title: Adverse Childhood Experiences and Mental Health, Chronic Medical Conditions, and Development in Young Children.
abstract: OBJECTIVE
  To determine the relationships between adverse childhood experiences (ACEs) and mental health, chronic medical conditions, and social development among young children in the child welfare system.
  
  
  METHODS
  This cross-sectional study used a nationally representative sample of children investigated by child welfare (National Survey of Child and Adolescent Well-Being II) from 2008 to 2009. Our analysis included caregiver interviews and caseworker reports about children aged 18 to 71 months who were not in out-of-home care (n = 912). We examined the associations between ACEs and mental health (measured by the Child Behavior Checklist [CBCL]), reported chronic medical conditions, and social development (measured by the Vineland Socialization Scale) in bivariate and multivariate analyses.
  
  
  RESULTS
  Nearly all children (98.1%) were reported to have had an ACE in their lifetime; the average number of ACEs was 3.6. For every additional reported ACE, there was a 32% increased odds of having a problem score on the CBCL (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.14, 1.53) and a 21% increased odds of having a chronic medical condition (OR 1.21, 95% CI 1.05, 1.40). Among children aged 36 to 71 months, for every additional reported ACE, there was a 77% increased odds of a low Vineland Socialization score (OR 1.77, 95% CI 1.12, 2.78).
  
  
  CONCLUSIONS
  ACEs were associated with poor early childhood mental health and chronic medical conditions, and, among children aged 3 to 5, social development. Efforts are needed to examine whether providing early intervention to families with multiple stressors mitigates the impact of ACEs on children's outcomes.
authors.affiliation: Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY; Nathan Kline Institute of Psychiatric Research, Orangeburg, NY. Electronic address: Bonnie.Kerker@nyumc.org.
authors.forename: Bonnie D
authors.initials: BD
authors.lastname: Kerker
authors.affiliation: Child and Adolescent Services Research Center, Rady Children's Hospital, San Diego, Calif.
authors.forename: Jinjin
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY.
authors.forename: Erum
authors.initials: E
authors.lastname: Nadeem
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Bronx, NY.
authors.forename: Ruth E K
authors.initials: RE
authors.lastname: Stein
authors.affiliation: School of Social Work, University of Southern California, Los Angeles, Calif.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Hurlburt
authors.affiliation: Department of Pediatrics, Palo Alto Medical Foundation, Palo Alto, Calif.
authors.forename: Amy
authors.initials: A
authors.lastname: Heneghan
authors.affiliation: Oregon Social Learning Center, Eugene, Ore.
authors.forename: John
authors.initials: J
authors.lastname: Landsverk
authors.affiliation: Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY.
authors.forename: Sarah
authors.initials: S
authors.lastname: McCue Horwitz
mesh_terms: D002649:Child Abuse / Q000523:psychology*; D002657:Child Development; D000068216:Child Protective Services; D002669:Child Welfare / Q000523:psychology*; D016241:Child of Impaired Parents / Q000523:psychology*; D002675:Child, Preschool; D002908:Chronic Disease; D000066479:Criminal Behavior; D003430:Cross-Sectional Studies; D000069581:Exposure to Violence / Q000523:psychology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D001523:Mental Disorders; D008603:Mental Health; D016017:Odds Ratio; D012922:Social Change; D019966:Substance-Related Disorders
keywords: ACE; adverse childhood experience; child welfare; mental health