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1.
BackgroundDespite strong associations between adverse childhood experiences (ACEs) and poor health, few studies have examined the cumulative impact of ACEs on causes of childhood mortality.MethodsThis study explored if data routinely collected by child death overview panels (CDOPs) could be used to measure ACE exposure and examined associations between ACEs and child death categories. Data covering four years (2012–2016) of cases from a CDOP in North West England were examined.ResultsOf 489 cases, 20% were identified as having ≥4 ACEs. Deaths of children with ≥4 ACEs were 22.26 (5.72–86.59) times more likely (than those with 0 ACEs) to be classified as ‘avoidable and non-natural’ causes (e.g., injury, abuse, suicide; compared with ‘genetic and medical conditions’). Such children were also 3.44 (1.75–6.73) times more likely to have their deaths classified as ‘chronic and acute conditions’.ConclusionsThis study evidences that a history of ACEs can be compiled from CDOP records. Measurements of ACE prevalence in retrospective studies will miss individuals who died in childhood and may underestimate the impacts of ACEs on lifetime health. Strong associations between ACEs and deaths from ‘chronic and acute conditions’ suggest that ACEs may be important factors in child deaths in addition to those classified as ‘avoidable and non-natural’. Results add to an already compelling case for ACE prevention in the general population and families affected by child health problems. Broader use of routinely collected child death records could play an important role in improving multi-agency awareness of ACEs and their negative health and mortality risks as well in the development of ACE informed responses.  相似文献   

2.
BackgroundAdverse Childhood Experiences (ACEs) may have a life-long impact on mental health and are related to physical disease, such as diabetes and cardiovascular diseases in adulthood. Research on ACEs suffers from recall bias when performed with adults.ObjectiveTo estimate the prevalence of ACEs and the interrelationships between ACEs as reported by children, and to determine the impact on their self-reported quality of life (QoL). Children’s opinions on the ACE-Questionnaire were also obtained.MethodA cross-sectional study was conducted with a child version of the ACE-Questionnaire. This questionnaire assesses parental separation or divorce, physical and emotional child abuse and neglect, sexual violence, domestic violence, household substance abuse, psychological issues or suicide, and incarceration of a household member. QoL was measured with the Kidscreen-10.Participants and settingThe questionnaire was completed by 644 children at a mean age of 11 years (range 9–13 years), in the two last grades of regular elementary schools, recruited throughout the Netherlands.ResultsData were weighted by ethnicity to obtain a representative sample of children in Dutch elementary education. Of all children, 45.3% had one or more out of ten ACEs. Child maltreatment was experienced by 26.4%. ACEs often co-occurred. A higher number of ACEs correlated with a lower mean level of QoL (p < 0.001). Mean QoL was 8.5 points lower (Cohen’s d = 0.8) in children who experienced child maltreatment. Children’s opinions on the questionnaire were positive in 82.4%.ConclusionPrevention of ACEs, professional training and trauma-focus in schools are urgently needed.  相似文献   

3.
Shaking and smothering in response to infant crying are life-threatening child abuse. Parental childhood abuse history is known to be one of the most robust risk factors for abusing their offspring. In addition to childhood abuse history, other adverse childhood exposures (ACEs) need to be considered due to co-occurrence. However, few studies have investigated the impact of ACEs on caregivers shaking and smothering their infant. This study aims to investigate the association of ACEs with shaking and smothering among caregivers of infants in Japan. A questionnaire was administered to caregivers participating in a four-month health checkup between September 2013 and August 2014 in Chiba City, Japan, to assess their ACEs (parental death, parental divorce, mentally ill parents, witness of intimate partner violence, physical abuse, neglect, psychological abuse and economic hardship), and shaking and smothering toward their infants (N = 4297). Logistic regression analysis was used to examine the cumulative and individual impacts of ACEs on shaking and smothering. Analyses were conducted in 2015. A total of 28.3% reported having experienced at least one ACE during their childhood. We found that only witness of IPV had a significant association with shaking of infant (OR = 1.93, 95% CI: 1.03–3.61). The total number of ACEs was not associated with either shaking or smothering. Our findings suggest that shaking and smothering in response to crying can occur regardless of ACEs. Population-based strategies that target all caregivers to prevent shaking and smothering of infants are needed.  相似文献   

