# Parental Adverse Childhood Experiences (ACEs) in an Early Childhood Mental Health Outpatient Clinic in Germany: Prevalence and Associations with Child Psychiatric Diagnoses

## TL;DR

Parents of preschool children with mental health issues in Germany report high rates of adverse childhood experiences, which are linked to adjustment disorders in their children.

## Contribution

This study is one of the few to examine parental ACEs in preschoolers receiving psychiatric care, revealing a significant association between parental neglect and child adjustment disorders.

## Key findings

- 30.2% of parents reported four or more ACEs, much higher than in the general population.
- Adjustment disorder in children was significantly associated with parental neglect ACEs.
- The most common ACEs were parental separation, household mental illness, and emotional abuse.

## Abstract

What are the main findings?
Parents of preschool children in psychiatric care reported high rates of ACEs, with 30.2% (n = 35) experiencing ≧ 4 ACEs—considerably higher than in the general population.The most common ACEs were parental separation, household mental illness, and emotional abuse.Parental neglect ACEs were significantly associated with adjustment disorder in children.

Parents of preschool children in psychiatric care reported high rates of ACEs, with 30.2% (n = 35) experiencing ≧ 4 ACEs—considerably higher than in the general population.

The most common ACEs were parental separation, household mental illness, and emotional abuse.

Parental neglect ACEs were significantly associated with adjustment disorder in children.

What is the implication of the main finding?
Intergenerational effects of ACEs may contribute to early psychiatric symptoms in preschoolers, particularly adjustment disorders. Screening for parental ACEs in child psychiatry could help identify at-risk families and develop early intervention strategies.

Intergenerational effects of ACEs may contribute to early psychiatric symptoms in preschoolers, particularly adjustment disorders. Screening for parental ACEs in child psychiatry could help identify at-risk families and develop early intervention strategies.

Parental adverse childhood experiences (ACEs) are linked to negative outcomes in children, including emotional and behavioral problems, developmental delays, and higher risk for psychopathology. Most research focuses on school-aged children or community samples, with few studies examining preschool-aged children in child psychiatric care. Understanding parental ACEs in this population is crucial, as early childhood is a sensitive developmental period, and intergenerational effects may be particularly pronounced in children already presenting with psychiatric symptoms. Background/Objectives: The goal of this study was to analyze how parents of patients in an early childhood (0–5.9 yrs) mental health outpatient clinic differ from the general population in terms of the frequency of ACEs. In addition, we investigated the connection between mental health disorders in young children and the specific ACE scores of their parents. Methods: A total of 116 caregivers (34.45 years (SD = 5.28)) and their children (71.6% boys, 28.4% girls) at an average age of 3.99 years (SD = 1.35, range = 0.31–5.95) were included in the analysis. The legal guardians completed the 10-item ACE questionnaire. The young children were diagnosed as part of outpatient treatment using the DC:0–5 classification system. We analyzed the ACE scores and diagnoses descriptively and in comparison to a community sample. Results: An average value of 2.38 parental ACEs was reported by our sample, and 68.1% (n = 79) reported at least one ACE. The high-risk group with four or more ACEs comprised 30.2% (n = 35). The most common diagnosis in young children was the Disorder of Dysregulated Anger and Aggression of Early Childhood, followed by global developmental delay. Adjustment disorder was third in terms of frequency. Among the examined child psychiatric diagnoses, adjustment disorder showed a significant correlation with parents being affected by the ACE category of neglect (OR = 2.54; 95% CI: 1.012–6.369; p = 0.047). Conclusions: Parents who presented their children at an early childhood mental health outpatient clinic reported significantly more ACEs as compared to representative data on ACEs in adulthood. These results highlight the need for further studies with larger samples to enable a more in-depth analysis of the general intergenerational transmission processes and the differential transmission of specific ACEs to specific diagnoses in preschool-aged children.