The Impact of Adverse Childhood Experiences on Household Resources, Intergenerational Risk of Adversity, and Behavior Problems in Subsequent Generations

Adverse childhood experiences (ACEs) have well-described life-course health correlates including higher risk of common chronic mental and physical illnesses. There is little evidence on the potential medical costs associated with experiencing more ACEs, nor on the associations between ACEs in parents and maltreatment or behavioral health problems in their children. Using the Panel Study of Income Dynamics (PSID) and its supplements, this series of studies examines 1) the differences in household out-of-pocket medical costs by the number of ACEs that individuals have experienced, 2) intergenerational associations and mediators between parents’ reported ACEs and ACEs reported by their adult children, and 3) the risk of child behavioral problems as a function of parent ACE counts. I find that increases in self-reported ACE scores are associated with increases in out-of-pocket medical expenses, showing a novel link within individuals between health care costs to the ACE score. Across generations, I find that parent mental health and parenting attitudes partially mediate the associations between parents’ and children’s ACE scores. I show that children’s behavioral health problems, including attention deficit hyperactivity disorder and childhood emotional disturbance diagnoses, are positively associated with their parents’ ACE scores with partial mediation by parent mental health and parenting attitudes as well. These findings extend the growing literature on ACEs and suggest opportunities to improve clinical practice through risk stratification based on ACE scores. These studies also validate an approach for studying ACEs and their financial and health consequences using the PSID