Biological Burden of Adverse Childhood Experiences in Children

Abstract

Objective: This study aimed to examine relationships between adverse childhood experiences (ACEs) and related life events and allostatic load (AL)-"wear and tear" from chronic stress-in a pediatric population.

Methods: Children were screened with the PEdiatric ACEs and Related Life Event Screener (PEARLS) tool, a 17-item questionnaire capturing experiences of abuse, neglect, household challenges, and related life events. Biological data were available for 207 participants, and AL was operationalized using clinical or empirical cutoff points across 4 physiological systems (i.e., cardiac, metabolic, inflammatory, neurologic). Covariate-adjusted multivariable regression models were used to examine associations between AL with adversity and health.

Results: Children (mean age = 6.5 years, range = 1-11 years) had an average AL score of 1.9 (standard deviation = 1.7), and a U-shaped relationship was observed with child's age. Continuous PEARLS and original ACE scores were not associated with AL. However, children with a reported PEARLS score of 1 to 2 or original ACEs score of 1 to 3 had 1.5 (incidence rate ratio [IRR] = 1.50, 95% confidence interval [CI] = 1.09-2.08) and 1.4 (IRR = 1.41, 95% CI = 1.08-1.84) times greater AL, respectively, compared with participants with none reported. In secondary analyses, caregiver mental illness was associated with higher child AL (adjusted IRR = 1.27, 95% CI = 1.01-1.58). AL was also associated with poorer perceived child general health (adjusted β = -0.87, 95% CI = -1.58 to -0.15) and greater odds of child obesity (adjusted odds ratio = 1.51, 95% CI = 1.23-1.89).

Conclusions: Measuring AL in a pediatric population requires careful consideration of age. Higher AL was associated with a greater number of reported adversities and worse child health.

Figure 1.

Schematic of research design. The first objective of this project was to operationalize allostatic load (AL) during early and mid-childhood (1–11 years) using stress-related biomarkers that represent cardiovascular [systolic blood pressure (SBP) percentile, diastolic blood pressure (DBP) percentile, resting heart rate (RHR) percentile, vascular endothelial growth factor (VEGF)], metabolic [insulin-like growth factor-binding protein (IGFBP)-1, IGFBP-3, leptin], inflammatory [tumor necrosis factor alpha (TNF-α), interleukin (IL)-1ß, IL-6, IL-8, and IL-10], and neurologic [brain-derived neurotrophic factor (BDNF)] system function. We then examined relationships between reported adverse childhood experiences (ACEs) and related life events measured using the PEdiatric ACEs and Related Life Event Screener (PEARLS) tool with AL (Objective 2). Lastly, the final objective was to assess if higher AL was associated with greater odds of behavioral, mental, and physical health outcomes previously associated with higher reported PEARLS scores (Thakur et. al 2022).

Figure 2.

Two Lines Test evaluating the U-shaped relationship between child age and allostatic load. Each circle represents a data point. Fitted values (grey dashed line) were obtained by smoothing cubic splines. The two lines are represented by blue and red arrows with a midpoint of 5.02 years (black dashed vertical line).