4.
BackgroundAdverse childhood experiences (ACEs) are an identified risk factor for the social and emotional development of children. What is less known is the long-term effects of ACEs when poverty and ACEs coincide.ObjectiveUsing longitudinal cohort-panel data, we examined whether exposure to ACEs by the age of three among poor children would longitudinally result in behavioral problems at ages three, five, nine, and 15, after controlling for mothers’ socioeconomic status and their children’s characteristics.Participants and settingWe used a subsample of 2750 children and their parents living in urban poverty from the Fragile Families and Child Wellbeing study.MethodsLogistic regression modeling was used to obtain adjusted odds ratios of ACE categories predicting behavioral problems after accounting for family socioeconomic position.ResultsOur findings indicate that experiencing ACEs in early childhood was significantly associated with later behavioral outcomes from childhood to adolescence. Exposure to multiple ACEs before the age of three was significantly associated with the top-risk behavior group at age five; the odd ratios were 2.0 (CI = 1.3–3.1) and 2.9 (CI = 1.8–4.6) for two ACEs and three or more ACEs, respectively. At both ages nine and 15, children experiencing two or more ACEs had 1.9 to 3.2 times higher odds to demonstrate more the top 10th percentile of behavioral problems. Among covariates, mothers’ race and education, and children’s gender and temperament were identified as significant factors to determine behavior problems.ConclusionsThe findings support policies and programs for families with children who have experienced economic disadvantages and early childhood adversity.  相似文献   

5.
Despite good reason to believe that children in foster care are disproportionately exposed to adverse childhood experiences (ACEs), relatively little research considers exposure to ACEs among this group of vulnerable children. In this article, we use data from the 2011–2012 National Survey of Children’s Health (NSCH), a nationally representative sample of non-institutionalized children ages 0–17 in the United States, to estimate the association between foster care placement and exposure to an array of ACEs. In adjusted logistic regression models, we find that children placed in foster care or adopted from foster care, compared to their counterparts, were more likely to experience parental divorce or separation, parental death, parental incarceration, parental abuse, violence exposure, household member mental illness, and household member substance abuse. These children were also more likely to experience ACEs than children across different thresholds of socioeconomic disadvantage (e.g., children in households with incomes below the poverty line) and across different family structures (e.g., children in single-mother families). These results advance our understanding of how children in foster care, an already vulnerable population, are disproportionately exposed to ACEs. This exposure, given the link between ACEs and health, may have implications for children’s health and wellbeing throughout the life course.  相似文献   

6.
BackgroundPreschool suspension and expulsion rates are typically based on teacher reports, and don’t simultaneously account for adverse childhood experiences (ACEs).ObjectiveTo examine estimates in the United States of parent-reported preschool suspension and expulsion rates, in the context of ACEs.Participants and settingParents of children aged 3–5 years old (N = 6,100) in the 2016 National Survey of Children’s Health dataset.MethodWe reported the prevalence estimates of preschool suspension and expulsion, and estimated the unique variance of ACEs as risk factors using weighted sequential logistic regression.ResultsAn estimated 174,309 preschoolers (2.0%) were suspended, and 17,248 (0.2%) children were expelled annually. If divided by 36 school weeks, the instances of weekly suspension and expulsion were at least 4,842 and 479 respectively. Controlling for previous risk factors (i.e., age, gender, race, ethnicity), the odds ratio increased by 80% for every unit of ACEs increment. Children were more likely to be suspended or expelled if they had domestic violence (OR = 10.6, p < .001), living with mental illness (OR = 9.8, p < .001), adult substance abuse (OR = 4.8, p < .001), and victim of violence (OR = 4.5, p = .004), living in high poverty (OR = 3.9, p = .001), divorced parents (OR = 3.3, p = .001), and parent incarceration (OR = 3.0, p = .009).ConclusionThe alarming suspension and expulsion rates call for more comprehensive outreach prevention and response efforts in preschool settings. Cross system collaboration and family support are essential to this work.  相似文献   

