Poster #55 - Examining Adverse Childhood Experiences (ACEs) and Child Psychosocial Functioning among Pediatric Psychiatric Inpatients

• In Event: 1-115 - Poster Session 03
  In Poster Session: PS 03 Section - Developmental Psychopathology

Integrative Statement

Adverse Childhood Experiences (ACEs) are associated with increased risks in adulthood (Felitti et al., 1998). The majority of ACE studies utilize adult retrospective reports of childhood adversity; few studies have examined ACEs among child populations. This may be particularly problematic when examining adversity among child populations with increased risk for developing pathology early in life, including those admitted to an inpatient psychiatric facility for self-harm behaviors, aggression, and/or serious mental illness. Because child-report of ACEs is infrequently studied, it is unclear whether self-reported or other-reported ACEs are more effective when examining associations between experiences of relational stress and social-emotional outcomes. The present study examined associations between child ACE scores and psychological diagnoses among a child psychiatric inpatient population, using both child self-report, and researcher-derived ACE score.

Participants included 125 children admitted to a state inpatient hospital within the course of a calendar year. Children ranged in age (8-17; M = 13.54; SD = 2.70). The sample was diverse (68% of participants were male, 63.2% were white). Participants had varied histories of previous psychiatric hospitalizations, which tended to be frequent and long (range = 1-20, M = 5.00, SD = 3.72); the average length of hospitalization was 106 days. Older participants tended to have more and longer hospital stays. Male participants were more likely to be diagnosed with externalizing disorders; female participants were more likely to be diagnosed with depressive diagnoses. At intake, participants 13 years or older (65.6% of sample) were administered a modified ACE measure (SR-ACE), which omitted the question assessing for sexual abuse history. Additionally, regardless of age, researchers examined each participant’s electronic medical record (EMR) and psychosocial history to compute a researcher-derived ACE score (R-ACE), which included accounting for sexual abuse history. Information regarding diagnoses and treatment history were also derived from the EMR.

All subsequent analyses controlled for child age and gender. Utilizing linear regression, higher R-ACE scores were associated with increased number of inpatient hospitalizations (R2 = .09, F (3, 121) = 4.11, p < .01). Utilizing logistic regression, increased SR-ACE was associated with increased odds of receiving depression diagnoses (ᵡ2 (3) = 13.10, p < .01; R2 = .22). Both SR-ACE (ᵡ2 (3) = 14.56, p < .01; R2 = .24) and R-ACE (ᵡ2 (3) = 45.65, p < .001; R2 = .41) scores were associated with increased odds of receiving a trauma diagnosis. Further examination revealed that some specific ACE items were most associated with increased odds of receiving a trauma diagnosis, including physical abuse, emotional abuse, sexual abuse, and witnessing violence toward maternal figures.

Findings highlight the importance of examining ACE scores among child populations, especially those at increased risk for poor outcomes. These findings highlight the importance of both self-reported and record-derived assessments of childhood adversity when examining psychosocial outcomes. Importantly, a vast majority of participants for whom a SR-ACE and R-ACE score were available, the total score was different. This suggests that there is a considerable difference between child perception/report of relational stress compared to what medical records may indicate.

Authors

• Jessica Riggs, Eastern Michigan University
  Presenting Author

• Alissa C Huth-Bocks, University Hospitals Cleveland Medical Center
  Non-Presenting Author

• Victoria Petti, Hawthorn Center
  Non-Presenting Author