Parenting stress and family resilience affect the association of adverse childhood experiences with children’s mental health and attention-deficit/hyperactivity disorder
Uddin J, Alharbi N, Uddin H, Hossain MB, Hatipoğlu SS, Long DL, Carson AP.
J Affect Disord. 2020 May 1;272:104-109. doi: 10.1016/j.jad.2020.03.132.
Commentary* by Dr. Margaret Weiss: The correlation of early ACEs and later mental and physical health is one of the most robust predictors of outcome. Looking at parental stress as a mediator and resilience as a moderator helps us translate ACE research into pathways for clinical intervention.
INTRODUCTION: Exposure to adverse childhood experience (ACE) has harmful consequences for children’s health and well-being. However, it is less clear how different social processes may amplify or mitigate the effects of ACE on children’s mental health. We examined how parenting stress mediates and family resilience moderates the associations of ACE with children’s mental health and attention-deficit/hyperactivity disorder (ADHD) outcomes.
METHODS: This secondary data analysis included 44,684 children aged 6-17 years from the 2016-17 National Survey of Children’s Health (NSCH). Logistic regression with survey weights was used to account for the complex survey design and obtain odds ratios (OR) and 95% CI adjusted for sociodemographics.
RESULTS: Overall, 7.3% of children had any mental health condition and 10.4% had ADHD. A higher ACE score (per 1-unit increase) was associated with a higher prevalence of any mental health condition (OR = 1.33, 95% CI: 1.27-1.40) and ADHD (OR = 1.21; 95% CI: 1.15-1.27) after adjustment for sociodemographics. Parenting stress mediated 57% of the total effect of ACE on any mental health condition and 60% of the total effect of ACE on ADHD diagnosis. The effect of ACE on mental health and ADHD outcomes was stronger among children with low levels of family resilience and connection index (FRCI) than among those with higher levels of FRCI.
CONCLUSIONS: Parenting stress may be a potential mechanism through which ACE impacts a child’s mental health and behavioral outcomes. Family resilience can lessen the impact of ACE on children’s mental health and behavioral disorders.
* Abstracts are selected for their clinical relevance by Dr. Margaret Weiss, Director of Clinical Research, Child Psychiatry, Cambridge Health Alliance, Harvard University. Her commentary reflects her own opinion. It is not approved or necessarily representative of the CADDRA board.