7.
OBJECTIVE: This study is a detailed examination of the association between parental alcohol abuse (mother only, father only, or both parents) and multiple forms of childhood abuse, neglect, and other household dysfunction, known as adverse childhood experiences (ACEs). METHOD: A questionnaire about ACEs including child abuse, neglect, household dysfunction, and exposure to parental alcohol abuse was completed by 8629 adult HMO members to retrospectively assess the relationship of growing up with parental alcohol abuse to 10 ACEs and multiple ACEs (ACE score). RESULTS: Compared to persons who grew up with no parental alcohol abuse, the adjusted odds ratio for each category of ACE was approximately 2 to 13 times higher if either the mother, father, or both parents abused alcohol (p < 0.05). For example, the likelihood of having a battered mother was increased 13-fold for men who grew up with both parents who abused alcohol (OR, 12.7; 95% CI: 8.4-19.1). For almost every ACE, those who grew up with both an alcohol-abusing mother and father had the highest likelihood of ACEs. The mean number of ACEs for persons with no parental alcohol abuse, father only, mother only, or both parents was 1.4, 2.6, 3.2, and 3.8, respectively (p < .001). CONCLUSION: Although the retrospective reporting of these experiences cannot establish a causal association with certainty, exposure to parental alcohol abuse is highly associated with experiencing adverse childhood experiences. Improved coordination of adult and pediatric health care along with related social and substance abuse services may lead to earlier recognition, treatment, and prevention of both adult alcohol abuse and adverse childhood experiences, reducing the negative sequelae of ACEs in adolescents and adults.  相似文献   

8.
BackgroundAlthough adverse childhood experiences (ACEs) are relatively common among children, there is limited knowledge on the co-occurrence of such experiences.ObjectiveThe current study therefore investigates co-occurrence of childhood adversity in the Netherlands and whether specific clusters are more common among certain types of families.Participants and SettingRepresentative data from the Family Survey Dutch population 2018 (N = 3,128) are employed.MethodWe estimate Latent Class Analysis (LCA) models to investigate co-occurrence of ACEs. As ACEs we examine maltreatment, household dysfunction, demographic family events, as well as financial and chronic health problems. Gradual measures for maltreatment and financial problems are studied to make it possible to differentiate with regard to the severity of experiences.ResultsOur results show that four ACE clusters may be identified: ‘Low ACE’, ‘Moderate ACE: Household dysfunction’, ‘Moderate ACE: Maltreatment’ and ‘High ACE’. Regression analyses indicated that mother’s age at first childbirth and the number of siblings were related to experiencing childhood adversity. We found limited evidence for ACEs to be related to a family’s socioeconomic position.ConclusionThe found clusters of ACEs reflect severity of childhood adversity, but also the types of adversity a child experienced. For screening and prevention of childhood adversity as well as research on its consequences, it is relevant to acknowledge this co-occurrence of types and severity of adversity.  相似文献   

