The Negative Effects of Adverse Childhood Experiences (ACEs) on Behavioral Problems of Children in Kinship Care: The Protective Role of Kinship Caregivers’ Mental Health

Abstract

This study aims to examine the (a) prevalence of adverse childhood experiences (ACEs) among children in kinship care; (b) relationships between the number and type of ACEs and children’s internalizing and externalizing problems; and (c) moderating role of kinship caregivers’ mental health on the relationships between ACEs and children’s internalizing and externalizing problems. A sample of children in kinship care (N = 224) obtained from the National Survey of Child and Adolescent Well-Being II was used. Ordinary least squares regression models were conducted. Results indicated that neglect followed by parental substance abuse were found to be the most prevalent of the ACEs. Child neglect, sexual and emotional abuse, and parental substance abuse were significantly associated with child internalizing problems, whereas sexual and emotional abuse were significantly associated with child externalizing problems. The total number of ACEs and experiencing three or more ACEs were significantly associated with child externalizing problems. Kinship caregivers’ mental health significantly moderated the relationships between neglect, sexual abuse, and child internalizing problems. Caregiver’s mental health also moderated the relationships between emotional and sexual abuse, neglect, and children’s externalizing problems. Findings suggest the importance of addressing ACEs and the need for mental health services to both kinship caregivers and children in kinship care.

Keywords

adverse childhood experiences kinship care caregivers’ mental health internalizing problems externalizing problems

Get full access to this article

View all access options for this article.

References

Achenbach

T. M.

(1991). Integrative guide for the 1991 CBCL/4-18, YSR, and TRF profiles. Department of Psychiatry, University of Vermont.

Achenbach

T. M.

Rescorla

L. A.

(2000). Manual for the ASEBA preschool forms and profiles (Vol. 30). Research Center for Children, Youth, & Families, University of Vermont.

Ariyo

Mortelmans

Wouters

(2019). The African child in kinship care: A systematic review. Children and Youth Services Review, 98, 178–187. https://doi.org/10.1016/j.childyouth.2018.12.013

Berens

A. E.

Jensen

S. K.

Nelson

C. A.

(2017). Biological embedding of childhood adversity: From physiological mechanisms to clinical implications. BMC Medicine, 15(1), 1–12. https://doi.org/10.1186/s12916-017-0895-4

Bolger

K. E.

Patterson

C. J.

(2001). Pathways from child maltreatment to internalizing problems: Perceptions of control as mediators and moderators. Development and Psychopathology, 13(4), 913–940. https://doi.org/10.1017/S0954579401004096

Buchner

Erdfelder

Faul

(1996). Teststärkeanalysen [Power analyses]. In Erdfelder

Mausfeld

Meiser

Rudinger

(Eds.), Handbuch quantitative methoden [Handbook of quantitative methods] (pp. 123–136). Psychologie Verlags Union.

Casey Family Program. (2018). https://www.casey.org/what-are-kinship-navigators/

Center on the Developing Child. (2021). Toxic stress. https://developingchild.harvard.edu/science/key-concepts/toxic-stress/

Clarkson Freeman

P. A

. (2014). Prevalence and relationship between adverse childhood experiences and child behavior among young children. Infant Mental Health Journal, 35(6), 544–554. https://doi.org/10.1002/imhj.21460

10.

Danese

McEwen

B. S.

(2012). Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiology & Behavior, 106, 29–39. https://doi.org/10.1016/j.physbeh.2011.08.019

11.

Davis

M. T.

Warfield

M. E.

Boguslaw

Roundtree-Swain

Kellogg

(2020). Parenting a 6-year old is not what I planned in retirement: Trauma and stress among grandparents due to the opioid crisis. Journal of Gerontological Social Work, 63(4), 295–315. https://doi.org/10.1080/01634372.2020.1752872

12.

Dowd

Dolan

Smith

Day

Kenney

Wheeless

Biemer

(2014). National Survey of Child and Adolescent Well-being II, combined waves 1-3: Data file users manual (DFUM), restricted release version. National Data Archive on Child Abuse and Neglect.

13.

Dube

S. R.

Anda

R. F.

Felitti

V. J.

Croft

J. B.

Edwards

V. J.

Giles

W. H.

(2001). Growing up with parental alcohol abuse: Exposure to childhood abuse, neglect, and household dysfunction. Child Abuse & Neglect, 25(12), 1627–1640. https://doi.org/10.1016/S0145-2134(01)00293-9

14.

Felitti

V. J.

Anda

R. F.

Nordenberg

Williamson

D. F.

Spitz

A. M.

Edwards

Marks

J. S.

(1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8

15.

Garcia

O’Reilly

Matone

Kim

Long

Rubin

D. M.

(2015). The influence of caregiver depression on children in non-relative foster care versus kinship care placements. Maternal and Child Health Journal, 19(3), 459–467. https://doi.org/10.1007/s10995-014-1525-9

16.

