risk, is supported in the literature [32]. Unsurprisingly, half of all childhood-onset and about one-third of adolescent-onset psychiatric disorders are associated with early life adversity exposure [33]. Our findings that parental psychopathology, household dysfunction, and neighborhood threat carried the greatest influence on problematic behaviors among 9- and 10-year-olds in our sample suggest identifying sources of resiliency that may combat these specific forms of exposure. For example, resources within the school and community, such as school-based programs, athletic associations, and peer mentorships, may act as sources of support for youth who are experiencing adversity within the home and immediate environment.
Youth with higher factor scores across the following domains had more internalizing problems: physical and sexual violence; parental psychopathology; and scarcity. Conversely, individuals with higher factor scores across the following domains had higher externalizing problems: neighborhood threat; prenatal substance exposure; and household dysfunction. While ELA exposure does not typically occur in isolation [8], these associations suggest possible mechanistic differences in type-specific ELA’s impact on associated behaviors. The mechanistic differences may be attributable to an individual’s neurodevelopmental stage during exposure and/or to the neurodevelopmental subtleties in how different forms of ELA are processed in a region-specific manner. Understanding the nuanced relationship between subtypes of ELA and different problematic behaviors may aid in the earlier identification of ELA exposure and targeted interventional efforts, particularly for those that may be less physically-apparent (e.g., parental psychopathology).
Implications of findings
Our findings spotlight the need to develop data-driven approaches to the categorization of ELA, highlighting the need to examine nuances of exposure, e.g., type, age of onset, frequency, duration, and relationship with the perpetrator. The youth in our sample endorsed discrete forms of ELA, the incidence of which significantly differed by sex, race, ethnicity and other sociodemographic characteristics. Additionally, different forms of ELA were associated with specific problematic behaviors. The use of broad domains, such as abuse and neglect [13]; active and passive
SDGs, Targets, and Indicators
SDGs Addressed:
- SDG 1: No Poverty
- SDG 3: Good Health and Well-being
- SDG 4: Quality Education
- SDG 5: Gender Equality
- SDG 10: Reduced Inequalities
- SDG 16: Peace, Justice, and Strong Institutions
Targets Identified:
- Target 1.2: By 2030, reduce at least by half the proportion of men, women, and children of all ages living in poverty in all its dimensions according to national definitions.
- Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
- Target 4.2: By 2030, ensure that all girls and boys have access to quality early childhood development, care, and pre-primary education so that they are ready for primary education.
- Target 5.1: End all forms of discrimination against all women and girls everywhere.
- Target 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status.
- Target 16.1: Significantly reduce all forms of violence and related death rates everywhere.
Indicators:
- Indicator 1.2.2: Poverty headcount ratio
- Indicator 3.4.1: Mortality rate attributed to cardiovascular disease, cancer, diabetes, or chronic respiratory disease
- Indicator 4.2.1: Proportion of children under 5 years of age who are developmentally on track in health, learning, and psychosocial well-being
- Indicator 5.1.1: Proportion of women aged 15-49 years who have ever experienced physical or sexual violence by an intimate partner
- Indicator 10.2.1: Proportion of people living below 50 percent of median income, by age, sex, and persons with disabilities
- Indicator 16.1.1: Number of victims of intentional homicide per 100,000 population, by sex and age
Table: SDGs, Targets, and Indicators
| SDGs | Targets | Indicators |
|---|---|---|
| SDG 1: No Poverty | Target 1.2: By 2030, reduce at least by half the proportion of men, women, and children of all ages living in poverty in all its dimensions according to national definitions. | Indicator 1.2.2: Poverty headcount ratio |
| SDG 3: Good Health and Well-being | Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. | Indicator 3.4.1: Mortality rate attributed to cardiovascular disease, cancer, diabetes, or chronic respiratory disease |
| SDG 4: Quality Education | Target 4.2: By 2030, ensure that all girls and boys have access to quality early childhood development, care, and pre-primary education so that they are ready for primary education. | Indicator 4.2.1: Proportion of children under 5 years of age who are developmentally on track in health, learning, and psychosocial well-being |
| SDG 5: Gender Equality | Target 5.1: End all forms of discrimination against all women and girls everywhere. | Indicator 5.1.1: Proportion of women aged 15-49 years who have ever experienced physical or sexual violence by an intimate partner |
| SDG 10: Reduced Inequalities | Target 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status. | Indicator 10.2.1: Proportion of people living below 50 percent of median income, by age, sex, and persons with disabilities |
| SDG 16: Peace, Justice, and Strong Institutions | Target 16.1: Significantly reduce all forms of violence and related death rates everywhere. | Indicator 16.1.1: Number of victims of intentional homicide per 100,000 population, by sex and age |
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Source: bmcmedresmethodol.biomedcentral.com
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