9.
BackgroundPrior research documents spatial concentration in the incidence of child maltreatment reported to and confirmed by Child Protective Services (CPS), but without estimates of the prevalence of such reports, the extent of CPS contact in different communities is unknown.ObjectiveTo estimate the prevalence of CPS reports during early childhood and substantiated investigations during childhood for children living in different types of neighborhoods.Participants and settingChildren who experienced CPS reports and substantiated investigations in Connecticut.MethodsThis study uses synthetic cohort life tables to estimate the cumulative risk of CPS reports before age five and substantiated CPS investigations before age 18, by neighborhood poverty rate and neighborhood racial composition.ResultsThe analysis reveals substantial stratification in the prevalence of CPS contact by the demographic characteristics of children’s residential neighborhoods. For example, while 7% of children in low-poverty neighborhoods (under 10% poor) experience a substantiated CPS investigation at some point during childhood at 2014 and 2015 rates, this risk more than doubles to 17% for their peers in moderate-poverty neighborhoods (10–20% poor) and more than triples to 26% for their peers in high-poverty neighborhoods (over 20% poor). Similar trends emerge when examining CPS reports in early childhood as well as when comparing neighborhoods with different proportions of White residents.ConclusionsCPS reports and substantiated investigations are a widespread and disproportionately experienced life event for children in poor neighborhoods and children in non-White neighborhoods.  相似文献   

10.
Ample evidence supports significant and enduring associations between adverse childhood experiences (ACEs) and negative outcomes later in life. Subsets of ACEs (e.g. childhood maltreatment and household dysfunction) have been examined in Chinese populations, but no known study has comprehensively examined the full constellation of different types of ACEs or patterns of ACE exposure in Chinese samples. As a direct response to the call to establish a global ACEs surveillance framework, this study provides the first translation and validation of the World Health Organization ACE – International Questionnaire (ACE-IQ). Further, patterns of ACE exposure were identified through latent class analysis. The 29-item ACE-IQ was translated and back-translated from English to traditional Chinese to measure exposure to 13 categories of ACEs. The Chinese ACE-IQ demonstrated good content validity; the ACE-IQ domain subscales also showed satisfactory test-retest reliability and semantic equivalence. In a sample of 433 Chinese young adults, three patterns of ACE exposure were uncovered: Low ACEs (65.82%), Household Violence (24.94%), and Multiple ACEs (9.24%). Concurrent exposure to physical abuse, domestic violence, and emotional abuse (i.e. Household Violence) was a novel pattern found in this study sample, and suggests there may be traditional Chinese norms that potentiate risks for violent household environments in the absence of other household risk factors. Findings underscore the importance of examining ACE exposure within local contexts, as children’s adverse experiences may be idiosyncratic to geographic, social, and cultural norms.  相似文献   

11.
Adverse childhood experiences (ACEs) have lifetime consequences for health and development. Identification of ACEs early in childhood provides the potential to intervene before health and development are impaired. This study examined the timing and duration of exposure to ACEs experienced by children from low-income families from ages one to three years to identify whether there were patterns of exposure when infants and toddlers were most vulnerable. We were able to confirm the early negative consequences on cognitive, health, and behavior outcomes previously reported in young children using a national, longitudinal data set of parents and children from low-income households (N = 2250). Using Finite Mixture Models, five classes of exposure were identified for children, Consistently Low (63.8%), Decreasing (10.3%), High at Age 2 (11.4%), Increasing (10.4%), and Consistently High (4%). The Consistently Low and Consistently High classes had the most and least optimal development across all domains, respectively. When examining child development outcomes among children with variable exposures to adversities, we found that for cognitive, language, and physical development, the most proximal ACEs were more robust for predicting child outcomes. For socioemotional health, exposure at any time from one to three to ACEs had negative consequences. As a whole, findings from this study highlight the need to consider ACEs screening tools that are both time-sensitive and permit a lifetime report.  相似文献   

12.

Objective

The goal of this study was to investigate the adverse childhood experiences (ACEs) in youth in a low-income, urban community.

Study design

Data from a retrospective chart review of 701 subjects from the Bayview Child Health Center in San Francisco are presented. Medical chart documentation of ACEs as defined in previous studies were coded and each ACE criterion endorsed by a traumatic event received a score of 1 (range = 0-9). This study reports on the prevalence of various ACE categories in this population, as well as the association between ACE score and two pediatric problems: learning/behavior problems and body mass index (BMI) ≥ 85% (i.e., overweight or obese).

