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Childhood adversity across generations and its impact on externalizing behavior

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Childhood adversity across generations and its impact on externalizing behavior

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CHILDHOOD ADVERSITY ACROSS GENERATIONS AND ITS IMPACT ON
EXTERNALIZING BEHAVIOR

By

Yoewon Yoon

A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(SOCIAL WORK)

May 2021

ii
Dedication

To Hae Gyun Lim and Jordan W. Lim

iii
Acknowledgements

I am grateful to so many people who supported me and made this dissertation a reality.
First, I would like to express my gratitude to my mentor and dissertation chair, Dr. Jungeun
Olivia Lee. Without your continuous encouragement and support, this study would not have been
possible. Thank you for unhesitatingly leading me through this process and advocating for me
every step of the way. Throughout the doctoral program, your unwavering enthusiasm for
research kept me engaged with my work, and your personal generosity helped make my time at
USC enjoyable.
My appreciation extends to my other mentor, Dr. Julie Cederbaum. Your mentoring and
encouragement have been especially valuable, and your insights helped launch the greater part of
this dissertation. She contributed to many discussions that helped shape my doctoral studies in
the U.S. I feel lucky to have met her and for our continued relationship.
I am also deeply appreciative of my dissertation committee members and other faculty
and colleagues from USC: Dr. Darby Saxbe, Dr. Chih-Ping Chou, Dr. Ferol Mennen, Dr. Lei
Duan, and Dr. Michael Hurlburt. It was a great pleasure working with all of you and I appreciate
for your invaluable guidance, collaborations, and support.
Lastly, my deepest appreciation belongs to my family for their support at all times. To
my parents and husband for their unequivocal support throughout this journey, for which my
mere expression of thanks does not suffice. Around the time I started working on this
dissertation, I became pregnant with our son, Jordan. Thank you for all the joy you have brought
to our life and giving us the most valuable experience of being your parent.

iv
Table of Contents
Dedication ....................................................................................................................................... ii
Acknowledgements ........................................................................................................................ iii
List of Tables ................................................................................................................................. vi
List of Figures ............................................................................................................................... vii
Abstract ........................................................................................................................................ viii
Chapter 1. Introduction ................................................................................................................... 1
Specific Aims ...................................................................................................................... 5
Chapter 2: Time dimension of childhood adversities and externalizing behavior among
offspring of teen mothers: Sensitive period hypothesis vs. accumulation hypothesis .................... 8
Introduction ......................................................................................................................... 8
Methods............................................................................................................................. 14
Analyses ............................................................................................................................ 19
Results ............................................................................................................................... 20
Discussion ......................................................................................................................... 26
Chapter 3: Intergenerational continuity and the mechanisms of childhood adversity among
teen mothers and their offspring ................................................................................................... 32
Introduction ....................................................................................................................... 32
Methods............................................................................................................................. 34
Analyses ............................................................................................................................ 38
Results ............................................................................................................................... 39
Discussion ......................................................................................................................... 46
Chapter 4: The role of teen mother’s antisocial behavior, illicit drug use, and depression in
the intergenerational continuity of childhood adversity ............................................................... 53
Introduction ....................................................................................................................... 53
Methods............................................................................................................................. 57
Analyses ............................................................................................................................ 62
Results ............................................................................................................................... 65
Discussion ......................................................................................................................... 72
Chapter 5: Conclusions And Implications .................................................................................... 79
v
References ..................................................................................................................................... 84

vi
List of Tables

Table 1. Childhood Adversity Constructs and Measures (YCDS Cohort 1) ................................ 17
Table 2. Description of the Sensitive Period and Accumulation Hypotheses .............................. 18
Table 3. Descriptive Statistics of Analysis Variables (N = 240) .................................................. 21
Table 4. Externalizing Behavior at Age 17, Predicted by Offspring’s Childhood Adversity. ..... 25
Table 5. Childhood Adversity Constructs and Measures.............................................................. 40
Table 6. Descriptive Statistics of Analysis Variables (N = 240) .................................................. 41
Table 7. Childhood Adversity Constructs and Measures.............................................................. 64
Table 8. Descriptive Statistics of Analysis Variables (N = 240) .................................................. 66

vii
List of Figures

Figure 1. Elbow plots illustrating the LARS variable selection procedure. ................................. 24
Figure 2. The mediation effect of parental stress. ......................................................................... 44
Figure 3. The domain-specific mediation model. ......................................................................... 45
Figure 4. The mediation effect of teen mothers’ antisocial behavior, illicit drug use, depression,
and parental stress. ........................................................................................................................ 70
Figure 5. The domain-specific mediation model. ......................................................................... 71

