Negative experiences during early adolescence strongly linked to later adverse outcomes

Exposure to negative experiences during early adolescence was more strongly linked to later adverse outcomes vs. exposure at other points during childhood, according to study results published in JAMA Network Open.

“The literature has shown [three] perspectives on when exposure to positive or negative experiences may be associated with outcomes later in life: (1) the early childhood critical period, (2) the adolescent critical period, and the (3) dose-response association,” Signe Hald Andersen, PhD, of the Rockwool Foundation Research Unit in Denmark, wrote. “Each perspective draws on equally plausible explanations of brain development and the consequences of stress; however, the empirical evidence in terms of their relative importance is scarce.”

In the current cohort study, Andersen aimed to assess potential associations between exposure to negative experiences in childhood and adolescence and outcomes in early adulthood. She analyzed administrative population data of all 605,344 individuals born in Denmark between 1987 and 1995 who were living there at age 19 years and assessed their exposure to six household dysfunction items (HDIs) from birth to age 17 years by age group. The items included parents’ unemployment, incarceration, mental disorders, death and divorce and the child’s experiences in foster care. Age groups included 0 to 2 years (early childhood), 3 to 5 years (preschool), 6 to 12 years (mid-childhood) and 13 to 17 years (early adolescence). Mental disorder, low educational attainment, disconnection from education and the labor market and criminal charges served as main outcomes and measures. Andersen used a fixed-effects model to estimate the dose-response and age-specific associations between exposure to HDIs and the collated outcome measure.

Results showed exposure to one or more of the six HDIs from birth to age 17 years among 278,115 (45.94%) individuals. Exposure was most prevalent at age 1 year, with an exposure rate of 11.3%, and the most common HDI was parental unemployment. Risk for experiencing the four outcomes was monotonically associated with the number of HDIs. Andersen highlighted the example of experiencing one HDI between birth and age 17 years being linked to an increased risk for experiencing an adverse outcome by approximately 1%. Moreover, risk for experiencing adverse outcomes varied significantly related to age at exposure. A stronger association with adverse outcomes was apparent during early adolescence vs. during early childhood.

“An association of proximity between exposure and the time at which the outcome was measured did not influence the overall results,” Andersen wrote. “In contrast, foster care was one of the HDIs with the strongest association with adverse outcomes, but the exclusion of this item did not undermine the results.”

In a related editorial, Gloria Huei-Jong Graf, MPH, of the department of epidemiology at Columbia University Mailman School of Public Health, and colleagues underscored the implications of Andersen’s findings for future policy and research endeavors.

“Prevention of [adverse childhood experiences] for children of all ages is a public health priority,” the authors wrote. “Effective design of programs and policies to prevent ACEs and to buffer children from the consequences of ACEs when they do occur depends on research studies like that by Andersen. Her findings contribute to evidence that programs and policies that stabilize and strengthen families well beyond the first years of a child’s life have potential to generate lasting benefits. Furthermore, her innovative application of big data to study the timing of ACEs reveals new evidence for adolescence as a critical period in child development.”