For decades, members of the Rural Health Research Center have been studying how childhood experiences impact long-term outcomes. Much of this research has examined the negative effects of adverse childhood experiences (ACEs) such as divorce, abuse and household dysfunction on factors like health, employment, mental health and relationships. Positive childhood experiences (PCE) also play an important role in lifelong health and well-being, and Center researchers have long looked at how the presence or absence of PCEs shape individuals as they grow into adults.
Published in the Journal of Developmental and Behavioral Pediatrics , one of their recent studies analyzed the prevalence of PCEs among children with special health care needs. The researchers found that members of this population were less likely to have experienced at least one PCE compared to their counterparts.
"An estimated 20% of children in the U.S. have at least one special health care need, and low-income and minority families are disproportionately represented in this group," says Emma Boswell , lead author on the study and a doctoral student in the Department of Health Services Policy and Management . "We know from prior research that the lived experiences of children, both adverse and positive, influence health and well-being across the lifespan and that PCEs have a protective, counteractive effects against the trauma that accompanies ACEs. It is therefore important to understand the occurrence of both types of experiences, especially for vulnerable populations."
Children's Health, the team identified children across the nation with a health condition that limits functioning and/or requires additional services (e.g., autism, sickle cell disease, diabetes, cerebral palsy and many others). Previous research had already shown that this group was more likely to experience most types of ACEs and more often throughout childhood – all of which increases the likelihood of risky behavior as they move into adulthood.
Because PCEs – defined as events that promote healthy development – help prevent or mitigate the effects of ACEs, Boswell and her team looked for their presence among children with special health care needs. The experiences fall into four categories: nurturing, supportive relationships; living, playing and learning in a safe, stable and equitable environment; opportunities for social engagement; and learning social-emotional proficiency.
"Earlier studies tell us that after adjusting for ACEs, children with PCEs are more likely to have better health and school success and, as adults, they are less likely to experience a psychiatric or physical condition," Boswell says. "When looking at this particularly at-risk group, however, we found that children with special health care needs were less likely to experiences PCEs. In fact, these children had lower odds of having a single PCE, with children of color, greater poverty and more complex health needs even less likely to have them."
The authors note that while the tracking and use of ACEs and PCEs in the development of programs and policies for children is increasing, certain groups have been left out of the conversation and planning. They recommend that children with special health care needs, alongside their caregivers and families, and other marginalized groups be included in these discussions along with ways to build resilience and foster opportunities for PCEs to improve health and well-being.