Results

The majority of subjects (67.2%, N = 471) had experienced 1 or more categories of adverse childhood experiences (ACE ≥ 1) and 12.0% (N = 84) had experienced 4 or more ACEs (ACE ≥ 4). Increased ACE scores correlated with increased risk of learning/behavior problems and obesity.

Conclusions

There was a significant prevalence of endorsed ACE categories in this urban population. Exposure to 4 or greater ACE categories was associated with increased risk for learning/behavior problems, as well as obesity.

Practice implications

Results from this study demonstrate the need both for screening of ACEs among youth in urban areas and for developing effective primary prevention and intervention models.  相似文献   

13.
Most research on adverse childhood experiences (ACEs) has been conducted in high-income countries in the global North. The current longitudinal study examined the prevalence, overlap, and impact of ACEs in a sample of Brazilian children and adolescents who use city streets as spaces for socialization and survival (i.e., street-involved youth). Participants (N = 113; M age = 14.18 years) were recruited in three cities following standardized procedures. Most youth were male (80.5%) and non-White (91%). Lifetime exposure to ACEs was assessed at the first study time point; six indicators of psychological, behavioral, and physical adjustment were assessed 6 months later. Analyses addressed three research goals. First, the prevalence of seven ACEs was examined. Youth reported an average of 4.8 ACEs (SD = 1.25); no significant age or gender differences were found in ACEs exposure (all ps > .05). Second, the overlap between different ACEs was explored. Family dysfunction was correlated with family disruption and physical abuse; poverty and physical abuse were related (ps < .05). Third, prospective associations between ACEs and adjustment were tested. Total number of ACEs was not significantly correlated with any outcome, but several associations emerged for specific ACEs. For example, death of a close friend or family member was prospectively associated with negative affect; sexual abuse was associated with illicit drug use and physical health symptoms (ps < .05). Findings highlight the prevalence of ACEs in this vulnerable population and underscore the value of extending research on ACEs into novel populations and contexts.  相似文献   

14.
Adverse childhood experiences (ACEs) can affect people's health and wellbeing not only at the time the ACE is experienced, but also later in life. The majority of studies on ACEs are carried out in high-income countries and little is known about its prevalence in low and middle-income countries. Thus, the aim of this study was to assess the prevalence of ACEs, associations between ACEs and sociodemographic factors, and the interrelationship between types of ACEs in adolescents of a Brazilian birth cohort. Data from 3,951 adolescents (78.4% of the original cohort) from the 1993 Pelotas Cohort were analyzed. Seven types of ACEs were assessed in those up to 18 years old: physical abuse, sexual abuse, physical neglect, emotional neglect, domestic violence, parental separation and parental death. The most common ACE was parental separation (42%), followed by emotional neglect (19.7%) and domestic violence (10.3%). Approximately 85% of the adolescents experienced at least one ACE, and females reported a higher number of adversities. Several socioeconomic, demographic and family-related characteristics were associated with the occurrence of ACEs, e.g. non-white skin color, low family income, low maternal schooling, absence of mother's partner, maternal smoking, and poor maternal mental health. A strong interrelationship was observed among the ACEs, indicating clustering of risk. These aspects should be considered by health and social care professionals in the prevention and identification of childhood adversities.  相似文献   

