Influence of Early Life Adversity on Academic, Behavioral, and Health Outcomes at Elementary School

Limited prospective data have examined the effects of adverse childhood experiences (ACEs) on outcomes as early as elementary school, and few studies have explored cortisol and oxytocin as biomarkers for risk and resilience that may predict later life outcomes.

The Hair Biomarkers Study (HBS-I) evaluated healthy preschool children (age 9-72 months) using parent surveys and scalp hair to measure cortisol (HCC; ng/mg) and oxytocin concentrations (HOC; ng/mg) via ELISA. Prospective follow-up at elementary school (age 7-12 years) included school attendance, Child Behavior Checklist (CBCL), and health outcomes.

The cohort (N = 189) was 62% male, 41% White, and 90% living in a nuclear family. In multivariate negative binomial, linear, and logistic regression models, 1+ versus 0 ACEs at preschool was associated with 57% higher absenteeism in first-grade (95% CI: 1.02, 2.41), 12.3 percentile higher CBCL Total Problems (95% CI: 1.69, 22.89), and 3.7-fold greater odds of medically unexplained symptom(s) (95% CI: 1.12, 12.04). Higher preschool HOC predicted fewer school absences (RR: 0.90; 95% CI: 0.82, 0.98), while higher HCC predicted more sleep problems (OR: 1.49; 95% CI: 1.02, 2.18). Higher parental stress at preschool age predicted internalizing (Est: 1.39; 95% CI: 0.82, 1.95) and externalizing problems (1.17; 95% CI: 0.67, 1.67), and lower child health ratings (OR: 0.92; 95% CI: 0.86, 0.97).

Preschool ACEs exposure was consistently associated with poorer outcomes across all 3 domains of academics, behavioral problems, and health. Collaboration among pediatricians, schools, mental health professionals, and community organizations is essential to mitigate ACEs-related long-term sequelae.