viii
Abstract
This dissertation aims to examine the intergenerational continuity of childhood adversity
among teen mothers and their offspring. To achieve this goal, three separate studies were
conducted. The study used data from the Young Women and Child Developmental Study, a
longitudinal study examining a broad range of developmental outcomes spanning multiple
developmental periods of teen mothers and their offspring. Eligible participants were pregnant,
unmarried adolescents aged 17 years or younger who were planning to carry their babies to term
at the time of enrollment (Lee et al., 2017). Participants were recruited from public and private
hospital prenatal clinics, public school alternative programs, and social services in three urban
counties in the Northwest United States (Oxford et al., 2010). The study featured a sample of 240
teen mothers and their offspring recruited from the three counties of a metropolitan region in the
Washington States.
The first study aimed to identify whether the time dimension of childhood adversity
impacted externalizing behaviors at age 17 among offspring of teen mothers. The study tested (a)
the sensitive period hypothesis regarding timing of childhood adversity on externalizing
behavior, (b) the accumulation hypothesis regarding the associations between the duration of
childhood adversity and externalizing behavior, and (c) the domain-specific impact of childhood
adversity on externalizing behavior. Childhood adversity was measured at seven waves (age
range: 5.5-16), which were used to test the sensitive period hypothesis. Childhood adversity at
each wave was summed across seven waves to test accumulation measure representing the
duration of childhood adversity. Least angle and multiple regression analyses were conducted.
Results supported the sensitive period hypotheses – the effect of childhood adversity was the
most prominent at age 11.5, whereas the accumulation of childhood adversity across waves was
ix
not a significant predictor of later externalizing behavior. Probing childhood adversity by
subdomains revealed maltreatment primarily accounted for externalizing behavior (p < .05).
Findings suggest that intervention efforts for children of teen mothers are critical during early
adolescence to prevent externalizing behavior in later adolescence. Unpacking childhood
adversity may further illuminate key areas of vulnerability to externalizing behavior.
The second study extended the first study and investigated factors that influence
offspring’s childhood adversity. The study investigated teen mother’s parental distress and
parent-child dysfunctional interaction (teen mother’s age 22; offspring’s age: 5) as mechanisms
linking childhood adversity across generations. The study explored childhood adversities by two
domains – child maltreatment vs. household dysfunction – to investigate how each domain
differently shapes the intergenerational continuity of childhood adversity and its mechanisms.
Results suggest intergenerational continuity of childhood adversity. Teen mother’s childhood
adversity was linked indirectly to offspring’s childhood adversity (at age 11.5 years) through
parental distress. Specifically, parental distress mediated the association between teen mother’s
maltreatment and offspring’s household dysfunction. No other indirect effect paths were
statistically significant. Our results may be of particular use for social work interventions
designed to mitigate parenting stress and eventually to prevent the cycle of childhood adversity
across generations.
The third study focused on teen mother’s antisocial behavior, illicit drug use, and
depression, and two domains of parenting stress (i.e. parental distress and parent-child
dysfunctional interaction) in their emerging adulthood (teen mother’s age: 21-23; offspring’s
age: 4-6) as mechanisms linking childhood adversity across generations. The study also explored
childhood adversities by two domains – child maltreatment vs. household dysfunction – to
x
investigate how each domain differently shapes the intergenerational continuity of childhood
adversity and its mechanisms. Results suggest the intergenerational continuity of childhood
adversity. Teen mother’s childhood adversity was linked indirectly to offspring’s childhood
adversity (at age 11.5 years) through teen mother’s antisocial behavior. Upon further probing the
linkage by childhood adversity domain, teen mother’s antisocial behavior mediated the
association between teen mother’s maltreatment and offspring’s household dysfunction. Our
results may inform practitioners and researchers to prioritize the intervention programs for teen
mothers in their emerging adulthood to optimally address the challenges related to antisocial
behavior that teen mothers may face during that particular period. Continued efforts to unveil the
mechanisms associated with the intergenerational continuity of childhood adversity are needed to
break the cycle of childhood adversity across generations.
1
Chapter 1. Introduction
Childhood adversity comprises various types of abuse – physical, sexual, and emotional
–, as well as household dysfunction, such as living in a home with a parent of violence, alcohol
or substance misuse problems, mental illness, incarceration, or parental divorce or separation,
under the age of 18 (Centers for Disease Control and Prevention, 2013; Felitti et al., 1998).
According to recent work, approximately 45% of children in the United States have experienced
at least one Adverse Childhood Experiences (ACEs) in their childhood, with around 10% of
children have been exposed to three or more types of ACEs, placing them in a category of
especially high risk (Sacks & Murphey, 2018). Extensive research has documented the
detrimental impact of exposure to early adversity and children’s later mental health (Crouch et
al., 2018; Jones et al., 2018), behavioral health (Fava et al., 2019) and well-being (Lanier et al.,
2018). Particularly, externalizing behavior problems, including aggression, disruptive or
oppositional behavior, and hyperactivity (Boeldt et al., 2012) tend to elevate during adolescence
(Figge et al., 2018). Offspring of teen mothers are at increased risk of externalizing behavior
(Lee et al., 2020), highlighting the importance of examining the factors that influence
externalizing behaviors in this vulnerable population (Handley & Chassin, 2013). Although the
impact of childhood adversity on externalizing behavior is well documented, prior studies are
limited in three critical ways. First, the “timing” of childhood adversity and its impact of
externalizing behavior is not fully studied (Dunn et al., 2018). The sensitive period hypothesis
posits that experiences in specific developmental periods are most influential in shaping
subsequent mental health problems (Heim & Binder, 2012). To date, very few studies have
evaluated the sensitive period hypothesis within the framework of childhood adversity and
reported mixed findings (Dahl et al., 2017; Dunn et al., 2017; Dunn et al., 2018; Harpur et al.,
2
2015; Sonuga-Barke et al., 2017), providing limited information on the timing of childhood
adversity and its impact on externalizing behavior. Second, the “duration” of childhood adversity
and its impact on later externalizing behavior has not been well documented. The accumulation
hypothesis posits that risk exposures are compounded over the life course (Cohen et al., 2010),
affecting poor health outcomes in a dose-response manner, irrespective of timing (Dunn et al.,
2019; Evans et al., 2013). Therefore, comparing these two hypotheses – sensitive period vs.
accumulation – may be important, because a greater understanding of the time dimensions of
childhood adversity could shed new light on the mechanisms underlying risk of externalizing
behavior. Third, differential impact of two domains of childhood adversity – child maltreatment
and household dysfunction – on externalizing behavior are known, but often unaccounted for in
the literature. Childhood adversity items are often used as a cumulative score to indicate a dose-
response effect of each additional adversity. Given the limitations of utilizing the accumulation
of childhood adversity, including oversimplifying childhood adversity by equally weighting each
childhood adversity item, unpacking risk factors into two domains will help identify which
domain drives the associations of childhood adversity and externalizing behavior.
Caregivers’ early adversity experiences, in addition to offspring’s own early experiences,
can play an important role in shaping offspring’s developmental outcomes. Recently, researchers
have sought to better understand the associations between caregivers’ childhood adversity and
their offspring’s development (Folger et al., 2018; Letourneau et al., 2020; Lê-Scherban et al.,
2018; McDonald et al., 2019; Yoon et al., 2019) as well as the intergenerational continuity of
childhood adversity (Narayan et al., 2017; Negriff, 2020). However, there are three critical gaps
in the existing literature. First, previous work on the intergenerational continuity of childhood
adversity mainly focused on the cycle of maltreatment, with very few studies incorporated both
3
maltreatment and household dysfunction (Narayan et al., 2017; Negriff, 2020; Schofield et al.,
2018). One of the studies incorporating both maltreatment and household dysfunction revealed
that higher number of parental childhood adversity in either category (maltreatment or household
dysfunction) predicted higher levels of their offspring’s childhood adversity in both categories
(Narayan et. al., 2017). Other found that child maltreatment experiences were more likely to
contribute to the risk of maltreatment in the next generation (Thornberry et al., 2012), including
between teen mothers and their offspring (Putnam-Hornstein et al., 2015). Fewer studies
unpacked childhood adversity into two domains to understand whether intergenerational
continuity of childhood adversity is related differentially to experiences of maltreatment vs.
household dysfunction. However, the influence of non-abusive forms of adversity, namely
household dysfunction, on child developmental outcomes (Narayan et al., 2017) has been
relatively overlooked. Second, mechanisms explaining intergenerational continuity of childhood
adversity among teen mothers and their offspring are not fully explained. One of the potential
mechanisms of intergenerational continuity of childhood adversity is parenting stress (Negriff et
al., 2020). While parent’s adverse experiences are known to predict later parenting and parent-
child interactions (Bert et al., 2009; Hughes & Cossar, 2016), limited work has examined
parenting stress as a mechanism linking teen mother’s childhood adversity and their offspring’s
adversity exposures. Although no known study has examined the mediating role of parenting
stress in the intergenerational continuity of childhood adversity, parenting stress was found to
intensify the intergenerational continuity of harsh discipline (Niu et al., 2018), implying the
importance of incorporating parenting stress as a factor shaping the associations of adversity
across generations. Third, in examining the mechanisms linking intergenerational continuity of
childhood adversity, domain-specific childhood adversity has not been examined, with prior
4
work instead mostly focusing on cumulative childhood adversity experiences. This might hinder
the possibility of discovering differential impact of maltreatment vs. household dysfunction on
parenting stress. Therefore, examining the relative contribution of two domains of childhood
adversity will enable us to clarify the associations of teen mothers’ and their offspring’s
adversity.
To better understand the continuity of childhood adversity among teen mothers and their
offspring, it is also important to consider the impact of teen mother’s development in emerging
adulthood on the intergenerational continuity of childhood adversity. Various mental health and
behavioral problems peak in emerging adulthood, including antisocial behavior (Duke et al.,
2010), substance use (Sussman & Arnett, 2014), and depression (Whiteford et al., 2015). Since
mental health and behavioral problems of mothers are known to confer further vulnerability for
the next generation (Rieder et al., 2019), it is critical to consider teen mothers’ antisocial
behavior, illicit drug use, and depression in emerging adulthood as mechanisms explaining the
childhood adversity across generations. During this period of instability, teen mother’s early
parenthood may heighten the vulnerability for mental health and behavioral problems during
emerging adulthood (Madigan et al., 2014). Combined with the developmental characteristics in
emerging adulthood, childhood adversity experiences can threaten teen mothers’ own
development and well-being and lead to antisocial behavior and illicit drug use problems
(Schilling et al., 2007), or depression (Giovanelli et al., 2016). This disrupted transition to
emerging adulthood (MacLeod & Brownlie, 2014; Schulenberg & Zarrett, 2006) may have a
negative influence on parenting roles (Bartlett & Easterbrooks, 2012; Cornish et al., 2006;
Tronick & Reck, 2009). Therefore, explaining the link between antisocial behavior, illicit drug
5
use, depression, and parenting stress of teen mothers represents a significant shift in addressing
the intergenerational continuity of childhood adversity.
Due to the gaps and limitations in existing studies, the current dissertation is focused on
examining the childhood adversity across generations and its impact on offspring’s externalizing
behavior, using a longitudinal study of teen mothers and their offspring. The knowledge gained
from the current study will help the field develop prevention and intervention strategies for teen
mothers and their offspring. Findings can inform prevention and intervention strategies to disrupt
the intergenerational cycle of childhood maltreatment and household dysfunction.

Specific Aims
Study 1: To test the impact of the “time dimension” of childhood adversity on externalizing
behaviors for offspring of teen mothers at age 17.
1a) To identify the impact of the developmental timing of childhood adversity on externalizing
behavior at age 17 (sensitive period hypothesis).
1b) To examine the impact of the duration of childhood adversity on externalizing behavior
(accumulation hypothesis).
1c) To test domain-specific impact of childhood adversity on externalizing behavior.
Study 2: To examine teen mothers’ parental distress and parent-child dysfunctional
interaction as mechanisms linking childhood adversity across generations.
2a) To test the intergenerational continuity of childhood adversity across generations among teen
mothers and their offspring.
2b) To investigate the relative contribution of the intergenerational continuity of maltreatment
vs. household dysfunction from teen mothers to their offspring.
6
2c) To examine whether teen mothers’ parental distress and parent-child dysfunctional
interaction explain the link between childhood adversity across generations.
Study 3: To examine teen mothers’ antisocial behavior, illicit drug use, depression, and two
domains of parenting stress in emerging adulthood as mechanisms linking childhood
adversity across generations.
3a) To examine whether teen mothers’ antisocial behavior, illicit drug use, depression, and
parenting stress mediate teen mothers’ childhood adversity and their offspring’s
childhood adversity.
3b) To investigate the relative contribution of maltreatment and household dysfunction across
generations, via mechanisms including teen mothers’ antisocial behavior, illicit drug use,
depression, and parenting stress.

