Zarei Kasra, Xu Guifeng, Zimmerman Bridget, Giannotti Michele, Strathearn Lane
Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, IA 52242, USA.
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA 52242, USA.
Children (Basel). 2021 Aug 31;8(9):761. doi: 10.3390/children8090761.
Adverse childhood experiences (ACEs) can have a significant but variable effect on childhood neurodevelopment. The purpose of this study was to quantify and compare the associations between "household challenge" ACEs and common childhood neurodevelopmental and behavioral health conditions, using nationally representative U.S.
This study used data from the 2016-2019 National Survey of Children's Health, a nationwide, population-based, cross-sectional survey. Seven household challenge ACEs (not including child maltreatment) were reported by parents/guardians: parental death, incarceration, divorce/separation, family violence, mental illness, substance abuse, and poverty. Logistic regression with sample weights was used to estimate the odds ratio (OR) for 15 parent-reported neurodevelopmental and behavioral health conditions, by the number of reported ACEs. A dose-response relationship was examined by applying tests of orthogonal polynomial contrasts to fitted logistic regression models.
Down syndrome, Tourette syndrome and cerebral palsy were not associated with household challenge ACEs, whereas behavior/conduct problems, depression, and substance abuse were strongly associated, with adjusted ORs ranging from 6.36 (95% confidence interval (CI) 5.53, 7.32) to 9.19 (95% CI 7.79, 10.84). Other neurodevelopmental conditions not traditionally associated with childhood adversity showed moderate yet robust associations with ACEs, including autism (adjusted OR 2.15, 95% CI 1.64, 2.81), learning disability (adjusted OR 3.26, 95% CI 2.80, 3.80), and attention deficit hyperactivity disorder (adjusted OR 3.95, 95% CI 3.44, 4.53). The ORs increased with the number of ACEs, showing significant positive linear trends.
We found significant dose-dependent or cumulative associations between ACEs and multiple neurodevelopmental and behavioral conditions.
童年不良经历（ACEs）会对儿童神经发育产生重大但可变的影响。本研究的目的是利用具有全国代表性的美国数据，量化并比较“家庭挑战”类ACEs与常见儿童神经发育及行为健康状况之间的关联。
本研究使用了2016 - 2019年全国儿童健康调查的数据，这是一项全国性的、基于人群的横断面调查。父母/监护人报告了七种家庭挑战类ACEs（不包括儿童虐待）：父母死亡、监禁、离婚/分居、家庭暴力、精神疾病、药物滥用和贫困。使用带样本权重的逻辑回归，根据报告的ACEs数量，估计15种父母报告的神经发育和行为健康状况的比值比（OR）。通过对拟合的逻辑回归模型应用正交多项式对比检验来检查剂量反应关系。
唐氏综合征、妥瑞氏综合征和脑瘫与家庭挑战类ACEs无关，而行为/品行问题、抑郁症和药物滥用与之密切相关，调整后的OR值范围为6.36（95%置信区间（CI）5.53，7.32）至9.19（95%CI 7.79，10.84）。其他传统上与童年逆境无关的神经发育状况与ACEs显示出中度但显著的关联，包括自闭症（调整后的OR 2.15，95%CI 1.64，2.81）、学习障碍（调整后的OR 3.26，95%CI 2.80，3.80）和注意力缺陷多动障碍（调整后的OR 3.95，95%CI 3.44，4.53）。OR值随着ACEs数量的增加而升高，呈现出显著的正线性趋势。
我们发现ACEs与多种神经发育和行为状况之间存在显著的剂量依赖性或累积性关联。
