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Research Letter
August 2015

Association of Parental Adverse Childhood Experiences and Current Child Adversity

Author Affiliations
  • 1Division of Emergency and Urgent Care Services, Children’s Mercy Hospital, Kansas City, Missouri
  • 2Department of Social Work, Children’s Mercy Hospital, Kansas City, Missouri
JAMA Pediatr. 2015;169(8):786-787. doi:10.1001/jamapediatrics.2015.0269

Prompted by a growing body of evidence demonstrating the significant lifelong effect of adverse childhood experiences (ACEs) and toxic stress, health care professionals have begun to address these issues more directly.1-3 The parental history of ACE may serve as a marker of risk for child adversity, thus offering opportunities for early intervention to prevent ACE or ameliorate the negative outcomes associated with ACE. However, associations between parental ACE and child adversity are not well described. Previous studies primarily examine associations between maternal childhood maltreatment and child behavioral health. This study examined associations between parental ACE and child current adversity.


Administrative data obtained from an urban Midwest Head Start center were analyzed. The Head Start center serves as many as 400 primarily African American children (81%) aged 6 weeks to 5 years. Single mothers head 94% of households. Twenty-three percent of children are homeless and 88% of families live below federal poverty guidelines. Data were obtained from an intake survey developed and administered by the Head Start center in 2012 to better understand parental ACEs and child adversity. Parents of children at the center were surveyed using the Felitti et al4 9 ACE questions. Questions developed by the center assessed current child adversity, including prolonged separation from parents, neglect, homelessness, death of a family member/close friend, and exposure to community violence, family violence, household criminal activity, or household substance abuse. The data set did not contain demographic data. The institutional review board at Children’s Mercy Hospital reviewed this study and determined it to be exempt.


The data set contained information for 215 parents (81% response rate; 1 survey administered per family). Fifty-one parents (23.7%) had an ACE score of zero, 92 parents (42.7%) had an ACE score of 1 to 3, and 69 parents (32.1%) had an ACE score of 4 or higher. Compared with a parental ACE score of zero, parental ACE scores of 1 to 3 and more than 4 were associated with increasing likelihood of child adversity (Table).

Table.  Association Between Parental ACE Score and Current Child Adversitya
Association Between Parental ACE Score and Current Child Adversitya


In this retrospective analysis of a Head Start population, there was a strong positive association between parental ACE and child adversity. This association was strongest among parents with an ACE score of 4 or more, indicating a dose-response relationship. Lack of demographic data limited our analysis; however, the center’s client population was strongly homogenous for race/ethnicity and socioeconomic status. A significantly higher proportion of survey respondents had an ACE score of 4 or more compared with African American individuals and the general US population in other studies.4,5 Further studies should examine the role of parental ACE as a contributing factor in high-risk pediatric populations.

Identification of parental ACE may enable early targeted interventions for children at particular risk for exposure to adversity, toxic stress, and associated negative outcomes. Approaching pediatrics as a 2-generation practice through routine assessment of parental ACE may enable physicians to better address risk for and consequences of ACE.6 Parents who have experienced toxic stress themselves may have difficulty providing the safe, stable, and nurturing relationship that is key for resilience in a child. Assessment for parental ACE may identify specific resource needs (eg, trauma-focused adult mental health services and parenting interventions) that, when met, may enable a parent to develop a safer, more stable and nurturing relationship with their child. Future studies should further explore the association of parental ACE and child adversity as well as the effect of parental ACE on factors contributing to child resilience, such as parenting style and attachment. If these associations prove to be predictive, screening for parental ACE in pediatric practice would allow for early intervention to increase family resiliency and minimize risk for current child adversity.

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Article Information

Corresponding Author: Kimberly A. Randell, MD, MSc, Division of Emergency and Urgent Care Services, Children’s Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108 (

Published Online: June 1, 2015. doi:10.1001/jamapediatrics.2015.0269.

Author Contributions: Dr Randell had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Randell.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Randell, Dowd.

Administrative, technical, or material support: Dowd.

Study supervision: Dowd.

Conflict of Interest Disclosures: None reported.

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