Organization of the Study
This dissertation is organized into five chapters. The present chapter (Chapter 1) provides
a general background of childhood adversity and its intergenerational continuity among teen
mothers and their offspring. It also explains the possible mechanisms linking childhood adversity
across generations. The chapter also highlights major gaps in the literature and aims of the three
analyses. Chapter 2 explores the time dimension of childhood adversity among offspring of teen
mothers and its impact on later-on externalizing behavior (age 17). The study followed a two-
stage structured life course modeling approach (SLCMA; Dunn et al., 2018) to evaluate two
competing hypotheses – sensitive period vs. accumulation – regarding the time dimension of
childhood adversity. Based on the findings from the first stage, the chosen hypothesis is then
carried forward to the multiple regression analysis. The study extended the regression model into
7
domain-specific childhood adversity (maltreatment vs. household dysfunction) to identify which
specific area of childhood adversity is more detrimental to their externalizing behavior at age 17.
Chapter 3 presents the second paper investigating the potential mechanisms of intergenerational
continuity of childhood adversity. The study tested the mediation effect of parental distress and
parent-child dysfunctional interaction in the association between teen mothers’ and their
offspring’s childhood adversity. Chapter 4 presents the third paper which examines teen
mothers’ antisocial behavior, illicit drug use, and depression in emerging adulthood as mediators
of the associations between teen mother’s childhood adversity and offspring’s childhood
adversity. In addition, the path linking teen mother’s childhood adversity, antisocial behavior,
illicit drug use, depression, parenting stress, and offspring’s childhood adversity is also
examined. In both mediation models in Chapter 3 and 4, domain-specific childhood adversity
was tested. Chapter 5 provides a discussion of the findings, implications for practice, study
limitations and strengths, directions for future research, and concluding remarks.

8
Chapter 2: Time dimension of childhood adversities and externalizing behavior among
offspring of teen mothers: sensitive period hypothesis vs. accumulation hypothesis

Introduction
Childhood adversity has significant long-term effects on the developmental outcomes of
children and adolescents (Fava et al., 2019; Lanier et al., 2018) and includes maltreatment (i.e.,
abuse and neglect) and household dysfunction (i.e., parental divorce, substance abuse, mental
illness, and incarceration of family members; Felitti & Anda, 2010). Prior works have
established the dose–response link between childhood adversity and poor health and behavioral
outcomes (Lanier et al., 2018) including externalizing behaviors; as the number of adverse
childhood experiences (ACEs) increases, the risk of externalizing behaviors also rises (Hunt et
al., 2017).
Externalizing behavior problems tend to elevate during adolescence (Figge et al., 2018).
They refer to a wide range of symptoms, including aggression, disruptive or oppositional
behavior, and hyperactivity (Boeldt et al., 2012; Fanti & Henrich, 2010). Research has
documented the developmental nature of externalizing behavior problems (Burke et al., 2008).
Given the fact that adolescents’ externalizing behaviors have been linked to disruptive behavior
and offending during adulthood (Barnes et al., 2013), understanding the factors that influence
adolescent externalizing behaviors is essential. Offspring of teen mothers are at increased risk of
externalizing behavior (Lee et al., 2020), underscoring the importance of understanding the
factors that influence externalizing behavior in this vulnerable population (Handley & Chassin,
2013).
Experiencing childhood adversity can lead to externalizing behavior problems (Brown &
Shillington, 2017). Longitudinal studies have found a significant association of adverse
9
childhood experiences with externalizing behavior. For example, Hunt et al. (2017) documented
the dose-response associations of adverse childhood experiences and externalizing behavior, in
that children with four or more ACEs before age of 5 had increased externalizing behavior.
Offspring of teen mothers may be at heightened risk of externalizing behavior (Schleider et al.,
2014) and adverse exposures during childhood (Easterbrooks et al., 2019; SmithBattle &
Leonard, 2012), because teenage parents are more likely to experience poor mental health
(Quinlivan et al., 2004), less social support (SmithBattle, 2007), and poverty and unemployment
(Easterbrooks et al., 2019).
Despite providing important insights into the role of childhood adversities in shaping
externalizing behavior, prior research is limited in three critical ways. First, limited studies have
considered timing when analyzing the impact of childhood adversity on externalizing behavior
(Dunn et al., 2018). Particularly, whether the developmental timing of exposure to childhood
adversity matters in shaping future risk of externalizing behavior has been understudied.
Locating a critical period of exposure to adversity is increasingly being recognized as essential to
tailoring intervention strategies for youth to improve behavioral health, because experiencing
adverse events in key developmental periods can generate particularly harmful effects on mental
and behavioral problems (McLaughlin et al., 2016; Slopen et al., 2012). Similarly, it is not
extensively understood whether the duration of childhood adversity has an important effect on
externalizing behavior. It is important to understand the duration of adverse exposures because
risk exposures are compounded over time. Second, developmental researchers have encouraged
the practice of unpacking risk factors to better understand how specific types of childhood
adverse events may influence developmental outcomes. Particularly, specific effects of different
domains of childhood adversity – child maltreatment versus household dysfunction – on mental
10
and behavioral problems have been explored. Yet limited studies to date have expanded this
work to experiences among offspring of teen mothers. Third, most studies largely depended on
retrospective reports of childhood adversity. Although retrospective accounts offer the benefit of
capturing data about experiences across childhood, they have several limitations. For example,
they are affected by various kinds of recall bias. Details from retrospective reports may be
inexact because recalled information can be distorted when people are asked about their
childhood experiences of maltreatment and household dysfunction. The current study, in
contrast, leveraged data from longitudinal cohort studies of teen mothers and their offspring in
which children’s exposure to adversity has been assessed prospectively and repeatedly over time,
eliminating concerns about possible recall bias.

