Effect of Childhood Adversity on the Relationship Between Family Resilience and Behavioral or Conduct Problems in Children With Special Healthcare Needs

Objective: Behavioral or conduct problems (BCPs) are common co-occurring conditions in children with special health care needs (CSHCNs), affecting their developmental and functional milestones. The role of family resilience in mitigating BCPs among these children and how adverse childhood experiences (ACEs) affect this dynamic remain largely unclear. The aim of the study was to disentangle the complex interplay between family resilience, ACEs, and BCPs by examining how ACEs moderate the relationship between family resilience and BCPs.

Methods: The study included 19,922 CSHCNs aged 3 to 17 years from the 2020-2021 National Survey of Children's Health. Weighted analysis was conducted using the Rao-Scott χ2 test and multivariable logistic regression to account for the complex survey design.

Results: Children from families with no and low resilience as compared with high-resilient families had 1.78 times (odds ratio [OR]: 1.78, 95% confidence interval [CI], 1.31-2.43) and 1.44 times (OR: 1.44, 95% CI, 1.18-1.76) higher odds of BCPs, respectively. While the odds of BCPs decreased in nonresilient families as ACEs increased from none to 1 ACE, 2 or more ACEs versus no ACE increased the odds of BCPs in low-resilient families from 1.42 times (OR: 1.42, 95% CI, 1.03-1.94) to 1.51 times (OR: 1.51, 95% CI, 1.13-2.02).

Conclusion: The findings suggest that family resilience is associated with a lower likelihood of BCPs in CSHCNs. ACEs have varying effects on the relationship between family resilience and BCPs across different levels of family resilience. These results highlight the importance of strengthening family resilience and addressing ACEs in interventions to reduce behavioral issues in CSHCNs.