Adverse childhood experiences linked to poor kindergarten outcomes

1. Child maltreatment and household dysfunction were associated with poorer academic skills and behavior at the kindergarten age.

2. Exposure to a greater number of adverse childhood experiences (ACEs) was associated with a higher likelihood of poor kindergarten outcomes.

Evidence Rating Level: 2 (Good)                   

Study Rundown: Adverse childhood experiences (ACEs), such as child maltreatment and household dysfunction, have previously been associated with poor health outcomes in older children and adults. This study examined a portion of an urban birth cohort from so-called “fragile families”, a large majority of which have unmarried parents. Kindergarten teachers provided ratings of academic skills, literacy skills, and behavior. Children with exposure to ACEs were more likely to have below-average academic skills and literacy skills. Furthermore, they were more likely to have behavioral difficulties, including attention problems, social problems, and aggression. While the study examined a fairly large number of children, it was limited by its focus on only urban, at-risk families. It also relies on maternal recollection and reporting of ACEs during interviews when the child was 5 years of age. In addition, there was no formal, direct observation of academic or behavioral skills, as teacher reporting was used as the metric. Nonetheless, the association of ACEs with poor educational achievement as well as previously-studied poor health outcomes underscores the need for physicians and other professionals to focus efforts on at-risk children.

Click to read the study, published today in Pediatrics

Relevant Reading: Adverse childhood experiences and child health in early adolescence

In-Depth [cohort study]: Data was obtained from the Fragile Families and Child Wellbeing study, a cohort of 5000 children born between 1998 and 2000 in large, urban centers in the United States. Of this cohort, 1007 had data available from kindergarten teachers in addition to maternal completion of 5-year follow-up interviews. Girls and boys were represented almost equally in the sample, and 46% of children were African American (compared with 36% white, 16% other). ACEs discussed in interviews with mothers included child maltreatment (psychological, neglect, physical, and sexual) as well as household dysfunction (maternal depression, substance use, incarceration, and violence toward mother). Forty-five percent of mothers reported no ACEs for their children while 12.3% reported 3 or more. When compared to no ACE exposure, exposure to ≥3 ACEs was associated with teacher-reported below average language and literacy skills (aOR 1.8, CI 1.1-2.9) and below average mathematical skills (aOR 1.8, CI 1.1-2.9). Similarly, exposure to ≥3 ACEs was associated with teacher-reported attention problems (aOR 3.5, CI 1.8-6.5), social problems (aOR 2.7, CI 1.4-5.0), and aggressive behavior (aOR 2.3, CI 1.2-4.6). Odds ratios were adjusted for child age, race, ethnicity, income, maternal education and parent relationship status at birth of child.

Image: PD

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