# Adverse childhood experiences and adolescent externalizing and internalizing problems in the ELSPAC-CZ cohort

## TL;DR

This study shows that childhood adversity is linked to mental health issues in adolescents, even after accounting for other factors like family background.

## Contribution

The study uses prospectively measured ACEs in a Central European cohort to demonstrate a robust link with adolescent adjustment.

## Key findings

- ACE score was associated with adolescent internalizing and externalizing problems reported by both adolescents and their mothers.
- Physical and emotional abuse were the main drivers of the association between ACEs and adolescent adjustment.
- ACEs were common in the sample and remained significant after controlling for socioeconomic status and early childhood factors.

## Abstract

Exposure to adverse childhood experiences (ACEs) has been linked to mental health difficulties later in life. However, much of the existing research relies on cross-sectional designs and retrospectively reported ACEs, which are susceptible to recall bias and confounding by early life factors, such as family socioeconomic status or childhood temperament. Moreover, the majority of these studies have been conducted in the United States and the United Kingdom, limiting the generalizability of their findings. To address these limitations, we examined the association between prospectively measured ACEs and adolescent adjustment using data from a longitudinal, population-based birth cohort in Central Europe.

Data were obtained from the Czech part of the European Longitudinal Cohort Study of Pregnancy and Childhood (ELSPAC-CZ; N = 2,741). ACE score was calculated as a sum of eight intra-familial adversities assessed prospectively between 6 months and 11 years postpartum. Adolescent internalizing and externalizing problems were measured via Strength and Difficulties Questionnaire (SDQ) at 11 years and were reported by adolescents and their mothers.

Linear regression models showed that ACE score was associated with internalizing problems reported by adolescent (β = 0.063, 95% CI [0.019, 0.107]) and mother (β = 0.120, 95% CI [0.077, 0.163]), and externalizing problems reported by adolescent (β = 0.088, 95% CI [0.045, 0.132]) and mother (β = 0.114, 95% CI [0.072, 0.157]). The association was driven particularly by physical and emotional abuse.

ACE were common in ELSPAC-CZ sample (69% of children experienced at least one ACE) and were prospectively associated with adjustment in adolescents, independently from family socioeconomic status, prenatal and birth characteristics, and early childhood temperament, suggesting a robust link between ACE and adolescent adjustment.