Excessive digital devices use as an intermediate variable between heterogeneous adverse childhood experiences and...

Adverse childhood experiences (ACEs) represent a significant public health concern in the US. While research has established links between ACEs and psychopathology, the behavioral mechanisms intermediating this relationship in adolescents remain limited, particularly regarding digital device usage behaviors in the technological era.

I examined the intermediate role of excessive digital device use (EDDU) in the relationship between heterogeneous ACEs and psychopathology in a nationally representative sample of US adolescents.

Data from the 2021-2023 National Survey of Children's Health included 50,285 adolescents ([Formula: see text]=14.47 ± 1.7, 49% girls, weighted N = 23,930,493). Latent class analysis identified ACE patterns. Logistic regression models and the Karlson-Holm-Breen method assessed associations between ACE classes, EDDU, and disorders, controlling for sociodemographic factors and accounting for complex survey design.

Four distinct ACE classes emerged: Low ACE Exposure (LAE), Economic and Family Hardship (EFH), Community and Discrimination Stress (CDS), and Pervasive ACEs Exposure (PAE). Compared to LAE, PAE showed the strongest association with EDDU (OR = 2.28, 95% CI [1.89,2.74]) and with depression (OR = 7.72, 95% CI [6.28,9.48]) and anxiety (OR = 5.36, 95% CI [4.43,6.47]). EDDU significantly intermediated the relationship between ACE classes and all three disorders, showing stronger effects for internalizing disorders than for ADHD.

ACE patterns show heterogeneous associations with adolescent EDDU and psychopathology in this cross-sectional analysis. Statistical relationships between ACEs, EDDU, and mental health problems suggest potential behavioral pathways that warrant longitudinal investigation. While causal relationships cannot be established, these findings highlight digital device use as a potentially relevant factor when supporting adolescents with adverse childhood experiences.