Childhood Adversity Exposure in Relation to Time: Accumulation vs. Sensitive Period
Scholars have argued that the time dimension of adversity likely matters for children’s
mental health and developmental outcomes. Although the importance of understanding adversity
exposure in relation to its time dimension has been consistently noted (Dunn et al., 2020; Nelson
& Gabard-Durnam, 2020; Schroeder et al., 2018), relative empirical findings on the time
dimension of childhood adversity have been mixed and inconclusive (Harpur et al., 2015; Jaffee
& Maikovich-Fong, 2011), calling for further investigation in childhood adversity research.
Specifically, two specific hypotheses postulate how the dimension of time intersects with
childhood adversity exposure to influence later developmental outcomes.
The sensitive period hypothesis posits that periods of increased plasticity of the brain
occur throughout development (Heim & Binder, 2012), and thus experiences in specific
developmental periods are most influential in shaping subsequent mental health problems. Prior
11
studies have typically aggregated adversity exposure across childhood and adolescence (prior to
age of 18). By extension, very few studies have evaluated the sensitive period hypothesis, and
they reported mixed findings. On one hand, some studies reported that negative experiences in
the early life stage, particularly the first 3 years of life (Sonuga-Barke et al., 2017), may generate
more deleterious impacts on later behavioral health outcomes (Dunn et al., 2017). Consistently,
domestic violence experiences in early childhood, as opposed to middle or late childhood, has
been reported to result in more psychological risk (Enlow et al., 2012; Slopen et al., 2013).
Similarly, child maltreatment before age 5 was associated with greater risk of youth externalizing
behavior compared to no or later exposure to child maltreatment (Dahl et al., 2017; Thornberry
et al., 2010). Adding to the confusion, other studies found that the developmental timing of
adversity experience did not generate differential impacts on emotional and behavioral problems
(Dunn et al., 2018). Although previous studies have established the link between the timing of
exposure to child maltreatment and behavioral health risks (Harpur et al., 2015) including
externalizing behavior problems, studies on the timing of childhood adversity as a whole –
including household dysfunction – are lacking, limiting us to more comprehensive forms of
adversity experiences. Extending previous work focused on the developmental timing of child
maltreatment, the current study explored the sensitive period of childhood adversity specifically,
maltreatment and household dysfunction – and its impact on later externalizing behavior.
Relatedly, another critical question that needs to be answered is the impact of the
accumulation of childhood adversity over time. The accumulation hypothesis posits that risk
exposures are compounded over the life course (Cohen et al., 2010; Kuh et al., 2003), in that
every additional year of exposure to adversity is associated with an increased risk of poor health
in a dose-response manner, irrespective of timing (Evans et al., 2013; Dunn et al., 2019). In other
12
words, the duration of length of exposure to adverse experiences may also shape further
development (Fine & Kotelchuck, 2010), including externalizing behavior. Comparing these two
hypotheses – sensitive period versus accumulation – may be important, because a greater
understanding of the time dimension of childhood adversity could shed new light on the
mechanisms underlying risk of externalizing behavior. More importantly, it could also help in
determining the optimal times to intervene, because childhood spans multiple developmental
periods when different types of interventions could be deployed to minimize the adverse effects
of childhood adversities based on the age of the child or the duration of the exposure (Dunn et
al., 2018). Existing relevant studies (Harpur et al., 2015; Jaffee & Maikovich-Fong, 2011)
generated mixed findings, highlighting the need for studies that simultaneously compare these
two hypotheses in relation to childhood adversities among offspring of teen mothers. The current
study simultaneously evaluated these two theoretical hypotheses. The findings of the current
study could improve our understanding of how the time dimension of childhood adversity affects
externalizing behavior and elucidate the fundamental risk of externalizing behavior by
suggesting developmental processes that are disrupted by adversity exposure.
Unpacking Childhood Adversities: Maltreatment vs. Household Dysfunction
Because many of these adverse experiences co-occur, it is challenging to tease apart the
unique contribution of each type of adversity. For these reasons, childhood adversity items are
often used as a cumulative score to indicate a dose-response effect of each additional adversity.
However, this cumulative approach to childhood adversity may apply equal weighting, which
may oversimplify childhood adversity as a risk factor for the outcome variable. Although recent
studies of childhood adversity and child development have encouraged the practice of
“unpacking risk factors” (Greeson et al., 2014; Negriff, 2020), findings are inconclusive
13
regarding which domains of childhood adversity – maltreatment or household dysfunction –
render stronger impacts on youth externalizing problems. In some studies, child maltreatment
typically had a stronger impact on adolescent externalizing behaviors (Herrenkohl & Herrenkohl,
2007; Schilling et al., 2008). Notably, more specific forms of maltreatment, like physical and
sexual violence in early childhood, resulted in a heightened risk of externalizing behavior in later
years (Dunn et al., 2020). In contrast, others revealed that household dysfunction was more
predictive of externalizing problems (Higgins & McCabe, 2003; Ryan et al., 2000). For instance,
household dysfunction during early adolescence predicted externalizing problems, particularly
substance use behavior (Hsu & Kawachi, 2019). Yet another study found that maltreatment and
household dysfunction independently predicted adolescents’ antisocial behavior (Schilling et al.,
2007). Such discrepancies in the existing literature underscore the importance of further
clarifying what domains of adversity, independently or jointly, drive the associations of
childhood adversity and externalizing behavior in later adolescence.
Current Study
Although evidence suggests that a relationship between childhood adversity and
externalizing behavior in adolescence exists, the current knowledge base regarding how the
timing and duration of childhood adversity affect externalizing behavior is lacking. Furthermore,
little is known about the relative contribution of maltreatment versus household dysfunction to
externalizing behavior in late adolescence, particularly among offspring of teen mothers.
Understanding how the time dimension of childhood adversity is associated with externalizing
behavior could elucidate the ideal intervention timing, because there are multiple developmental
periods when different types of interventions could be implemented to reduce the impact of
adversity. In addition, attention to specific adversity domains could capture meaningful
14
information related to the relative contribution of maltreatment and household dysfunction to
externalizing behavior in late adolescence.
The current study addressed these gaps in research on childhood adversity by: (a) testing
the impact of the developmental timing of childhood adversity on externalizing behavior at age
17 (sensitive period hypothesis); (b) examining the impact of the duration of childhood adversity
on externalizing behavior (accumulation hypothesis); and (c) dividing childhood adversity into
maltreatment and household dysfunction and testing their associations with externalizing
behavior.
Methods
Samples and Procedures
The current study used data from the Young Women and Child Development Study, a
longitudinal study examining a broad range of developmental outcomes spanning multiple
developmental time points of teen mothers and their offspring. Eligible participants were
pregnant, unmarried adolescents aged 17 years or younger who were planning to carry their
babies to term at the time of enrollment (Lee et al., 2017). Participants were recruited from
public and private hospital prenatal clinics, public school alternative programs, and social
services in three urban counties in the Northwest United States (Oxford et al., 2010). The data
collection began in 1987 and concluded in 2007 with a total of 240 offspring of teen mothers.
The current analysis utilized the data from waves when offspring were 5.5, 6, 9.6, 10.5, 11.5,
15.1, 16, and 17 years old. Sample retention rates were consistently high across study years,
averaging 94.6%. The sample was racially diverse (37.9% White, 32.4% African American, and
29.7% mixed or other racial groups); 58.3% of the analytic sample was boys. The sample varied
with respect to maternal education (50.2% had mothers with a high school diploma) and
15
grandmother’s education (71.4% had grandmothers with a high school diploma). The study was
approved by the human subjects review committee at the affiliated university.
Measures
Childhood Adversity (Ages 5.5 to 16 Years)
The current study measured offspring’s childhood adversity before age of 17 by obtaining
teen mothers’ self-report of their experiences while raising their children. Our childhood
adversity items were informed by the original Adverse Childhood Experiences study (Anda et
al., 2002). In the existing dataset, eight items mapped onto the original 10 items (Table 1).
Childhood adversities before age 17 were measured at seven time periods (ages 5.5, 6, 9.6, 10.5,
11.5, 15.1, and 16). At each time period, each childhood adversity item was coded as 1 when
participants positively endorsed a given item; otherwise, they were coded as 0. The resultant
dichotomized childhood adversity items were summed to form a childhood adversity composite
measure at each wave of data collection that also was dichotomized, with exposure to more than
three adversities as the threshold (Felitti et al., 1998). Subsequently, these dichotomized
measures were summed across all seven time periods (ages 5.5-16), representing the
accumulated duration of childhood adversity (range = 0-7), assuming that every additional year
of exposure to adversity is associated with an increased risk of poor outcomes. This measure was
used to test the accumulation hypothesis. More details about these measures are provided in
Table 2.
Child Externalizing Behavior at Age 17
Offspring’s externalizing behaviors were measured using the Youth Self Report
(Achenbach & Rescorla, 2001), a 112-item child report measure designed to assess
competencies, adaptive function, and problems for offspring aged 11 to 18. Items on
16
externalizing behaviors were scored on a 3-point Likert scale (0 = not true, 1 = somewhat or
sometimes true, 2 = very true or often true), summed to calculate t-scores for total externalizing
behavior.
Covariates
Covariates included teen mother’s age (continuous), child’s sex (0 = male, 1 = female),
child’s race (1 = White, 2 = African American, 3 = American Indian, 4 = Asian or Pacific
Islander, 5 = multiracial, 6 = other), teen mother’s educational attainment at baseline (at
offspring’s age 5.5; 0 = < high school, 1 = ≥ high school), grandmother’s educational attainment
(at teen mother’s age 16.6; 0 = < high school, 1 = ≥ high school), and externalizing behavior at
age 5.5, which was assessed using the Child Behavior Check List (Achenbach et al., 1991).

17
Table 1. Childhood Adversity Constructs and Measures (YCDS Cohort 1)
Category of
Childhood Exposure
Original ACEs Items Study Measure
Maltreatment
Emotional abuse (Did a parent or other adult in the
household) often or very often
swear at, insult, or put you down?
Act in a way that made you afraid
that you might be physically hurt?
Teen mothers threatened to throw
or something or to spank child
Physical abuse (Did a parent or other adult in the
household) often or very often
push, grab, shove, or slap you?
Hit you so hard that you had
marks or were injured?
Teen mothers pushed, grabbed, or
shoved the child; spanked the
child; spanked the child with
something; threw something at
child
Household
dysfunction

Food or money
insecurity
-- Teen mothers worried about
enough food for children, worried
about having enough money
Divorce Were your parents were ever
separated or divorced?
Teen mothers got divorced
Intimate partner
violence
(Was your mother or stepmother)
sometimes, often or very often
pushed, grabbed, slapped, or had
something thrown at her? Kicked,
bitten, hit with a fist, or hit with
something hard? Ever repeatedly
hit over at least a few minutes?
Threatened with or hurt by, a
knife or gun?
Eight items from the Conflict-
Tactics Scale
Parental substance
use
Live with anyone who was a
problem drinker or alcoholic or
who used street drugs?
Amount of alcohol per occasion
(4 or more cans of alcohol: heavy
episodic drinking) by teen
mothers (frequency; more than
once a month = problematic use)
Parental mental
health
Was a household member
depressed or mentally ill? Did a
household member attempt
suicide?
Brief Symptom Inventory
Incarceration Did a household member go to
prison?
Teen mother was arrested
(including for driving under the
influence)

