Research Letter: Childhood Adversity and Risk of Subsequent Head and Neck Injury: an ABCD Cohort Analysis

ObjectiveThis study examined whether baseline reports of adverse childhood experiences (ACEs) and early life adversity (ELA) were associated with subsequent head/neck injury or probable brain injury in the Adolescent Brain Cognitive Development (ABCD) Study(R) cohort. SettingABCD Study(R) cohort ParticipantsABCD Study(R) data release 5.0 provided baseline and partial longitudinal data through Year 4. Inclusion required at least one follow-up timepoint, data to compute the ACEs or ELA score, sex, and attention-deficit/hyperactivity disorder (ADHD) diagnosis status. The final sample included 10,853 participants for ACEs analyses and 10,850 ELA analyses. DesignProspective observational design. Main MeasuresHead and/or neck injuries and probable brain injuries were assessed using the caregiver-reported Ohio State University Traumatic Brain Injury Identification Method Short Form. We used previously published recommendations for the ABCD study to calculate a proxy ACEs score and a broader measure of ELA using both caregiver and youth report at baseline. Age, gender, race/ethnicity, primary caregiver education, childs history of ADHD, report of head/neck or probable brain injury at baseline, and broken bone injury at baseline or follow-up were covariates in logistic regression models examining the association between risk of head/neck injury or probable brain injury with ACEs or ELA. ResultsExposure to more adversity (ACES: Odds Ratio [95% Confidence Interval] OR[95%CI]=0.04[0.001,0.08]; ELA: OR[95%CI]=0.05[0.01,0.08]) was associated with higher odds of sustaining a head or neck injury at any of the follow-up time points but not of probable brain injury (ACES: OR[95%CI]=0.002[-0.08,0.08]; ELA: OR[95%CI]=0.01[-0.06,0.07]). ConclusionLimited public knowledge of and reliance on caregiver report of head/neck injury increases misclassification bias and underscores the need for improved education and measurement strategies. We observed a stronger association between ELA and head/neck injury, potentially reflecting differences in disclosure and awareness rather than due to types of exposure.