Research Roundup: September 2021

The idea that your childhood years are formative is an intuitive one. One mechanism through which ACEs may affect outcomes in adulthood is through disrupted neurodevelopment, which then leads to delayed or impaired social, emotional, and cognitive function. One early indicator of this effect may be observed by looking at educational outcomes in childhood: early impairments may result in challenges on behavioral, academic, and social fronts. These difficulties, in turn, result in poor educational outcomes that set a trajectory for poor future health. In this month’s column, we review several recent articles that further explore the relationship between ACEs and school performance.

There have been several studies documenting the relationship between ACEs and child education outcomes such as absenteeism, academic performance, and class engagement. Two recent studies reinforce these findings using data from the National Survey of Children’s Health. Crouch and colleagues examined the relationship between ACEs and a variety of school performance indicators (specifically lack of school engagement, school absenteeism, and grade repetition) based on caregiver report in the 2016 National Survey of Children’s Health (NSCH).1 Consistent with previous research, they found that children with 4 or more ACEs had approximately twice the odds of non-engagement in school, of absenteeism, and of repeating a grade. The authors also found that older children were more likely to experience challenges, as well as children with special needs. Results provide further evidence for the relationship between ACEs and poor school outcomes, and suggest that these impacts may become more severe over time. A similar study conducted by Ghanem, using data from the 2017-2018 NSCH, reported similar results.2

In a separate study, Blodgett and Lanigan collected reports of school personnel’s knowledge of ACE experiences and academic performance for 2,101 sixth-grade children at 10 elementary schools.3 They found that school personnel reported approximately 10% of students as having experienced three of more ACEs. Further, they found that there was a dose-response relationship between ACEs and poor school attendance, behavioral issues, and failure to meet grade-level standards in mathematics, reading, or writing, all based on school personnel reports. These results are concordant with other studies that use caregiver reports or self-report to assess the same association. One important implication of this study, in addition to reinforcing previous findings, is that school personnel may represent both an important source of information to identify children at risk of ACEs and a leverage point for interventions to prevent or mitigate ACE impacts.

Finally, a study by Suleiman and colleagues tested the hypothesis that the relationship between ACEs and school performance can be partly explained by behavioral health conditions like anxiety, depression, and/or conduct problems.4 Using the same dataset as the Crouch and Ghanem papers, the authors found that behavioral health conditions accounted for 20.4% of the total effect of ACEs on school performance. These findings provide support for the hypothesis that disrupted neurodevelopment and difficulties in social and cognitive functioning may mediate the relationship between ACEs and school performance.

Taken together, these studies add more supporting evidence that ACEs are associated with poor school performance, which in turn may lead to poor health outcomes in adulthood. The results from these studies also indicate that the impacts of ACEs can be observed in childhood and adolescence, and that early interventions might disrupt long-term trajectories between ACEs and poor health.

Works Cited

1 Crouch, E., Radcliff, E., Hung, P., & Bennett, K. (2019). Challenges to school success and the role of adverse childhood experiences. Academic pediatrics, 19(8), 899-907.
2 Ghanem, Nouran. “The effect of violence in childhood on school success factors in US children.” Child Abuse & Neglect 120 (2021): 105217.
3 Blodgett, C., & Lanigan, J. D. (2018). The association between adverse childhood experience (ACE) and school success in elementary school children.
4 Suleiman, A. O., Grasso, D. J., Hunter, A. A., Rosenheck, R. A., & Rhee, T. G. (2021). Association of Adverse Family Experiences with School Engagement and Performance in US Adolescents: Do Behavioral Health Conditions Mediate the Relationship?

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Gloria Hu
Gloria Hu

Doctoral Student, Epidemiology, Mailman School of Public Health

Gloria is an incoming doctoral student in epidemiology at the Mailman School of Public Health. Her recent research includes work with the Global Violence Against Children and Youth Surveys (VACS) and qualitative research involving HIV-positive, formerly incarcerated individuals and the reentry process. She has also previously volunteered at youth correctional facilities in upstate New York.

Authors express their own opinions which do not necessarily reflect the opinions of the Stop Abuse Campaign.




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