18

Table 2
Table 2. Description of the Sensitive Period and Accumulation Hypotheses Tested in the Current Study
Hypothesis
Models
Definition Variables Variables Entered into the LARS Model
Sensitive
period
Seven waves, each with adversity
exposure. To test if presence (1 = > 3
childhood adversities) versus absence (0
= ≤ 3 childhood adversities) of childhood
adversity at a specific time period
explains the most variability in
externalizing behavior.
7 Age 5.5 = exposed (1) vs. unexposed (0)
Age 6 = exposed (1) vs. unexposed (0)
Age 9.6 = exposed (1) vs. unexposed (0)
Age 10.5 = exposed (1) vs. unexposed (0)
Age 11.5 = exposed (1) vs. unexposed (0)
Age 15.1 = exposed (1) vs. unexposed (0)
Age 16 = exposed (1) vs. unexposed (0)
Accumulation Sum of the waves of childhood adversity
exposure. To test whether the number of
time periods of exposure to childhood
adversity explains the most variability in
externalizing behavior.
1 Accumulation of waves= sum of the number
of waves exposed to childhood adversity
(range: 0–7; ages: 5.5–16)

19
Analyses
The study followed a two-stage structured life course modeling approach (SLCMA;
Dunn et al., 2018; Smith et al., 2015) to evaluate two theoretical hypotheses – sensitive period
versus accumulation – regarding the time dimension of childhood adversity. Compared to the
traditional regression modeling strategy, which has a limited capacity for handling highly
correlated variables, SLCMA enabled us to enter all childhood adversity measures (i.e., seven
measures representing childhood adversity at each age and a single measure representing the
total number of childhood adversity exposures) simultaneously to predict externalizing behavior,
then choose only those childhood adversity measures that have the strongest association with the
outcome variable, externalizing behavior at age 17. The SLCMA used least angle regression
(LARS; Efron et al., 2004), a variable selection technique for identifying childhood adversity
measures that explains the most variability (R
2
) in children’s externalizing problems (Dunn et al.,
2018). LARS begins by identifying the variable with the strongest association with the outcome
variable. It then identifies the combination of two variables with the strongest association,
followed by three variables, and so on, until all variable combinations are included. LARS,
therefore, achieves parsimony by identifying the smallest combination of encoded variables that
explain the most outcome variation. Through this process, it provides an unbiased way to
evaluate two competing hypotheses (Dunn et al., 2018) without overinflating the estimates of
effect size (Efron et al., 2004).
In the first stage, to test two competing hypotheses simultaneously, childhood adversity
variables (i.e., each of seven time period [ages 5.5-16] vs. accumulation of time periods [total
periods of childhood adversity exposure, ranging from 0 to 7]) were entered into the LARS
20
variable selection procedure. Then we examined elbow plots (Figure 1) to determine whether the
selected models were supported by our data.
In the second stage, based on the elbow plot and variability (R
2
), the chosen hypothesis in
the first stage that best fit the outcome variable was then carried forward to the multiple
regression framework. The hypothesis that most explained the outcome variable, determined by a
p-value threshold of .05 in this stage, was selected. With the selected hypothesis tested in the
LARS and multiple regression in previous stages, the study extended the multiple regression to
domain-specific childhood adversity (maltreatment vs. household dysfunction) to identify which
specific area of childhood adversity is more detrimental to externalizing behavior at age 17. All
covariates were included in the models. Analyses were conducted in R version 1.2 and Mplus 7
version 1.6. Missing data were managed with full information likelihood estimation, a
recommended way to address missingness (Schlomer et al., 2010).

Results
Sample Characteristics and Distribution of Exposure to Childhood Adversity
Table 3 shows the frequencies of childhood adversities at each wave of data collection
(seven waves; offspring ages 5.5-16; teen mother’s age 22.4-32.8) and across the time periods.
At each wave of data collection, 2.3% to 15.5% of youth experienced at least four types of
adversities; 19% of adolescents reported experiencing more than four childhood adversities for
at least one wave of data collection; and 12.8% experienced adversity for more than two waves
of data collection. Across the time periods, children at age 6 (teen mother’s age at 22.9)
experienced childhood adversity the most (15.5%), whereas age 15.1 (teen mother’s age at 31.9)
experienced least childhood adversity (2.3%).
21
Table 3. Descriptive Statistics of Analysis Variables (N = 240)
Measures n (%) or M (SD) Range
Child sex (N = 233)
Male 137 (58.3)
Female 96 (40.9)
Child’s race and ethnicity (N = 219)
White 83 (37.9)
African American 72 (32.4)
American Indian 11 (5.0)
Asian/Pacific Islander 10 (4.6)
Black or White 15 (6.8)
Hispanic 13 (5.9)
Others 16 (7.3)
Teen mother’s education (N = 233)
a

< High school 116 (49.8)
> High school 117 (50.2)
Grandmother’s education (N = 227)
b

< High school 65 (28.6)
> High school 162 (71.4)
Child’s baseline externalizing behavior (age 5.5; N = 183) 56.56 (10.59) 30–88
Child’s externalizing behavior (age 17; N = 184) 57.47 (10.78) 29–79
Accumulation of childhood adversity waves
0 wave 159 (67.9)
1 wave 45 (19.2)
2 waves 18 (7.7)
3 waves 8 (3.4.)
4 waves 4 (1.7)
Childhood adversity at each wave
Age 5.5 30 (12.9)
Age 6 36 (15.5)
Age 9.6 13 (6.3)
Age 10.5 10 (4.5)
Age 11.5 20 (9.0)
Age 15.1 5 (2.3)
Age 16 7 (3.2)
Note. The cutoff score for childhood adversity is 1 = > 3 childhood adversities vs. 0 = ≤ 3
childhood adversities (Felitti et al., 1998).
a
Teen mothers’ education (teen mother’s age = 22.4; offspring’s age = 5.5).
b
Grandmother’s education (teen mother’s age = 16.6).
22
Least Angle Regressions
Figure 1 shows elbow plots guiding the model selection using the LARS procedure.
Based on the elbow plot, the point where the plot levels off indicates the point of diminishing
marginal improvement to the model goodness-of-fit from adding additional predictors,
suggesting that the predictors included in the model at this point represent an optimal balance of
parsimony and thoroughness. Two models were selected as the best-fitting time periods
explaining externalizing behavior at age 17: childhood adversity exposure at age 11.5 and
childhood adversity exposure at the combination of ages 9.6, 11.5, and 16. The model with
childhood adversity exposure at age 11.5 years explained 7.9% of the variation in child
externalizing behavior at age 17 (Model 1, Table 4), whereas the models with childhood
adversity exposure at ages 9.6, 11.5, and 16 years explained 11.5% of the variation (Model 2,
Table 4). Accumulation of the childhood adversity time periods was not selected as one of the
best-fitting models from the elbow plot; therefore, the accumulation hypothesis did not move to
further steps of effect estimation.
Effect Estimation
After identifying the model that explained the most variance in externalizing problems
using LARS, a multiple regression with all selected measures, along with covariates, was
estimated to test the significance of selected adversity measures (i.e., at ages 9.6, 11.5, and 16),
after controlling for covariates in cases where more than one hypothesis was chosen in the first
stage. In the regression, childhood adversity exposure at age 11.5 emerged as a statistically
significant predictor of externalizing problems at age 17 (β = .15, p < .05; Model 1, Table 4),
suggesting that age 11.5 may represent a sensitive period in relation to the influences of
childhood adversity exposure on externalizing problems in adolescence. Further probing this
23
association by two domains of adversities, child maltreatment at age 11.5 was a significant
predictor of higher externalizing behavior at age 17 (β = .16, p < .05; Model 3, Table 4)
controlling for corresponding covariates in the prior steps, whereas household dysfunction was
not.

24

Figure 1. Elbow plots illustrating the LARS variable selection procedure testing life course
models.