Gibson

L. E.

Leitenberg

(2001). The impact of child sexual abuse and stigma on methods of coping with sexual assault among undergraduate women. Child Abuse & Neglect, 25(10), 1343–1361. https://doi.org/10.1016/S0145-2134(01)00279-4

17.

Hankerson

S. H.

Weissman

M. M.

(2012). Church-based health programs for mental disorders among African Americans: A review. Psychiatric Services, 63(3), 243–249. https://doi.org/10.1176/appi.ps.201100216

18.

Hunt

T. K.

Slack

K. S.

Berger

L. M.

(2017). Adverse childhood experiences and behavioral problems in middle childhood. Child Abuse & Neglect, 67, 391–402. https://doi.org/10.1016/j.chiabu.2016.11.005

19.

Kelley

S. J.

Whitley

D. M.

Campos

P. E.

(2011). Behavior problems in children raised by grandmothers: The role of caregiver distress, family resources, and the home environment. Children and Youth Services Review, 33(11), 2138–2145. https://doi.org/10.1016/j.childyouth.2011.06.021

20.

Kobulsky

J. M.

Dubowitz

(2020). The global challenge of the neglect of children. Child Abuse & Neglect, 110, Article 104296. https://doi.org/10.1016/j.chiabu.2019.104296

21.

Lee

Kramer

Choi

M. J.

Pestine-Stevens

Huang

(2020). The cumulative effect of prior maltreatment on emotional and physical health of children in informal kinship care. Journal of Developmental & Behavioral Pediatrics, 41(4), 299–307. https://doi.org/10.1097/DBP.0000000000000769

22.

Lee

K. A.

Jones Harden

Jaramillo

Norman

Jimenez-Parra

(under review). Conventional and expanded adverse childhood experiences (ACEs) and maternal functioning among low-income black mothers.

23.

Masten

A. S.

(2018). Resilience theory and research on children and families: Past, present, and promise. Journal of Family Theory & Review, 10(1), 12–31. https://doi.org/10.1111/jftr.12255

24.

Maughan

Cicchetti

Toth

S. L.

Rogosch

F. A.

(2007). Early-occurring maternal depression and maternal negativity in predicting young children’s emotion regulation and socioemotional difficulties. Journal of Abnormal Child Psychology, 35(5), 685–703. https://doi.org/10.1007/s10802-007-9129-0

25.

McEwen

B. S.

(2007). Physiology and neurobiology of stress and adaptation: Central role of the brain. Physiological Reviews, 87, 873–904. https://doi.org/10.1152/physrev.00041.2006

26.

Miller

J. J.

Koh

Niu

Bode

Moody

(2019). Examining child trauma knowledge among kin caregivers: Implications for practice, policy, and research. Children and Youth Services Review, 100, 112–118. https://doi.org/10.1016/j.childyouth.2019.02.026

27.

Muniz

C. N.

Fox

Miley

L. N.

Delisi

Cigarran

G. P.

Birnbaum

(2019). The effects of adverse childhood experiences on internalizing versus externalizing outcomes. Criminal Justice and Behavior, 46(4), 568–589. https://doi.org/10.1177/0093854819826213

28.

National Center for Injury Prevention and Control, Division of Violence Prevention. (n.d.). About the CDC-Kaiser ACE study. https://www.cdc.gov/violenceprevention/aces/about.html

29.

Negriff

(2020). ACEs are not equal: Examining the relative impact of household dysfunction versus childhood maltreatment on mental health in adolescence. Social Science & Medicine, 245, Article 112696. https://doi.org/10.1016/j.socscimed.2019.112696

30.

Osborne

Berger

L. M.

(2009). Parental substance abuse and child well-being: A consideration of parents’ gender and coresidence. Journal of Family Issues, 30(3), 341–370. https://doi.org/10.1177/0192513X08326225

31.

Petruccelli

Davis

Berman

(2019). Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis. Child Abuse & Neglect, 97, Article 104127. https://doi.org/10.1016/j.chiabu.2019.104127

32.

Phua

D. Y.

Kee

M. Z.

Meaney

M. J.

(2020). Positive maternal mental health, parenting, and child development. Biological Psychiatry, 87(4), 328–337. https://doi.org/10.1016/j.biopsych.2019.09.028

33.

Ports

K. A.

Ford

D. C.

Merrick

M. T.

Guinn

A. S.

(2020). ACEs: Definitions, measurement, and prevalence. In Asmundson

G. J. G.

Afifi

T. O.

(Eds.), Adverse childhood experiences (pp. 17–34). Academic Press.

34.

Richter

Bondü

Spiess

C. K.

Wagner

G. G.

Trommsdorff

(2018). Relations among maternal life satisfaction, shared activities, and child well-being. Frontiers in Psychology, 9, 1–12. https://doi.org/10.3389/fpsyg.2018.00739

35.

