Abstract
Background
Adverse childhood experiences (ACE) are associated with increased risk for schizophrenia spectrum symptoms, including PLEs. However, ACE and PLEs are also both associated with a several shared factors (i.e., stress, fluid cognition, internalizing symptoms, and suicidality). These factors, PLEs, and ACE may interrelate in complex ways, but research has not explicitly examined whether the association between ACE and PLEs remains over and above these shared correlates. This presentation will also examine evidence of PLEs mediating the associated between ACE and stress, fluid cognition, internalizing symptoms, suicidality or vice versus. Clarifying these interrelationships has important clinical implications, including understanding the mechanisms contributing to the development of PLEs and other negative psychopathological correlates.
Methods
The current study used hierarchical linear models to examine data from 10,800 9-11-year-olds from the ABCD study, recruited from 21 research sites across the United States. The analyses used hierarchical linear models (HLMs), with family unit and research site modeled as random intercepts, and age, sex, and race/ethnicity included as covariates. Child participants completed the Prodromal Questionnaire-Brief Child Version as a measure of PLEs. The ACE variable was defined as summations of parent-rated child experience of traumatic experiences from the Kiddie-Structured Assessment for Affective Disorders and Schizophrenia (KSADS) for DSM-5 and a demographic measure of financial adversity. In terms of shared correlates, internalizing symptoms and suicidality were measured using the KSADS, fluid cognition was measured using the NIH Toolbox, and stress was measured using the Child Behavior Checklist.
Results
Greater number of ACE were associated with greater PLEs (β=.102; 95% CI=0.083,0.120; p<.001), including several specific ACE, including witnessing domestic violence [β=0.100; 95% CI=0.027,0.174; False Discovery Rate- Corrected (FDR)-corrected p=.04], traumatic grief (β=0.066; 95% CI=0.022,0.110; FDR-corrected p=.025), bullying (β=0.304; 95% CI=0.252,0.356; FDR-corrected p<.001), and financial adversity (β=0.046; 95% CI=0.026,0.066; FDR-corrected p<.001). Furthermore, specific types of PLEs (e.g., suspiciousness) are specifically associated with ACE. Importantly, ACE and PLEs were related even when accounting for shared correlates. Further, there is evidence that PLEs partially mediated the relationship between number of ACE and internalizing symptoms. Lastly, the presentation will provide evidence that PLEs partially mediated the relationship between number of ACE and suicidality, including that PLEs mediated and 58.74% of the association between ACE and suicidal behavior.
Discussion
The current presentation provides evidence that school-age PLEs are associated with adverse experiences in childhood over and above shared correlates, and helps clarify the nature of this association, including evidence for specificity both on the part of ACE and PLE. This work also indicates that PLEs mediate the association between trauma and both internalizing symptoms and suicidality, and some evidence for internalizing symptoms mediating the association between PLEs and ACE. This work has important implications regarding mechanisms underlying the development of negative psychological outcomes and implications for treatment pathways following trauma. Novel interventions that aim to address how PLEs mediate these associations, as well as interventions to reduce the distress and impairment associated with PLEs, could improve mental health outcomes in children and adolescents.
The Number of Adverse Childhood Experiences Is Associated with Emotional and Behavioral Problems among Adolescents