25
Table 4. Externalizing Behavior at Age 17, Predicted by Offspring’s Childhood Adversity at
Three Time Periods (Ages 9.6, 11.5, and 16) and Domain-Specific Childhood Adversity at Age
11.5.
Externalizing Behavior Model 1 Model 2 Model 3
Standardized Coefficient β
Childhood adversity
Age 9.6 0.14
Age 11.5 0.15* 0.10*
Age 16 0.07
Domain-specific childhood adversity at age 11.5
Maltreatment 0.16*
Household dysfunction 0.14+
Covariates
Sex -0.12 -0.02 -0.12
Race and ethnicity -0.14* -0.14 -0.12
Teen mother’s education -0.01 -0.01 -0.02
Grandmother’s education -0.03 -0.04 -0.04
Externalizing behavior at age 5.5 0.09** 0.44** 0.07**
Note. Maltreatment: emotional abuse, physical abuse; household dysfunction: food or money
insecurity, parental divorce, intimate partner violence, maternal substance use, maternal
depression, maternal incarceration.
+p < .10. *p < .05. **p<.01

26
Discussion
The purpose of the current study was to better understand the timing and duration of
childhood adversity and externalizing behavior at age 17. The primary finding indicates that
adolescent externalizing behavior at age 17 was largely explained by exposure to adversity in
early adolescence (age 11.5), compared to any other developmental periods from ages 5.5-16.
Capitalizing on the longitudinal dataset with repeated assessment across multiple developmental
epochs, our findings extend the existing literature by revealing the importance of adversity
exposure during early adolescence and teasing apart the effects of child maltreatment versus
household dysfunction.
Several possible explanations might explicate this finding. First, adolescents are more
prone to engage in problematic behaviors in response to adverse experiences than younger
children (Thornberry et al., 2001). Particularly, early adolescence is known to be a sensitive
period of development (Knudsen, 2004). During this stage, adolescents undergo dramatic
physical, social, cognitive, and emotional changes (Dahl & Gunnar, 2009), as well as
environmental changes, which may contribute to the overall health outcomes of adolescents
(Steinberg, 2019). Because puberty is the most salient biological event during adolescence, the
events youth experience during this transition period may be significant, influencing
developmental outcomes later in adolescence. Given these characteristics in this developmental
period, childhood adversity experienced during early adolescence may be important, particularly
given the vulnerability that early adolescents face during this stage.
Second, early adolescence represents a transition period from primary (or elementary) to
secondary (or middle or junior high) school. This developmental junction point is characterized
27
by changes in school environment, along with increased pressure regarding academic
performance and adjustment to new school environment (Neal et al., 2016; Riglin et al., 2013).
Especially, the transition to middle school likely requires more guidance, structure, and support
from parents as children in early adolescence learn to navigate their new environment and social
context (Way et al., 2007). In this period, children who experience adversity in their family may
lack attention from parents and have fewer parental attachments (Strong et al., 2016); therefore,
they might be less likely to observe healthy relationship patterns and may fail to develop
problem-solving skills (Herrenkohl et al., 2010). Thus, co-occurrence of adversity experiences
such as physical abuse, food or money insecurity, or parental divorce during this transition
period may be significant and require extra support, particularly given the risk of externalizing
behaviors in adolescence (Bos et al., 2018).
When childhood adversity was divided into maltreatment and household dysfunction,
exposure to maltreatment significantly predicted higher externalizing behavior at age 17,
whereas household dysfunction did not. This finding aligns with previous studies that have
documented the particularly negative effects of child maltreatment on externalizing behavior
(Negriff, 2020) and deviates from other studies reporting the predictive capacity of household
dysfunction for externalizing behavior (Higgins & McCabe, 2003). Child maltreatment may be
particularly harmful for children of teen mothers because it represents a severe disruption of the
parent–child relationship, involving a significant betrayal by a trusted caregiver that leads to
conflict because the child continues to rely on the caregiver for care (Atzl et al., 2019).
Nevertheless, it might be premature to conclude that household dysfunction is not important for
youth development outcomes. Conclusions drawn from current study need to be replicated, given
the significant impact of household dysfunction.
28
Strengths and Limitations
This study has at least three important strengths. First, it leveraged data from longitudinal
cohort studies of teen mothers and their children in which children’s exposure to adversity and
developmental outcomes have been assessed prospectively and repeatedly across childhood and
adolescence. Second, the study tested two competing hypotheses—sensitive period and
accumulation hypotheses—using an innovative analytic strategy, LARS. Although other studies
created a childhood adversity measure without reference to developmental periods, there are
several benefits to separating these periods. Our study findings suggest that early adolescence
may represent a developmental period during which the impact of experiencing childhood
adversity on later externalizing problems will be most pronounced. Third, the study tested
domain-specific childhood adversities to clarify the effects of different domains of adversities on
externalizing behavior and identified the importance of maltreatment in assessing risk of
externalizing behavior in later adolescence.
While the current study added to the extant literature in very important ways, it was not
without limitations. First, although the study closely mirrored the items from the original ACEs
scale, some of the items were missing. For example, the study did not have an item on neglect, a
potent predictor of adolescents’ externalizing behavior (Chen et al., 2011; Shin et al., 2013),
leaving only child abuse as part of the maltreatment measure. To my knowledge, there is no
reason to speculate that including a neglect measure will necessarily change the conclusion of the
study findings. Nevertheless, incorporating a neglect measure will be a fruitful future direction to
further clarify the time dimension of childhood adversity and its effect on youth externalizing
problems. Second, measures of children’s childhood adversities relied on teen mothers’ self-
29
report, creating possible errors or biases. However, the current study has administered private
and confidential surveys with the sample of teen mothers for many years, and such methods
are likely to provide valid self-report data (Hindelang et al., 1981). Third, our analytic sample
included only children of teen mothers. Thus, these results may not be generalizable to other
populations. Fourth, other elements may be linked to externalizing behavior in late adolescence,
such as youth’s school performance, peer associations, or neighborhood environment. As such,
our parsimonious models indicate that there is much variance left to be explained. Since this is
beyond the scope of the current study, the study did not incorporate other related factors. As a
next step in research on childhood adversity and child development, attention should be given to
other critical factors that lead to later externalizing behavior problems. Fifth, when creating the
“divorced” variable among the eight childhood adversity items, the study limited the sample to
those who had been previously married. Incorporating more detailed information on parenting
(i.e., main caregiver, current parenting status) may provide more information about the adverse
marriage or divorce environment. In future work, it will be informative to consider coparenting
status to further clarify the association between childhood adversity and later externalizing
problems. Sixth, although prospectively collected in short intervals, the repeated assessments of
childhood adversity through self-report may have produced recall biases, impacting the accuracy
or completeness of the data. However, having a prompt anchoring time window can mitigate this
concern to some degree, at least in relation to repeated assessments. Seventh, although previous
studies consistently suggested gender differences in child externalizing behaviors (Mandara et
al., 2012), our sample did not have gender differences in externalizing behavior. One possible
explanation may be the measurement of externalizing behavior, because gender differences may
be less prominent with continuous forms of externalizing behavior. Eighth, the co-occurrence of
30
maltreatment and household dysfunction needs to be further considered to better understand the
impact of early adversity on child development. Follow-up studies should examine more detailed
possibilities of maltreatment and household dysfunction (i.e., experiencing both categories of
maltreatment and household dysfunction vs. only one category vs. no experience at all). This
could expand our knowledge about the impact of childhood adversity and guide decisions about
the types of intervention provided.
Conclusion and Implications
This is the first study to examine the time dimension of childhood adversity and its
impact on subsequent externalizing behavior among children of teen mothers. There are several
implications of our findings. First, identifying heightened vulnerability related to developmental
timing is critical, because our findings indicate that experiences of childhood adversity during
early adolescence are particularly disruptive among children born to young mothers. This
information can be used to tailor interventions for children of teen mothers who have
experienced adverse life events during this period, an important developmental period of puberty
and educational transition. Second, interventions geared toward child maltreatment are
necessary. To raise awareness of child maltreatment and move toward prevention, it has been
continuously suggested that professionals work together with parents and community members
(Tyler et al., 2008). In fact, prevention programs have contributed to positive outcomes for
children and families (Dagenais et al., 2004). Namely, Triple P – the Positive Parenting Program
– can be a possible intervention strategy for children of teen mothers, because it caters to the
entire population, including teenagers and children of divorced parents. It may respond to
consequences of adversity (Prinz et al., 2009) and have a great preventive impact on subsequent
externalizing behavior. Third, universal and primary prevention is recommended to increase
31
resources available to teen mothers and their children to raise awareness of childhood adversities.
Taken together, our findings demonstrate that it is important to consider when the adversity
occurred, a question that prior studies have not addressed. Such an approach may prevent
offspring of teen mothers from experiencing externalizing behaviors in late adolescence. Future
research is needed to identify various mechanisms by which the developmental timing of
adversity is linked to behavioral problems across childhood and adolescence.

