Journal of Child & Adolescent Trauma

, Volume 12, Issue 3, pp 307–321 | Cite as

Examining the Differing Effects of Economic Hardship and Poor Maternal Wellbeing on Cumulative Exposure to Adverse Childhood Experiences

  • Kiley W. LimingEmail author


Extensive research supports a strong and cumulative relationship between adverse childhood experiences (ACEs) and risky adult behaviors, mental health disorders, diseases, and health status. Additional factors, such as poor maternal wellbeing and economic hardship, compound the detrimental health and wellbeing implications associated with childhood exposure to ACEs. However, limited research has explored the differentiating effects of economic hardship and maternal wellbeing on a child’s cumulative ACE exposure. This study examined the differing effects of poor maternal wellbeing and economic hardship on a child’s exposure to ACEs. This study used a random sub-sample (n = 4000) from the 2011 to 2012 National Survey on Children’s Health (NSCH), a nationally representative cross-sectional study of children (N = 95,677) between birth and 17 years old. Confirmatory factor analysis results revealed greater economic hardship had a significant direct effect on a child’s ACE exposure and poorer maternal wellbeing. Poor maternal wellbeing had a significant mediation-like effect on the relationship between economic hardship and a child’s cumulative ACE exposure. Practice and policy implications include early ACE assessments tailored to identify children and families experiencing adversity across multiple domains.


Economic hardship Maternal wellbeing Adverse childhood experiences (ACEs) 


Compliance with Ethical Standards

Conflict of Interest

The corresponding author declares no conflict of interest.

Ethical Standards and Informed Consent

For this type of study, secondary data analysis, formal consent is not required. In the original study, the National Survey on Children’s Health (NSCH) 2011–2012, informed consent was obtained from all individual participants included in the study.


