Somatic Symptoms and Adverse Childhood Experiences (ACEs) in Children and Adolescents

Abstract

Background: Somatic symptoms are commonly understood as subjective reports of physical discomfort without an identified cause. Common somatic symptoms such as headaches, stomachaches, and fatigue are particularly prevalent in children and adolescents, and are associated with impaired functioning, negative health outcomes, and unnecessary medical expenses. Previous research has suggested that adverse childhood experiences (ACEs), such as child maltreatment and household dysfunctions, are associated with somatic symptoms in childhood and adolescence. However, the longitudinal relationship between ACEs and somatic symptoms, the mediating mechanisms between ACEs and somatic symptoms, and the trajectory patterns of somatic symptoms across various stages of childhood and adolescence remain unknown.Purpose: The overarching purpose of this dissertation is to advance the understanding of the effects of ACEs on the etiology and development of somatic symptoms in childhood and adolescence. This dissertation has three specific aims: 1) to examine the concurrent and longitudinal relationships between ACEs and somatic symptoms across adolescence (ages 12-16 years), comparing the effects between maltreatment and household dysfunctions, 2) to examine if anxiety and depression symptoms in adolescence mediate the effect of ACEs on concurrent and future somatic symptoms in adolescence (ages 12-16 years), and 3) to identify and describe the heterogeneity of trajectory patterns of somatic symptoms across childhood and adolescence (ages 6-16 years) and their potential predictors and outcomes. Methods: This dissertation is comprised of three quantitative studies that were secondary analyses of the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), a consortium of five longitudinal prospective studies conducted at different geographical locations across the United States using standard procedures. Participants included 1354 child and primary caregiver dyads. Data were collected when children were ages 4, 6, 8, 10, 12, 14, 16, and 18 years. The Ecobiodevelopmental framework is the guiding framework for this dissertation. Paper 1 used a longitudinal cross-lagged path analysis with the data collected when children were ages 12, 14, and 16 years. Paper 2 also used data collected when children were ages 12, 14, and 16 years to conduct a longitudinal cross-lagged path analysis and mediation analysis. Finally, paper 3 used the data from all time points (child ages 6, 8, 10, 12, 14, 16, and 18 years) to conduct a latent class growth analysis (LCGA). Results: The findings of paper 1 indicated that a greater number of ACEs experienced at age 12 were associated with increased somatic symptoms at age 12, and concurrent exposure to household dysfunctions had stronger effects on somatic symptoms at age 12 as compared with concurrent exposure to maltreatment. The findings suggest that the accumulation, timing, and types of ACEs have unique effects on somatic symptoms in adolescence. Paper 2’s results demonstrated significant concurrent associations between ACEs and increased anxiety/depression symptoms and between anxiety/depression symptoms and increased somatic symptoms at ages 12, 14, and 16. Moreover, anxiety/depression symptoms mediated the pathway between ACEs and concurrent somatic symptoms at ages 12, 14, and 16. However, there were no significant longitudinal mediation effects. Paper 3’s results identified four distinct patterns of somatic symptom trajectories across ages 6 to 16: low-stable (43.6%), increasing (24.5%), decreasing (22% ), and high-stable (9.9%). Being a female and exposure to maltreatment before age 6 predicted increased chances of membership in the increasing and high-stable group compared to the low-stable group. Compared to the low-stable group, those in the increasing and the high-stable group were more likely to have a diagnosis of major depressive disorder at age 18. Conclusion: This dissertation’s findings contribute to our understanding of the relationship between somatic symptoms and ACEs across childhood and adolescence. The findings indicate that children with persistent somatic symptoms across childhood and adolescence are more likely to have experienced early childhood maltreatment, may be experiencing increased anxiety and depressive symptoms, may be concurrently exposed to ACEs, and are at increased risk for developing major depressive disorder in young adulthood. These findings call for addressing ACEs in adolescence, for example, by preventing maltreatment and family dysfunctions, and providing effective interventions for mitigating the effects of ACEs. Further research is needed to develop methods that effectively detect, address, and advocate for children experiencing somatic symptoms and ACEs in community settings.