32
Chapter 3: Intergenerational continuity and the mechanisms of childhood adversity among
teen mothers and their offspring

Introduction
Experiencing childhood adversities, including child maltreatment and dysfunctional
household, are known to have a negative dose-response effect on mental health and behavioral
problems over the life course (Fava et al., 2019; Hunt et al., 2017; Lanier et al., 2018). Although
prevalence may vary across samples, studies consistently show that more than half of the U.S.
adults have suffered at least one Adverse Childhood Experiences (ACEs) (Felitti et al., 2019). In
contrast to the extensive evidence of within-generation impact of childhood adversities on later
behavioral outcomes, the intergenerational impact of childhood adversity has received less
attention with two critical gaps remaining.
First, when intergenerational effects are examined, studies have primarily focused on
intergenerational continuity of child maltreatment only (Renner & Slack, 2006; Schofield et al.,
2013). The relevant prior studies suggest that a parental history of maltreatment heightens risk
for maltreatment among the offspring of these maltreated parents (Dixon et al., 2005).
Specifically, parents who experienced child abuse and neglect are more likely to have children
who experience maltreatment (Berlin et al., 2011; Thornberry et al., 2012). These patterns have
been found among diverse groups, including among teen mothers – teen mother’s childhood
maltreatment emerged as the strongest predictor for their offspring’s maltreatment in infancy
(Putnam-Hornstein et al., 2015). Despite these findings, the inclusion of adversity in domains
outside of child maltreatment (as included by Felitti et al., 1998 in their work on childhood
adversity) have been examined in very few studies (i.e., Narayan et al., 2017; Negriff et al.,
2020; Schofield et al., 2018), leaving unclear which specific adversity contributes to childhood
33
adversities across generations. Child maltreatment is typically known to be an important factor
for intergenerational cycle of abuse (Dixon et al., 2005), which may undermine perceived safety
within the caregiving environment (Narayan et al., 2017). On the other hand, living in a
dysfunctional household would explain non-abuse type of adversities, such as parental absence
or maternal substance abuse (Davies & Woitach, 2008). Therefore, involvement in maltreatment
and/or household dysfunction would explain differential risk into the next generation.
Second, teen mother’s childhood adversity may also affect their offspring through
parenting stress (Negriff et al., 2020) and parenting practices (Narayan et al., 2017). Higher
parenting stress was found to be associated with greater intergenerational continuity of harsh
discipline (Niu et al., 2018). In particular, maternal childhood adversities have been explicitly
linked with dysfunctional parent-child dysfunctional interactions (Chung et al., 2009; Hughes &
Cossar, 2016), as well as parental distress (which was common among abused and neglected
parents; Berzenski et al., 2014). Although studies have examined the associations among
parents’ adverse childhood experiences, later parenting, and insecure parent-child attachment
(Bert et al., 2009; Hughes & Cossar, 2016; Lange et al., 2019), limited work focused on the
childhood adversity among teen mothers and their parenting stress in early adulthood. It is
critical to navigate teen mother’s parenting stress as a mechanism linking teen mothers’ and their
offspring’s childhood adversity since parenting stress is a well-documented risk factor for child
maltreatment, exposure to multiple adverse events (Gonzalez & MacMillan, 2008), and a more
chaotic family environment for offspring (Bagner et al., 2009; Coldwell et al., 2008).
Domain-specific Childhood Adversities: Maltreatment vs. Household Dysfunction
Unpacking childhood adversities into the categories of child maltreatment and household
dysfunction may be illuminating to understanding each domain’s relative impact on outcome
34
measures (Negriff, 2020; Yoon, 2020). While maltreatment is directed at the child (including
abuse and/or neglect), household dysfunction is explained as more of indirect adversities that
affect the child through changes in their environments (Clemens et al., 2019). Maltreatment and
household dysfunction often co-occur, and are interrelated with cumulative negative effects
(Brown et al., 2019; Mulder et al., 2018). Existing studies, however, investigated childhood
adversity in a cumulative manner, in that experiencing multiple adversities, compared to a single
adversity, is relatively more damaging (Menard et al., 2004). This approach hinders the
possibility of distinguishing the differential impact of varying adversities and identifying areas
for targeted intervention. Such limitations in the existing literature highlight the importance of
further clarifying which domains of childhood adversity, independently or jointly, explain
intergenerational childhood adversity.
Current Study
The current study builds on prior work and examines the potential mechanisms of
intergenerational continuity of childhood adversity among teen mothers and their offspring. The
central research questions are: (a) Is there an intergenerational continuity of childhood adversity
across generations among teen mothers and their offspring?, (b) Do teen mother’s parental
distress and parent-child dysfunctional interaction explain the link between childhood adversity
across generations? (c) Are there differential impact of teen mother’s maltreatment and
household dysfunction on their offspring’s maltreatment and household dysfunction?

Methods
Sample and Procedures
35
The current study used Young Women and Child Development Study (YCDS), a
longitudinal panel study examining a broad range of developmental outcomes involving teen
mothers and their offspring across multiple developmental spans. Eligible participants were
pregnant, unmarried adolescents aged 17 years or younger who were planning to carry their
babies to term at the time of enrollment (Lee et al., 2017). The current study used 9 waves of
data from Cohort 1 to capture 1) teen mother’s childhood adversities (teen mother’s age before
20.5; offspring’s age before 3.5), 2) parental distress and parent-child dysfunctional interaction
(teen mother’s age 21.9; offspring’s age 5), 3) offspring’s childhood adversity in early
adolescence (teen mother’s age 28.4; offspring’s age 11.5). A total of 240 teen mothers and their
offspring were included in the study. The sample retention rates were consistently high across
study years, averaging 94.6%. The sample was racially diverse (37.9% White, 32.4% African
American, and 29.7% mixed or other racial groups), and 58.3% of the analytic sample was boys.
The study was approved by the Human Subjects Review Committee at the affiliated universities.
Measures
Childhood Adversity of Teen Mothers (Prior to maternal age 20.5)
Our childhood adversity items were informed by the original ACEs study (Anda et al.,
2002; Felitti et al., 1998) (Table 5). In the YCDS dataset, nine items mapped onto the original 10
ACEs. Childhood adversity of teen mothers prior to the maternal age 20.5 assessment were
measured using the following items: Exposure to: (1) emotional abuse (Put down by parents), (2)
physical abuse (did parents ever throw something at you, pushed, shoved, or slapped you?), (3)
sexual abuse (Have you ever been forced to have sexual intercourse against your will?), (4)
foster care (Being in the foster care) , (5) food or money insecurity (How often have you worried
about having enough food for yourself; Parents had serious money problems; Worried about
36
having money in the past 6 months), (6) parental divorce (Were your parents divorced?), (7)
parent alcohol use (Did you ever live with an alcoholic parent or parent figure?), (8) death of a
parent, and (9) parental arrest (Were your parents arrested?) (Table 5). Each childhood adversity
exposure was coded as “1” (yes) vs. “0” (no). The total childhood adversity score was calculated
with the sum of the positive items of exposure, which ranged from 0 to 9. In addition to the
composite childhood adversity score, adversities are also divided into two domains – childhood
maltreatment (i.e. emotional abuse, physical abuse, sexual abuse, foster care) and household
dysfunction (i.e. food or money insecurity, divorce, parental alcohol use, death of a parent,
parental arrest) – to identify what domains of childhood adversity, independently or jointly, drive
the association of intergenerational continuity of childhood adversity among teen mothers and
their offspring.

Parenting Stress (Teen mother’s age: 21.9; Offspring’s age: 5)
The current study captured two domains of parenting stress from the Parenting Stress
Index-Short Form (PSI-SF) – parental distress (PD) and parent-child dysfunctional interaction
(P-CDI) (Abidin, 2012). A third domain, difficult child (DC) was excluded, because it captures
temperament and behavior of the child that might influence the parent-child relationship, which
is not the main scope of our study. PD contains 12 items on to what extent parents feel
competent, restricted, conflicted, supported, and/or depressed in their role as a parent. P-CDI
includes 12 items on parent’s feelings or disappointment, rejection from the child, or a lack of
proper bonding with their child. Both subscales were measured when the offspring were 5 years
old (average teen mother’s age: 21.9). Teen mothers used a 5-point scale to indicate the degree to
which they agreed with each statement (1=Strongly agree, 2=agree, 3=not sure, 4=disagree,
37
5=strongly disagree). This study utilized the sum of the total responses across 12 items for each
subscale of parenting stress (Cronbach’s α = .84 and .86, respectively).
Childhood Adversity of Offspring of Teen Mothers (Teen mother’s age 28.4; Offspring’s age:
11.5)
Childhood adversity for offspring was also informed by the original ACEs study (Anda et
al., 2002; Felitti et al., 1998) (Table 5). For the offspring of teen mothers, childhood adversities
at age 11.5 were reported by mothers and measured using following 8 items: (1) emotional abuse
(mothers threatened to throw something at or spanked child), (2) physical abuse (mothers
pushed, grabbed, shoved, spanked, spanked with something, throw something at child), (3) food
or money insecurity (mothers worried about enough money for children; worked about having
enough money), (4) parental divorce (mothers got divorced), (5) intimate partner violence
between teen mother and partner (8 items from the conflict-tactics scale), (6) maternal substance
use (amount of alcohol per occasion [four or more cans or glasses] or marijuana use), (7)
maternal depression (Brief Symptom Inventory), and (8) maternal incarceration (Been charged or
arrested for a Driving While Intoxicated [D.W.I] or drunk driving). Positively endorsed item was
coded as “1”, otherwise “0”. The resultant dichotomized childhood adversity items were summed
to form a final childhood adversity composite measure at age 11.5, which ranged from 0 to 8.
Offspring’s childhood adversities are also divided into two domains, childhood maltreatment (i.e.
emotional abuse, physical abuse) and household dysfunction (i.e. food or money insecurity,
parental divorce, intimate partner violence, maternal substance use, maternal depression, and
maternal incarceration).

