Demographics and family-related adverse childhood experiences influence developmental and behavioral outcomes in maltreated young children – a real-life study in Singapore

Background and objectives

Adverse childhood experiences (ACEs) are known to affect physical and mental health outcomes. In this study, we investigated the role of demographical factors and ACEs focusing on family-related factors on behavioral and developmental outcomes in young children exposed to maltreatment in Singapore.

Participants and setting

Children suspected of maltreatment and their siblings (<4y of age) were prospectively enrolled (n = 112) in a cross-sectional, correlational cohort study recruited through convenience sampling.

Methods

Developmental outcomes were evaluated using Ages and Stages Questionnaire-3 (ASQ-3) and behavioral outcomes by Child Behavior Checklist (CBCL). Two multivariable logistic regression analyses were conducted: (A)presence/absence of ≥3 ACEs, and (B)effect of family-related ACEs, after controlling for demographics including maternal education and per capita income (PCI).

Results

The mean ACEs score was 2.8 ± 1.5, with developmental and behavioral concerns in 76% and 27%, respectively. Children with ≥3 ACEs had higher abnormal T-scores on CBCL and lower scores in gross-motor domain (p < 0.05). Logistic regression analysis(A) identified lower PCI as affecting ASQ-3 communication (p = 0.02) and predisposing to concerns in CBCL (p < 0.03), while maternal education ≤12 years was associated with concerns in personal-social and gross-motor domains (p < 0.01). In contrast, in logistic regression analysis(B), caregiver substance abuse was found to adversely affect ASQ-3 communication and problem-solving domains (p < 0.05), and maternal mental illness predisposed children to concerns in CBCL(p < 0.05).

Conclusions

Lower family income, lower maternal education, caregiver substance abuse and maternal mental health issues predispose children subjected to ACEs to further delays and behavioral concerns. Early identification and intervention in this high-risk cohort is imperative to mitigate the long-term impact of ACEs exposure.