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Original Investigation
December 2017

Association Between Early Life Adversity and Risk for Poor Emotional and Physical Health in AdolescenceA Putative Mechanistic Neurodevelopmental Pathway

Author Affiliations
  • 1Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
  • 2Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
JAMA Pediatr. 2017;171(12):1168-1175. doi:10.1001/jamapediatrics.2017.3009
Key Points

Question  What is a neurobiological pathway by which early childhood adversity becomes biologically embedded in the developing child to increase risk for emotional and physical health problems?

Findings  Results from this longitudinal prospective neuroimaging study suggest that early childhood adversity negatively affects the volume of a subregion of the prefrontal cortex, the inferior frontal gyrus, resulting in impairments in emotional competence and increased risk for adolescent depression and poor health outcomes.

Meaning  Findings elucidate a possible mechanistic pathway by which early childhood adversity leads to poor emotional and physical health outcomes and suggests specific targets for prevention.

Abstract

Importance  Adverse childhood experiences (ACEs) have been associated with poor mental and physical health outcomes. However, the mechanism of this effect, critical to enhancing public health, remains poorly understood.

Objective  To investigate the neurodevelopmental trajectory of the association between early ACEs and adolescent general and emotional health outcomes.

Design, Setting, and Participants  A prospective longitudinal study that began when patients were aged 3 to 6 years who underwent neuroimaging later at ages 7 to 12 years and whose mental and physical health outcomes were observed at ages 9 to 15 years. Sequential mediation models were used to investigate associations between early ACEs and brain structure, emotion development, and health outcomes longitudinally. Children were recruited from an academic medical center research unit.

Exposure  Early life adversity.

Main Outcomes and Measures  Early ACEs in children aged 3 to 7 years; volume of a subregion of the prefrontal cortex, the inferior frontal gyrus, in children aged 6 to 12 years; and emotional awareness, depression severity, and general health outcomes in children and adolescents aged 9 to 15 years.

Results  The mean (SD) age of 119 patients was 9.65 (1.31) years at the time of scan. The mean (SD) ACE score was 5.44 (3.46). The mean (SD) depression severity scores were 2.61 (1.78) at preschool, 1.77 (1.58) at time 2, and 2.16 (1.64) at time 3. The mean (SD) global physical health scores at time 2 and time 3 were 0.30 (0.38) and 0.33 (0.42), respectively. Sequential mediation in the association between high early ACEs and emotional and physical health outcomes were found. Smaller inferior frontal gyrus volumes and poor emotional awareness sequentially mediated the association between early ACEs and poor general health (model parameter estimate = 0.002; 95% CI, 0.0002-0.056) and higher depression severity (model parameter estimate = 0.007; 95% CI, 0.001-0.021) in adolescence. An increase from 0 to 3 early ACEs was associated with 15% and 25% increases in depression severity and physical health problems, respectively.

Conclusions and Relevance  Study findings highlight 1 putative neurodevelopmental mechanism by which the association between early ACEs and later poor mental and physical health outcomes may operate. This identified risk trajectory may be useful to target preventive interventions.

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