Association of youth age at exposure to household dysfunction with outcomes in early adulthood.
Open accessAbstract
Importance: The current focus on the association of negative experiences in early childhood with adverse outcomes later in life is based on limited empirical evidence. Objective: To evaluate whether age at exposure to negative experiences in childhood and adolescence is associated with outcomes in early adulthood. Design, Setting, and Participants: This cohort study used population data from administrative sources for all Danish individuals born between 1987 and 1995 who were living in Denmark at 19 years of age. Data were analyzed in July 2020. Exposures: Exposure to 6 household dysfunction items (HDIs) from birth to 17 years of age by age group. Age groups were as follows: 0 to 2 years (early childhood), 3 to 5 years (preschool), 6 to 12 years (mid-childhood), and 13 to 17 years (early adolescence). The 6 items were parents' unemployment, incarceration, mental disorders, death, and divorce and the child's foster care experiences. Main Outcomes and Measures: Mental disorders, low educational attainment, disconnection from education and the labor market, and criminal charges. A fixed-effects model was used to estimate the dose-response and age-specific associations between HDI exposure and the collated outcome measure. Results: The study sample included 605 344 individuals observed from birth to 19 years of age (mean [SD] birth year, 1991 [2.56] years; range, 1987-1995; 335 725 [55%] male). Overall, 278 115 individuals (45.94%) were exposed to 1 or more of the 6 HDIs from birth to 17 years of age. Exposure was most prevalent at 1 year of age (exposure rate, 11.3%), and parental unemployment was the most common HDI (15.5% observed in mid-childhood). The risk of experiencing the 4 outcomes was monotonically associated with the number of HDIs. For example, experiencing 1 HDI between birth and 17 years of age was associated with an increased risk of experiencing an adverse outcome by approximately 1.0 percentage point (β = 0.011; 95% CI, 0.010-0.012; P < .001). Similarly, the risk of experiencing adverse outcomes varied significantly in association with age at exposure. Exposure during early adolescence was more strongly associated with adverse outcomes than was exposure during early childhood (increased risk of 5.8 percentage points [β = 0.058; 95% CI, 0.052-0.063; P < .001] vs 1.0 [β = 0.010; 95% CI, 0.004-0.015; P = .001]). Conclusions and Relevance: In this cohort study, exposure to negative experiences in early adolescence was more strongly associated with later adverse outcomes than was exposure at other points in childhood. Knowledge of age-specific associations is important information for policy makers who need to prioritize resources targeting disadvantaged children and youths.
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Effect sizes for adolescent exposures were nearly 2-fold those for exposures in middle childhood and more than 3-fold those for exposures earlier in life.
“Effect sizes for adolescent exposures were nearly 2-fold those for exposures in middle childhood and more than 3-fold those for exposures earlier in life.”
From Critical Periods in Child Development and the Transition to Adulthood (2021) · cites this paper as [1]
Andersen identified a dose-response association between accumulation of ACEs and increased likelihood of experiencing disruption to the transition to adulthood.
“Using this sibling comparison design, Andersen identified a dose-response association between accumulation of ACEs and increased likelihood of experiencing disruption to the transition to adulthood.”
From Critical Periods in Child Development and the Transition to Adulthood (2021) · cites this paper as [1]
Adversity exposures during adolescence (ages 13-17 years) had larger magnitude risk associations compared with adversities that occurred earlier in development.
“Adversity exposures during adolescence (ages 13-17 years) had larger magnitude risk associations compared with adversities that occurred earlier in development.”
From Critical Periods in Child Development and the Transition to Adulthood (2021) · cites this paper as [1]
Andersen's results resonate with emerging research streams in both neuroscience and the social sciences to suggest that benefits of interventions in adolescence may be underappreciated.
“Andersen's results 1 resonate with emerging research streams in both neuroscience and the social sciences to suggest that benefits of interventions in adolescence may be underappreciated.”
From Critical Periods in Child Development and the Transition to Adulthood (2021) · cites this paper as [1]
The register data analyzed by Andersen captured household dysfunction dimensions of ACEs but not abuse or neglect.
“The register data analyzed by Andersen captured household dysfunction dimensions of ACEs but not abuse or neglect.”
From Critical Periods in Child Development and the Transition to Adulthood (2021) · cites this paper as [1]
Andersen's study used administrative records that prospectively recorded the ACE exposures of an entire nation's population of children across a series of birth cohorts.
“First, Andersen's study used administrative records that prospectively recorded the ACE exposures of an entire nation's population of children across a series of birth cohorts.”
From Critical Periods in Child Development and the Transition to Adulthood (2021) · cites this paper as [1]
Effect sizes from the sibling comparison design are far from trivial, but they are much smaller.
“Effect sizes from the sibling comparison design are far from trivial, but they are much smaller.”
From Critical Periods in Child Development and the Transition to Adulthood (2021) · cites this paper as [1]
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Critical Periods in Child Development and the Transition to Adulthood
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- Authors
- Andersen, S. H.
- Affiliations
- Rockwool Foundation (DK)
- Corresponding author
- Andersen, Signe Hald
- ORCID
- Andersen, Signe Hald
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2021-01-07
- Volume
- 4
- Issue
- 1
- Pages
- e2032769
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC7791359
- OpenAlex
- W3118692603
- Cited by
- 45
- References
- 21
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 9 · 2023: 10 · 2022: 6 · 2021: 4
- FWCI
- 4.95
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Rockwool Fonden
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Safety Research › Child Welfare and Adoption
- Social Sciences › Demography › Family Dynamics and Relationships
- Keywords
- household dysfunction, age at exposure, early childhood adversity, parental unemployment, parental incarceration, parental mental illness, parental death, parental divorce, foster care, mental illness, educational attainment, criminal charges, early adulthood outcomes, dose-response relationship, developmental origins of health and disease
- MeSH terms
- Adverse Childhood Experiences, Adolescent, Mental Disorders, Child, Child, Preschool, Death, Denmark, Divorce, Family Characteristics, Female, Foster Home Care, Humans, Infant, Male, Risk Factors, Unemployment, Young Adult
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