  1. Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C. H., Perry, B. D., … Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience, 256, 174–186.Google Scholar
  2. Anderson, J. C., & Gerbing, D. W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin, 103(3), 411–423.CrossRefGoogle Scholar
  3. Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182.CrossRefGoogle Scholar
  4. Bramlett, M. D., & Radel, L. F. (2014). Adverse family experiences among children in nonparental care, 2011–2012. (Report No. 74). Hyattsville, MD: National Center for Health Statistics.Google Scholar
  5. Bronfenbrenner, U. (1977). Toward an experimental ecology of human development. American Psychologist, 32(7), 513–531.CrossRefGoogle Scholar
  6. Brooks-Gunn, J., & Duncan, G. J. (1997). The effects of poverty on children. The Future of Children, 7, 55–71.CrossRefGoogle Scholar
  7. Brown, T. A. (2014). Confirmatory factor analysis for applied research. New York, NY: The Guilford Publications.Google Scholar
  8. Burke, N. J., Hellman, J. L., Scott, B. G., Weems, C. F., & Carrion, V. G. (2011). The impact of adverse childhood experiences on an urban pediatric population. Child Abuse & Neglect, 35, 408–413.CrossRefGoogle Scholar
  9. Bynum, L., Griffin, T., Riding, D. L., Wynkoop, K. S., Anda, R. F., Edwards, V. J., … Croft, J. B. (2010). Adverse childhood experiences reported by adults-five states, 2009. Morbidity and Mortality Weekly Report, 59(49), 1609–1613.Google Scholar
  10. Cheng, E. W. (2001). SEM being more effective than multiple regression in parsimonious model testing for management development research. Journal of Management Development, 20(7), 650–667.CrossRefGoogle Scholar
  11. Child and Adolescent Health Measurement Initiative (CAHMI). (2012). 2011/12 National Survey of Children’s health (2012), sampling and survey administration. Data resource center, supported by cooperative agreement 1-U59-MC06980–01 from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved from
  12. Child and Adolescent Health Measurement Initiative (CAHMI). (2013). 2011-2012 NSCH: Child Health Indicator and Subgroups SAS Codebook, Version 1.0 [data file and code book]. Data resource Center for Child and Adolescent Health. Retrieved from
  13. Cicchetti, D., & Lynch, M. (1993). Toward an ecological/transactional model of community violence and child maltreatment: Consequences for children’s development. Psychiatry, 56(1), 96–118.CrossRefGoogle Scholar
  14. Cicchetti, D., Toth, S. L., & Maughan, A. (2000). An ecological-transactional model of child maltreatment. In A. J. Sameroff, M. Lewis, & S. M. Miller (Eds.), Handbook of Developmental Psychopathology (pp. 689–722). New York, NY: Springer US.Google Scholar
  15. Cole, D. A., & Maxwell, S. E. (2003). Testing mediational models with longitudinal data: Questions and tips in the use of structural equation modeling. Journal of Abnormal Psychology, 112(4), 558–577.CrossRefGoogle Scholar
  16. Dong, M., Anda, R. F., Felitti, V. J., Dube, S. R., Williamson, D. F., Thompson, T. J., … Giles, W. H. (2004). The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse & Neglect, 28(7), 771–784.
  17. Dube, S. R., Anda, R. F., Felitti, V. J., Chapman, D. P., Williamson, D. F., & Giles, W. H. (2001). Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: Findings from the adverse childhood experiences study. JAMA, 286, 3089–3096.CrossRefGoogle Scholar
  18. Dube, S. R., Felitti, V. J., Dong, M., Chapman, D. P., Giles, W. H., & Anda, R. F. (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The adverse childhood experiences study. Pediatrics, 111(3), 564–572.CrossRefGoogle Scholar
  19. Dube, S. R., Fairweather, D., Pearson, W. S., Felitti, V. J., Anda, R. F., & Croft, J. B. (2009). Cumulative childhood stress and autoimmune diseases in adults. Psychosomatic Medicine; Baltimore, 71, 243–250.CrossRefGoogle Scholar
  20. Duncan, G. J., Brooks-Gunn, J., & Klebanov, P. K. (1994). Economic deprivation and early childhood development. Child Development, 65(2), 296–318.CrossRefGoogle Scholar
  21. Edwards, V. J., Holden, G. W., Felitti, V. J., & Anda, R. F. (2003). Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: Results from the adverse childhood experiences study. American Journal of Psychiatry, 160(8), 1453–1460.CrossRefGoogle Scholar
  22. Evans, G. W. (2004). The environment of childhood poverty. American Psychologist, 59(2), 77–92.CrossRefGoogle Scholar
  23. Evans, G. W., & Kim, P. (2013). Childhood poverty, chronic stress, self-regulation, and coping. Child Development Perspectives, 7, 43–48.CrossRefGoogle Scholar
  24. Fang, X., Brown, D. S., Florence, C. S., & Mercy, J. A. (2012). The economic burden of child maltreatment in the United States and implications for prevention. Child Abuse & Neglect, 36, 156–165.CrossRefGoogle Scholar
  25. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14, 245–258.Google Scholar
  26. Finkelhor, D., Ormrod, R., Turner, H., & Hamby, S. L. (2005). The victimization of children and youth: A comprehensive, national survey. Child Maltreatment, 10, 5–25.CrossRefGoogle Scholar
  27. Finkelhor, D., Ormrod, R. K., & Turner, H. A. (2007). Poly-victimization: A neglected component in child victimization. Child Abuse & Neglect, 31, 7–26 h.CrossRefGoogle Scholar
  28. Finkelhor, D., Ormrod, R., Turner, H., & Holt, M. (2009). Pathways to poly-victimization. Child Maltreatment, 14, 316–329.CrossRefGoogle Scholar
  29. Finkelhor, D., Turner, H., Hamby, S. L., & Ormrod, R. (2011). Polyvictimization: children’s exposure to multiple types of violence, crime, and abuse. OJJDP Juvenile Justice Bulletin - NCJ235504 (pgs. 1-12). Washington, DC: US Government Printing Office.Google Scholar
