Adverse Experiences and Special Health Care Needs Among Children

Kristin Kan*, Ruchi Gupta, Matthew M. Davis, Nia Heard-Garris, Craig Garfield

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objectives: To evaluate the association of exposure to adverse childhood experiences (ACEs) and being a child with special health care needs (CSHCNs), and risks of specific ACE exposures with CSHCN status. Methods: An analysis of 91,219 children from the 2011–2012 National Survey of Children’s Health. Multivariable logistic regression was used to compare the odds of CSHCN status based on total ACE exposure and on distinct types of ACE exposure. Results: Overall, 20% of children met CSHCN criteria. Although 57% of children had no ACEs, 23% had experienced 1, 13% had experienced 2–3 ACEs, and < 1% had experienced 4 or more ACEs. The odds of CSHCN status increased by 38% with 1 ACE [adjusted odds ratio (aOR) 1.38, 95% confidence interval (95% CI) (1.25–1.52)], but with ≥ 4 ACEs, the odds of CSHCN status increased nearly threefold [aOR 2.95 (95% CI 2.54–3.45)]. Presence of mental illness in the family [aOR 2.12 (95% CI 1.89–2.38)], domestic violence [aOR 1.69 (95% CI 1.48–1.93)], and neighborhood violence [aOR 1.89 (95% CI 1.67–2.14)] were the ACEs most strongly associated with CSHCN status. Conclusions for Practice: Each additional ACE exposure increased the likelihood of CSHCN status, and family and community-level ACEs were associated with increased risk for CSHCN status. The findings suggest that systems of care for CSHCN, including public health, health care, education, and social welfare, should incorporate supports for addressing ACEs among this population and a trauma-informed approach.

Original languageEnglish (US)
Pages (from-to)552-560
Number of pages9
JournalMaternal and child health journal
Issue number5
StatePublished - May 1 2020


  • Adverse childhood experiences
  • Children with special health care needs
  • Community health
  • Family health

ASJC Scopus subject areas

  • Epidemiology
  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology
  • Public Health, Environmental and Occupational Health


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