802 - Can Positive Childhood Experiences Counter Adverse Childhood Experiences? The Impact of Positive Childhood Experiences on Flourishing in Children with Autism and ADHD

Publication Number: 802.4194

Katherine E. McGreal, Wright State University Boonshoft School of Medicine, Beavercreek, OH, United States; Samantha Doehring, Wright State University Boonshoft School of Medicine, Fairborn, OH, United States; Alexander R. Becker, Wright State University Boonshoft School of Medicine, Fairborn, OH, United States; Adrienne Stolfi, Wright State University Boonshoft School of Medicine, Dayton, OH, United States; Jeannette Manger, Wright State University Boonshoft School of Medicine, Dayton, OH, United States; Lisa Journell, Wright State University Boonshoft School of Medicine, Dayton, OH, United States

Background: Positive Childhood Experiences (PCEs) are ones that nurture children’s sense of belonging, connection, and safety. Evidence indicates that PCEs improve child flourishing and counter effects of Adverse Childhood Experiences (ACEs). ACEs disproportionately affect children with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) compared to children without.

Objective: This study investigated effects of PCEs on flourishing in children with ASD, ADHD, and ACEs.

Design/Methods: The 2021-2022 National Survey of Children’s Health was used to examine the influence of PCEs and ACEs on flourishing in 6-17 year-old children with ASD or ASD + ADHD. Flourishing was defined as positive responses to 3 of 3 questions about a child’s ability to stay in control, learn new things, and finish tasks. Seven PCEs were grouped into 0-2, 3-4, and 5-7 PCEs. Ten ACEs were grouped into rankings of 0, 1, and ≥2. Comparisons between children with ASD alone and ASD + ADHD were made with chi-square tests. Adjusted odds ratios (AOR, 95% confidence interval, CI) of flourishing were determined for PCEs within 0, 1, and ≥2 ACEs using multiple logistic regressions. All analyses incorporated sampling weights.

Results: A total of 2261 children were included; 1076 (47.6%) had ASD, and 1185 (52.4%) had ASD + ADHD. Children with ASD alone were more likely to flourish (22.4% vs. 13.5%, P=0.010) and less likely to have two or more ACEs (P < 0.001), but there was no difference in the number of PCEs between groups (Table 1). Of children who flourished (n=368), 196 (56.5%) had 5-7 PCEs compared to 501/1893 (21.8%) children who did not flourish (P < 0.001). Flourishing children were more likely to have no ACEs (46.0% vs. 28.2%, P< 0.001), mild parent-rated ASD severity (76.3% vs. 42.5%, P< 0.001), and private health insurance (53.3% vs.41.1%, P=0.014). At all categories of ACEs, children with 5-7 PCEs had significantly higher adjusted odds of flourishing compared to children with 0-2 PCEs, impacting children with both ASD + ADHD (AOR 8.91; 95% CI, 1.60-49.50) and with the greatest effect seen at two or more ACEs (AOR 10.62; 95% CI, 3.36-33.63) (Table 2).

Conclusion(s): Flourishing was significantly greater in children experiencing the highest number of PCEs and ACEs across all groups. This is especially relevant among children with ASD + ADHD as they experience a higher number of ACEs. Strategies should focus on increasing opportunities for PCEs in children with ASD, ADHD, and comorbid ADHD and ASD to increase their ability to flourish and mitigate the effect of ACEs.

Table 1. Demographic characteristics of children in the study and comparisons between children with ASD alone and children with both ASD and ADHD
Values in table are unweighted count (weighted percent). Statistically significant P values are bolded.
Abbreviations: ACE, adverse childhood experience; ADHD, attention-deficit hyperactivity disorder; ASD, autism spectrum disorder; FPL, federal poverty level; GED, General Educational Development test; PCE, positive childhood experience.


Table 2. Adjusted odds ratios and 95% confidence intervals for the odds of flourishing within different levels of ACEs and PCEs
Abbreviations: ACE, adverse childhood experience; ADHD, attention-deficit hyperactivity disorder; AOR, adjusted odds ratio; ASD, autism spectrum disorder; CI, na, not available; confidence interval; PCE, positive childhood experience. AORs were adjusted for parent-rated severity of ASD and type of health insurance. AORs could not be determined for the ASD + ADHD group within one ACE because no children with 0-2 PCEs flourished at that level.