Originally published by 2 Minute Medicine® (view original article). Reused on AccessPediatrics with permission.

1. In this cross-sectional study, researchers discovered that as children’s adverse childhood events (ACEs) scores went up, their school performance and attitude declined; conversely, as the number of protective factors (PFs) increased, these negative outcomes were reduced.

2. The strongest PF associated with reduced negative outcomes was parents who talked to their children about things that matter and shared ideas.

Evidence Rating Level: 2 (Good)

Study Rundown:

Much research has been done in recent years exploring the negative impacts of ACEs, though fewer studies have explored how to best combat the effects of ACEs. In this cross-sectional analysis, researchers studied how ACEs impacted school performance and how various PFs were able to combat or reverse those effects. Using survey data from across all 50 states, researchers found that negative school outcomes — such as repeating a grade, not completing homework, or simply not caring about school — were all associated with higher ACE scores. Conversely, these same outcomes were decreased in participants with higher PF scores. When ACE and PF scores were combined in the same outcomes model, there was a slight decrease in the likelihood of negative school outcomes, demonstrating a possible interaction between ACEs and PFs. The strongest PF associated with a decrease in negative academic outcomes was the presence of a parent who talks to their child about things that matters and shares ideas. This last point is a key take away from the study, highlighting how protective a strong parent-child relationship can be for behavioral outcomes such as school performance. This association also offers pediatricians a meaningful, targeted point of intervention for families struggling with their child’s school performance in the setting of families burdened by high ACE scores.

Study author Dr. Angelica Robles M.D., speaks to 2 Minute Medicine

“School is an important part of children’s lives and may predict their life trajectory. Adverse Childhood Experiences (ACEs) leads to a decline in school engagement and performance. However, a few protective factors in the family and community have shown to have a positive effect on these outcomes. The most significant protective factor noted in this study is a parent and child that can talk about things that matter and share ideas. This reiterates the importance of a positive adult relationship in a child’s life. It would be ideal for all professionals (physicians, teachers, school counselors, social workers, and community organizations) who come in contact with these families to collaborate and connect them with protective factors that help mitigate the negative impact of adverse events and develop further prevention.”

In-Depth [cross-sectional study]:

In this study, researchers completed a cross-sectional analysis of data collected during the 2011-2012 National Survey of Children’s Health, a national telephone survey administered on local and state levels. Of the 95 677 children ages 0 to 17 years included in the initial survey, study participants were only those aged 6 to 17. In total, 65 680 children were included for the ACEs analysis (48.8% female, 66.4% white, 15.2% African American) and 63 467 (48.5% female, 66.5% white, 15.2% African American) for the PFs analysis. Of the children assessed for ACEs, 44% had no ACEs, 25% had 1 ACE, 11% had 2, 6% had 3, and 13% had ≥4. Of those children assessed for PFs, 4% of school-aged children had less ≤3, 10% had 4, 26% had 5, 38% had 6, and 22% had all 7. Protective factors included smoke-free homes, safe neighborhoods, daily shared meals, neighborhood amenities, and parents who talked to their children about things that matter and shared ideas. When combining ACE and PF scores, children with all 7 PFs had the lowest odds ratio for each of the negative school outcomes (repeating a grade: 0.57, 95% CI 0.42 – 0.78; not completing homework: 0.28, 95% CI 0.21-0.37; not caring about school: 0.37, 95% CI 0.29-0.48). The strongest PF associated with decreased negative academic outcomes was a parent who talks to their children about things that matter and shares ideas (not repeating grades: OR = 1.89, always completes homework: OR = 6.10, child cares about school: OR = 6.60).

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