15.
OBJECTIVE: To examine relationships between childhood autobiographical memory disturbance (CAMD) and adverse childhood experiences (ACEs) which are defined as common forms of child maltreatment and related traumatic stressors. METHODS: We use the ACE score (an integer count of eight different categories of ACEs) as a measure of cumulative exposure to traumatic stress during childhood. In a cross sectional analysis we assess the relationship of the ACE score to the prevalence of CAMD in a sample of 9,460 relatively healthy adults evaluated for wellness care at a southern California health maintenance organization between August 1995 and March 1996. In addition, we examined possible secular influences by examining association among each of four birth cohorts. Logistic regression was used to obtain the adjusted relative odds of CAMD associated with increasing ACE score. RESULTS: Overall, the age-standardized prevalence of CAMD was 18% (men: 15%; women: 19%). As the ACE score increased, the prevalence of CAMD increased in a graded fashion for both men and women (p for trend <.0001). After adjustment for age, sex, race/ethnicity, and education, adults with an ACE score >or=6 were 5.9 (95% CI, 4.4-7.9) times more likely to have CAMD compared to adults with an ACE score of 0. The prevalence of CAMD increased with each successive birth cohort, and graded relationships between the ACE score and CAMD were observed among each of the four birth cohorts though no statistical difference in the association was found across birth cohorts. CONCLUSIONS: The accumulation of ACEs across several domains is associated CAMD among men and women and in each of four birth cohorts. Further research is needed that describes the prevalence of CAMD in population-based samples and that examines whether impaired memory is a marker for persons neurobiologically affected by multiple forms of child maltreatment and related traumatic stressors.  相似文献   

16.
BackgroundExposure to greater Adverse Childhood Experiences (ACEs) has been associated with increased likelihood of general and sex offending behaviors. However, few studies consider both the impact of varied ACE exposures and other early experiences on pathways to offending behaviors in adolescents who have engaged in sexually abusive behaviors.ObjectiveThe purpose of this study was to examine the impact of ACEs and sexual boundary problems within the home on the development of delinquent and sexually abusive behavior.Participants & settingData were collected from archival records of male adolescents (N = 285) who had received treatment for sexually abusive behavior at a youth facility.MethodsThis study investigated the effects of individual adverse experiences on delinquent nonsexual and sexually abusive behaviors through structural equation modeling.ResultsStructural equation modeling revealed a three-factor model for ACEs. Direction and significance of paths between ACEs and the onset, persistence, and nature of maladaptive behaviors differed. Household dysfunction was related to an earlier onset (β = 1.19, p = 0.013) and more persistent nonsexual delinquent offending (β = 1.05, p = 0.048) and contact sexual offending (β = 1.19, p = 0.010). Conversely, sexual abuse and exposure to sexual boundary problems were associated with an earlier onset of sexually abusive behavior (β = −1.08, p = 0.038) as well as indicators of adolescent-onset (β = −1.30, p = 0.002), less persistent (β = −1.53, p = 0.001), and nonviolent (β = −1.89, p = 0.001) delinquency.ConclusionsFindings suggest variations in ACE exposures differentially influence the onset, severity, and persistence of delinquent and sexually abusive behaviors among these youths.  相似文献   

17.
OBJECTIVE: Childhood abuse and other adverse childhood experiences (ACEs) have historically been studied individually, and relatively little is known about the co-occurrence of these events. The purpose of this study is to examine the degree to which ACEs co-occur as well as the nature of their co-occurrence. METHOD: We used data from 8,629 adult members of a health plan who completed a survey about 10 ACEs which included: childhood abuse (emotional, physical, and sexual), neglect (emotional and physical), witnessing domestic violence, parental marital discord, and living with substance abusing, mentally ill, or criminal household members. The bivariate relationship between each of these 10 ACEs was assessed, and multivariate linear regression models were used to describe the interrelatedness of ACEs after adjusting for demographic factors. RESULTS: Two-thirds of participants reported at least one ACE; 81%-98% of respondents who had experienced one ACE reported at least one additional ACE (median: 87%). The presence of one ACE significantly increased the prevalence of having additional ACEs, elevating the adjusted odds by 2 to 17.7 times (median: 2.8). The observed number of respondents with high ACE scores was notably higher than the expected number under the assumption of independence of ACEs (p <.0001), confirming the statistical interrelatedness of ACEs. CONCLUSIONS: The study provides strong evidence that ACEs are interrelated rather than occurring independently. Therefore, collecting information about exposure to other ACEs is advisable for studies that focus on the consequences of a specific ACE. Assessment of multiple ACEs allows for the potential assessment of a graded relationship between these childhood exposures and health and social outcomes.  相似文献   