Rodriguez-JenKins

Furrer

C. J.

Cahn

George

(2021). Kinship navigator program development: Listening to family, youth, and advocate voice. Journal of Public Child Welfare, 15, 670–692. https://doi.org/10.1080/15548732.2020.1798324

36.

Sakai

Hua

Flores

(2011). Health outcomes and family services in kin-ship care: Analysis of a national sample of children in the Child Welfare System. Archives of Pediatric and Adolescent Medicine, 165(2), 159–165. https://doi.org/10.1001/archpediatrics.2010.277

37.

Shapiro

J. R.

Applegate

(2018). The neurodevelopmental impact of stress, adversity and trauma: Implications for social work with vulnerable parent-child dyads. In Shapiro

Applegate

(Eds.), Neurobiology and clinical social work: Theory and practice (2nd ed., pp. 5–18). W. W. Norton & Company.

38.

Sharda

E. A.

Sutherby

C. G.

Cavanaugh

D. L.

Hughes

A. K.

Woodward

A. T.

(2019). Parenting stress, well-being, and social support among kinship caregivers. Children and Youth Services Review, 99, 74–80. https://doi.org/10.1016/j.childyouth.2019.01.025

39.

Shern

D. L.

Blanch

A. K.

Steverman

S. M.

(2016). Toxic stress, behavioral health, and the next major era in public health. American Journal of Orthopsychiatry, 86(2), 109–123. https://doi.org/10.1037/ort000120

40.

Shonkoff

J. P.

Garner

A. S

., The committee on psychosocial aspects of child and family health, committee on early childhood, adoption, and dependent care, and section on developmental and behavioral pediatrics, Siegel

B. S.

Dobbins

M. I.

Earls

M. F.

Garner

A. S.

McGuinn

Pascoe

Wood

D. L

. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246. https://doi.org/10.1542/peds.2011-2663

41.

Smithgall

Mason

Michels

LiCalsi

Goerge

(2009). Intergenerational and interconnected: Mental health and well-being in grandparent caregiver families. Families in Society, 90(2), 167–175. https://doi.org/10.1606/1044-3894.3869

42.

Spratt

E. G.

Lowe

Ruffing

Papa

Maher

Harris

Wilkes

(2018, October). Adverse childhood events and parental stress in kinship care families. Presented at American Academy of Child and Adolescent Psychiatry 65th Annual Meeting, Seattle, Washington, United States. https://aacap.confex.com/aacap/2018/meetingapp.cgi/Paper/32748

43.

Staton-Tindall

Sprang

Clark

Walker

Craig

C. D.

(2013). Caregiver substance use and child outcomes: A systematic review. Journal of Social Work Practice in the Addictions, 13(1), 6–31. https://doi.org/10.1080/1533256X.2013.752272

44.

Sutphin

S. T.

(2015). Using kinship navigators to assess the needs of kinship caregivers. GrandFamilies: The Contemporary Journal of Research, Practice and Policy, 2(1), Article 3. https://scholarworks.wmich.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1027&context=grandfamilies

45.

U.S. Department of Health and Human Services, Administration for Children and Families. (2020). The AFCARS report. https://www.acf.hhs.gov/sites/default/files/documents/cb/afcarsreport27.pdf

46.

Walsh

(2013). Community-based practice applications of a family resilience framework. In Becvar

(Ed.), Handbook of family resilience (pp. 65–82). Springer.

47.

Ware

J. E.

Jr Kosinski

Keller

S. D.

(1996). A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.

48.

Wegman

H. L.

Stetler

(2009). A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood. Psychosomatic Medicine, 71, 805–812. https://doi.org/10.1097/PSY.0b013e3181bb2b46

49.

Winokur

Holtan

Batchelder

K. E.

(2014). Kinship care for the safety, permanency, and well-being of children removed from the home for maltreatment. Cochrane Database of Systematic Reviews, (1), 1–201. Advance online publication. https://doi.org/10.1002/14651858.CD006546.pub3

50.

Bright

Barth

R. P.

Ahn

(2021). Poverty and economic pressure, financial assistance, and children’s behavioral health in kinship care. Child Maltreatment, 26(1), 28–39. https://doi.org/10.1177/1077559520926568

51.

Jedwab

Levkoff

S. E.

(2020a). Understanding the relationships between parenting stress and mental health with grandparent kinship caregivers’ risky parenting behaviors in the time of COVID-19. Journal of Family Violence, 1–13. https://doi.org/10.1016/j.chiabu.2014.05.009

52.

Levkoff

S. E.

Jedwab

(2020b). Material hardship and parenting stress among grandparent kinship providers during the COVID-19 pandemic: The mediating role of grandparents’ mental health. Child Abuse & Neglect, 110, 104700. https://doi.org/10.1016/j.chiabu.2020.104700