  30. Folger, A. T., Eismann, E. A., Stephenson, N. B., Shapiro, R. A., Macaluso, M., Brownrigg, M. E., & Gillespie, R. J. (2018). Parental adverse childhood experiences and offspring development at 2 years of age. Pediatrics, 141, e20172826.CrossRefGoogle Scholar
  31. Goodman, S. H., Rouse, M. H., Connell, A. M., Broth, M. R., Hall, C. M., & Heyward, D. (2011). Maternal depression and child psychopathology: A meta-analytic review. Clinical Child and Family Psychology Review, 14, 1–27.CrossRefGoogle Scholar
  32. Hayes, A. F. (2009). Beyond baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs, 76(4), 408–420.CrossRefGoogle Scholar
  33. Hayes, A. F. (2017). Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York, NY: Guilford Publications.Google Scholar
  34. Herman, D. B., Susser, E. S., Struening, E. L., & Link, B. L. (1997). Adverse childhood experiences: Are they risk factors for adult homelessness? American Journal of Public Health, 87, 249–255.CrossRefGoogle Scholar
  35. Hillis, S. D., Anda, R. F., Dube, S. R., Felitti, V. J., Marchbanks, P. A., & Marks, J. S. (2004). The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death. Pediatrics, 113, 320–327.CrossRefGoogle Scholar
  36. Kahn, R. S., Wise, P. H., Kennedy, B. P., & Kawachi, I. (2000). State income inequality, household income, and maternal mental and physical health: Cross sectional national survey. BMJ [British Medical Journal], 321, 1311–1315.CrossRefGoogle Scholar
  37. Kahn, R. S., Brandt, D., & Whitaker, R. C. (2004). Combined effect of mothers’ and fathers’ mental health symptoms on children’s behavioral and emotional well-being. Archives of Pediatrics & Adolescent Medicine, 158, 721–729.CrossRefGoogle Scholar
  38. Kalmakis, K. A., & Chandler, G. E. (2014). Adverse childhood experiences: Towards a clear conceptual meaning. Journal of Advanced Nursing, 70(7), 1489–1501.CrossRefGoogle Scholar
  39. Kerker, B. D., Zhang, J., Nadeem, E., Stein, R. E. K., Hurlburt, M. S., Heneghan, A., … Horwitz, S. M. (2015). Adverse childhood experiences and mental health, chronic medical conditions, and development in young children. Academic Pediatrics, 15, 510–517.Google Scholar
  40. Kline, R. B. (2011). Principles and practice of structural equation modeling (3rd ed.). New York: Guilford Press.Google Scholar
  41. Liming, K. W., & Grube, W. A. (2018). Wellbeing outcomes for children exposed to multiple adverse experiences in early childhood: a systematic review. Child and Adolescent Social Work Journal, 32, 1–19.
  42. Little, T. D. (2013). Longitudinal structural equation modeling. New York, NY: Guilford Press.Google Scholar
  43. Little, T. D., Card, N. A., Bovaird, J. A., Preacher, K. J., & Crandall, C. S. (2007). Structural equation modeling of mediation and moderation with contextual factors. In T. D. Little, J. A. Bovaird, & N. A. Card (Eds.), Modeling contextual effects in longitudinal studies (pp. 207–230). Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers.Google Scholar
  44. Liu, Y., Croft, J. B., Chapman, D. P., Perry, G. S., Greenlund, K. J., Zhao, G., & Edwards, V. J. (2013). Relationship between adverse childhood experiences and unemployment among adults from five US states. Social Psychiatry and Psychiatric Epidemiology, 48(3), 357–369. Scholar
  45. MacKinnon, D. P., & Fairchild, A. J. (2009). Current directions in mediation analysis. Current Directions in Psychological Science, 18(1), 16–20.CrossRefGoogle Scholar
  46. Murphy, N. A., Christian, B., Caplin, D. A., & Young, P. C. (2007). The health of caregivers for children with disabilities: Caregiver perspectives. Child: Care, Health and Development, 33, 180–187.Google Scholar
  47. Pelton, L. H. (2015). The continuing role of material factors in child maltreatment and placement. Child Abuse & Neglect, 41, 30–39.CrossRefGoogle Scholar
  48. Petterson, S. M., & Albers, A. B. (2001). Effects of poverty and maternal depression on early child development. Child Development, 72, 1794–1813.CrossRefGoogle Scholar
  49. Prince, M., Patel, V., Saxena, S., Maj, M., Maselko, J., Phillips, M. R., & Rahman, A. (2007). No health without mental health. The Lancet, 370, 859–877.CrossRefGoogle Scholar
  50. Sabri, B., Hong, J. S., Campbell, J. C., & Cho, H. (2013). Understanding children and adolescents’ victimizations at multiple levels: An ecological review of the literature. Journal of Social Service Research, 39, 322–334.CrossRefGoogle Scholar
  51. Sege, R. D., & Browne, C. H. (2017). Responding to ACEs with HOPE: Health outcomes from positive experiences. Academic Pediatrics, 17(7), S79–S85.CrossRefGoogle Scholar
  52. Spence, S. H., Najman, J. M., Bor, W., O’callaghan, M. J., & Williams, G. M. (2002). Maternal anxiety and depression, poverty and marital relationship factors during early childhood as predictors of anxiety and depressive symptoms in adolescence. Journal of Child Psychology and Psychiatry, 43, 457–469.CrossRefGoogle Scholar
  53. Spieker, S. J., Larson, N. C., Lewis, S. M., Keller, T. E., & Gilchrist, L. (1999). Developmental trajectories of disruptive behavior problems in preschool children of adolescent mothers. Child Development, 70, 443–458.CrossRefGoogle Scholar
  54. Turner, H. A., Finkelhor, D., & Ormrod, R. (2006). The effect of lifetime victimization on the mental health of children and adolescents. Social Science & Medicine, 62, 13–27.CrossRefGoogle Scholar
  55. Turner, H. A., Finkelhor, D., & Ormrod, R. (2010). Poly-victimization in a national sample of children and youth. American Journal of Preventive Medicine, 38, 323–330.CrossRefGoogle Scholar
  56. Waltermaurer, E., Watson, C. A., & McNutt, L. A. (2006). Black women's health: The effect of perceived racism and intimate partner violence. Violence Against Women, 12, 1214–1222.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.School of Social WelfareUniversity of KansasLawrenceUSA

Personalised recommendations