Lest we forget: comparing retrospective and prospective assessments of adverse childhood experiences in the prediction of adult health

Abstract

Background Adverse childhood experiences (ACEs; e.g., abuse, neglect, parental loss, etc.) have been associated with increased risk for later-life disease and dysfunction using adults’ retrospective self-reports of ACEs. Research should test whether associations between ACEs and health outcomes are the same for prospective and retrospective ACE measures. Methods We estimated agreement between ACEs prospectively-recorded throughout childhood (by Study staff at Study member ages 3, 5, 7, 9, 11, 13, and 15) and retrospectively-recalled in adulthood (by Study members when they reached age 38), in the population-representative Dunedin cohort (N=1,037). We related both retrospective and prospective ACE measures to physical, mental, cognitive, and social health at midlife measured through both objective (e.g., biomarkers and neuropsychological tests) and subjective (e.g., self-reported) means. Results Dunedin and CDC ACE distributions were similar. Retrospective and prospective measures of adversity showed moderate agreement (r=.47, p<.001; weighted Kappa = .31, 95% CI: .27–.35). Both associated with all midlife outcomes. As compared to prospective ACEs, retrospective ACEs showed stronger associations with life outcomes that were subjectively assessed, and weaker associations with life outcomes that were objectively assessed. Recalled ACEs and poor subjective outcomes were correlated regardless of whether prospectively-recorded ACEs were evident. Individuals who recalled more ACEs than had been prospectively recorded were more neurotic than average, and individuals who recalled fewer ACEs than recorded were more agreeable. Conclusions Prospective ACE records confirm associations between childhood adversity and negative life outcomes found previously using retrospective ACE reports. However, more agreeable and neurotic dispositions may respectively bias retrospective ACE measures toward underestimating the impact of adversity on objectively-measured life outcomes and overestimating the impact of adversity on self-reported outcomes. Associations between personality factors and the propensity to recall adversity were extremely modest and warrant further investigation. Risk predictions based on retrospective ACE reports should utilize objective outcome measures. Where objective outcome measurements are difficult to obtain, correction factors may be warranted.

Effects of Early-Life Adversity on Hippocampal Structures and Associated HPA Axis Functions

“…To date, most studies conducted in adults have assessed the experience of maltreatment by means of retrospective self-reports, which have the potential for reporting bias [25]. Higher perceived stress has also been related to significant hippocampal volume and CA2/3 and CA4/DG subfield reductions in older adults [49].…”

“…Disentangling the effects of ELA and psychopathology on hippocampal development is difficult, because many studies investigating hippocampal differences in childhood maltreatment include children with psychopathology [24]. In addition, ELA is often assessed using subjective retrospective report (e.g., questionnaires), which can lead to a reporting bias [25].…”

Childhood and Adolescent Adversity and Cardiometabolic Outcomes: A Scientific Statement From the American Heart Association

“…5,16 This is problematic because research shows that there is only moderate agreement between prospective and retrospective measures of childhood adversity, such that groups of individuals identified with these 2 different methods of assessment may show only limited overlap and different disease risk. 127 Longitudinal designs are increasing in frequency, and a few longitudinal studies have assessed adversity in childhood and/or adolescence. 4,9,10,29,68,109,111,[128][129][130][131] As an example, the British National Child Development Study, a 50-year longitudinal study, assessed experiences of bullying when children were between 7 and 11 years of age.…”

“…149,150 For adults, a retrospective assessment of childhood adversities and current trauma could be coupled with mental health assessments and screenings for substance use, although the validity of retrospective recall of childhood adversity remains debated. 127 Newly identified mental health problems should lead to referrals and treatment for those conditions, in addition to already provided clinical care for physical health conditions. For minors, in addition to screening for adversity and behavioral and mental health issues, the safety and security of the child must be considered because the adversity identified may be ongoing.…”

Child maltreatment is associated with poor socioeconomic outcomes at 50 years of age

“…The authors have shown agreement between retrospective ACE (from self-reports) and prospective assessments (from archival records),3 and that ACE, including a poor neurodevelopment profile at 3 years of age, strongly predicts poor adult outcomes. They did this through use of a longitudinal data set and administrative data, the analysis of which, while a challenging read, is both novel and robust.…”