18.
Responses from N = 60,598 interviews from the 2010 Behavioral Risk Factor Surveillance System (the 10 states and the District of Columbia that included the optional Adverse Childhood Experience (ACE) module) were used to test whether associations between childhood adversity and adult mental health and alcohol behaviors vary by race/ethnicity and sex. ACE items were categorized into two types – household challenges and child abuse. Outcomes were current depression, diagnosed depression, heavy drinking and binge drinking. Logistic regression models found ACEs significantly associated with depression and excessive alcohol use, but sex did not moderate any relationships. Race/ethnicity moderated the relationship between ACEs and heavy drinking. In stratified analyses, compared to those not exposed to ACEs, non-Hispanic blacks who experienced either type of ACE were about 3 times as likely to drink heavily; Non-Hispanic whites who experienced child abuse or both ACE types were 1.5–2 times as likely to drink heavily; and Hispanics who experienced household challenges or both ACE types were 1.2 and 11 times as likely to report heavy drinking. ACEs impact depression and excessive alcohol use similarly across men and women. With the exception of heavy drinking, ACEs appear to have the same association with excessive alcohol use across race/ethnicity. It may be prudent to further investigate why the relationship between ACEs and heavy drinking may differ by race/ethnicity such that prevention strategies can be developed or refined to effectively address the needs of all sub-groups.  相似文献   

19.
Using cross-sectional data regarding 793 rural children aged 10–16 in Sichuan Province of China, the present study examined the preceding-year rates of seven forms of child victimization (physical assault, property crime, peer/sibling victimization, child maltreatment, sexual victimization, witnessing family violence, and exposure to community violence) and poly-victimization, and found children’s victimization experiences increased as the degree of parental absence increased (from the presence of two biological parents, to parental migration and parental separation and divorce). Elevated levels of depression were also found among left-behind children and children of separated or divorced parents, compared to children living with both biological parents; and child poly-victimization added to the risk of child depression. Certain demographic characteristics (being a boy and younger) and parental factors were associated with child victimization in rural China. This study highlights the need for child protection in rural China, and in particular for parent-absent children.  相似文献   

20.
BackgroundInvestigations have found mothers’ adverse childhood experiences (ACEs) confer an intergenerational risk to their children's outcomes. However, mechanisms underlying this transmission have only been partially explained by maternal mental health. Adult attachment insecurity has been shown to mediate the association of ACEs and mental health outcomes, yet an extension of this research to children's behavioral problems has not been examined.ObjectiveTo examine the cascade from maternal ACEs to risk for child behavioral problems at five years of age, via mothers’ attachment insecurity and mental health.Participants and settingParticipants in the current study were 1994 mother-child dyads from a prospective longitudinal cohort collected from January 2011 to October 2014.MethodsMothers retrospectively reported their ACEs when children were 36 months of age. When children were 60 months of age, mothers completed measures of their attachment style, depression and anxiety symptoms, and their children's behavior problems.ResultsPath analysis demonstrated maternal ACEs were associated with children's internalizing problems indirectly via maternal attachment avoidance, attachment anxiety, and depression symptoms, but not directly (β = .05, 95% CI [−.001, .10]). Maternal ACEs indirectly predicted children's externalizing problems via maternal attachment avoidance, attachment anxiety, and depression. A direct effect was also observed from maternal ACEs to child externalizing problems (β = .06, 95% CI [.01, .11]).ConclusionsMaternal ACEs influenced children's risk for poor behavioral outcomes via direct and indirect intermediary pathways. Addressing maternal insecure attachment style and depression symptoms as intervention targets for mothers with histories of ACEs may help to mitigate the intergenerational transmission of risk.  相似文献   

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