Developmental, behavioural problems prevalent in kids with adverse childhood experiences

Exposure to adverse childhood experiences (ACEs) appears to result in developmental, academic, and behavioural concerns among kindergarten children, suggests a Singapore study.

Furthermore, many of these children have not completed their vaccinations and often come from families facing several social or financial difficulties.

"Comprehensive screening of these children and families and timely intervention are essential to improving outcomes,” the researchers said.

Fifty-two children were included in this prospective cross-sectional study conducted between January 2023 and March 2024. The researchers collected demographic and health information using a data collection form. They screened the child’s development, academics, behaviour, and caregiver’s mental well-being using a standardized screening tool. For categorical variables, chi-square statistics was used.

Of the children, 78.8 percent experienced maltreatment, and 21.2 percent had exposure to household dysfunction (HD) alone. More than a third of the children (35.9 percent) had experienced at least four ACEs. [Proc Singap Healthc 2025;doi:10.1177/20101058251396675]

The most common type of abuse was physical abuse (70.0 percent), while the most common alleged perpetrators were biological parents (73.1 percent). Most of the children (63.5 percent) were victims of repeated maltreatment, and many came from families with financial difficulties (55 percent), domestic violence (50 percent), or divorced parents (40.4 percent).

Based on the screening, there was a high prevalence of developmental delay (65.9 percent in maltreated group, 54.5 percent in HD group), academic concerns (61 percent in maltreated group, 54.5 percent in HD group), and behavioural concerns (65.8 percent in maltreated group, 33.3 percent in HD group).

Notably, children with behavioural concerns tended to have developmental delays (p=0.02) and academic concerns (p=0.04). Moreover, 15.4 percent had incomplete immunizations.

“A holistic assessment of the child and family is thus essential and should be extended to all children exposed to ACEs,” the researchers said. “Early identification allows timely interventions and support, facilitating a smooth transition to primary school and mitigating negative impacts on future academic achievement, health, and overall well-being.”

Maltreatment

A previous study has shown the association of child maltreatment with lower family socioeconomic status, domestic violence, substance use disorders, and caregiver criminality issues, which may adversely impact parental functioning and stress and thus increase the risk for maltreatment. [Child Abuse Negl 2018;79:465-475]

“This is consistent with our results, as about half of the study population faced financial difficulties and stayed in rental housing,” the researchers said. 

Their median per capita income (PCI) is SGD 1,224.40, which is lower than the average PCI of SGD 2,886 in 2020. [https://www.singstat.gov.sg/-/media/files/publications/households/pp-s27.pdf]

Immunization

Furthermore, “[m]any children in our study sample have missed vaccinations with vaccine coverage being lower (84.6 percent) than the national average of 95 percent to 99 percent for the key preventable childhood diseases despite many of these vaccinations being fully subsidized. [https://cdn.who.int/media/docs/default-source/country-profiles/immunization/2023-country-profiles/immunization_sgp_2023.pdf?sfvrsn=41726ec0_5&download=true]

Under Singapore’s Infectious Diseases Act, schoolchildren are required to be vaccinated. “Hence, it is important to understand parental barriers and perceptions around routine health-related behaviours in order to address these knowledge-practice gaps,” the researchers said.