Covariates
38
Covariates included teen mother’s age (continuous), offspring’s sex (0= male, 1=
female), offspring’s race (1= White, 2= African American, 3= American Indian, 4= Asian or
Pacific Islander, 5= multiracial, 6= other), teen mother’s educational attainment at offspring’s
age 5.5 (0= < high school, 1 = > high school), and grandmother’s educational attainment (at teen
mother’s age 16.6; 0= < high school, 1 = > high school).

Analyses
The analytic strategy had three parts. First, the study measured the total effect of teen
mother’s childhood adversity on offspring’s childhood adversity. Second, we tested the indirect
effect of two subscales of parenting stress (i.e. parental distress and parent-child dysfunctional
interaction) to examine whether teen mother’s parenting stress mediates the association between
teen mother’s childhood adversity and offspring’s childhood adversity. Third, the study extended
the mediation model to domain-specific childhood adversity (maltreatment vs. household
dysfunction) to identify whether a domain of childhood adversity of teen mothers is more
predictive of their offspring’s childhood adversity domains, through parental distress and parent-
child dysfunctional interaction mechanisms. All covariates were included in each model.
Multiple fit indexes were used to evaluate the model fit, including comparative fit index (CFI)
>.95 (Hu & Bentler, 1999), root-mean-square error of approximation (RMSEA) <.06, and
standardized root mean square residual (SRMR) <0.08 (Hu & Bentler, 1999). 95% confidence
interval of the indirect effects was obtained with 5000 bootstrap resamples (Preacher & Hayes,
2008). Analyses were conducted in Mplus version 8.5. Missing data were managed with full
information likelihood estimation, a recommended way to address missingness (Schlomer et al.,
2010).
39
Results
Sample characteristics and distribution of exposure to childhood adversity
Table 6 shows the frequencies of childhood adversities for teen mothers and their
offspring. For teen mothers, 95% responded to have experienced at least one type of adversity
before age of 20.5. In addition, 34.6% of the total sample experienced at least four types of
adversities. For the offspring, by age 11.5 years, 65.5% experienced at least one type of
adversity, and 8.9% experienced more than four types of adversity. The mean score for parental
distress was 27.32 (SD=8.49, range 12-49) and for parent-child dysfunctional interaction was
20.62 (SD=6.91, range 12-46).

40

Table 5
Table 5. Childhood Adversity Constructs and Measures (YCDS Cohort 1)
Category of Childhood
Exposure
Original ACEs Items Teen Mother’s Childhood Adversity
Items
Offspring’s Childhood Adversity Items
Maltreatment
Emotional abuse (Did a parent or other adult in the
household) often or very often swear
at, insult, or put you down? Act in a
way that made you afraid that you
might be physically hurt?
Put down by parents (Conflict-tactics scale) Threatened to
throw or something or to spank child
Physical abuse (Did a parent or other adult in the
household) often or very often push,
grab, shove, or slap you? Hit you so
hard that you had marks or were
injured?
Parents ever throw something at you,
pushed, shoved, or slapped you?
(Conflict-tactics scale) Pushed,
grabbed, or shoved the child; spanked
the child; spanked the child with
something; threw something at child
Sexual abuse (Did an adult or person at least 5 years
older ever…) Touch or fondle you or
have a touch their body in a sexual
way/ Try to have oral, anal, or vaginal
sex with you
Have you ever been forced to have
sexual intercourse against your will?
-
Foster care - Being in the foster care -
Household dysfunction
Food or money insecurity - How often have you worried about
having enough food for yourself?;
Parents had serious money problems;
Worried about having money in the
past 6 months
Worried about enough food for
children, worried about having enough
money
Divorce Were your parents were ever separated
or divorced?
Were your parents divorced? Got divorced
Intimate partner violence (Was your mother or stepmother)
sometimes, often or very often pushed,
grabbed, slapped, or had something
thrown at her? Kicked, bitten, hit with
a fist, or hit with something hard? Ever
repeatedly hit over at least a few
minutes? Threatened with or hurt by, a
knife or gun?
- (Conflict-tactics scale) Threatened to
hit or throw something at you?
Actually thrown something at you?
Pushed, grabbed, shoved, or slapped
Parental substance use Live with anyone who was a problem
drinker or alcoholic or who used street
drugs?
Did you ever live with an alcoholic
parent or parent figure?
Amount of alcohol per occasion (4 or
more cans of alcohol: heavy episodic
drinking) by mothers or maternal pot
use
Death of a parent Death of a parent -
Parental mental health Was a household member depressed or
mentally ill? Did a household member
attempt suicide?
- Brief Symptom Inventory
Incarceration Did a household member go to prison? Were your parents arrested? Mother was arrested (including for
driving under the influence)
Table 6. Descriptive Statistics of Analysis Variables (N = 240)
Measures n (%) or M (SD) Range
Child sex (N = 233)
Male 137 (58.3)
Female 96 (40.9)
Child’s race and ethnicity (N = 219)
White 83 (37.9)
African American 72 (32.4)
American Indian 11 (5.0)
Asian/Pacific Islander 10 (4.6)
Black or White 15 (6.8)
Hispanic 13 (5.9)
Others 16 (7.3)
Teen mother’s education (N = 233)
a

< High school 116 (49.8)
> High school 117 (50.2)
Grandmother’s education (N = 227)
b

< High school 65 (28.6)
> High school 162 (71.4)
Teen mother’s childhood adversity prior to age of 20 (N = 240)
0 childhood adversity 12 (5.0)
1 childhood adversity 43 (17.9)
2 childhood adversity 53 (22.1)
3 childhood adversity 49 (20.4)
> 4 childhood adversity 83 (34.6)
Offspring’s childhood adversity at age 11.5 (N = 233)
0 childhood adversity 77 (34.5)
1 childhood adversity 69 (30.9)
2 childhood adversity 38 (17.0)
3 childhood adversity 19 (8.5)
> 4 childhood adversity 20 (8.9)
Parenting Stress Index (offspring’s age= 5.0)
Parental distress 27.32 (8.49) 12-49
Parent-child dysfunctional interaction 20.62 (6.91) 12-46
Note. The cutoff score for childhood adversity is 1 = > 3 childhood adversities vs. 0 = ≤ 3
childhood adversities.
a
Teen mothers’ education (teen mother’s age = 22.4; offspring’s age = 5.5).
b
Grandmother’s education (teen mother’s age = 16.6).

42
Mediation effects
Figure 2 shows the mediation model depicting the hypothesized mechanism underlying
teen mother’s overall childhood adversity to their offspring’s childhood adversity at age 11.5.
The model fit was good (X
2
(8) = 9.29, p=0.05, RMSEA=0.02, CFI=0.99, SRMR=0.03)
accounting for 17.4% of the variance in offspring’s childhood adversity. The total effect of teen
mother’s childhood adversity on offspring’s childhood adversity (path c) was significant (B =
0.16, SE = 0.04, p < .01). The direct effect (path c’) suggested a reduction in magnitude of the
coefficient representing the association between teen mothers’ childhood adversity and
offspring’s childhood adversity with the hypothesized mediators, specifically, parental distress
(B = 0.10, SE = 0.05, p = .05). The effect of teen mother’s childhood adversity on parental
distress (path a) was statistically significant (B =1.41, SE = 0.35, p < .001). The effect of parental
distress on offspring’s childhood adversity (path b) was also significant
(B =0.03, SE = 0.01, p < .01). No significant association was found between parent-child
dysfunctional interaction and offspring’s childhood adversity. Teen mother’s childhood adversity
also had a significant impact on the parent-child dysfunctional interaction
(B =0.83, SE = 0.26, p < .01). The results from an indirect test confirmed the mediating role of
parental distress in the association between teen mothers’ childhood adversity and their
offspring’s childhood adversity (B =0.06, 95% CI [0.02, 0.08]).
The study further probed the mediation model by two domains of childhood adversity
(Figure 3). The model fit was good (X
2
(8) = 9.30, p=0.05, RMSEA=0.02, CFI=0.99) and
accounted for 10.6% of the variance in offspring’s maltreatment and 22.7% for offspring’s
household dysfunction. The total effect for the association between teen mother’s maltreatment
and offspring’s household dysfunction was significant (path c; B =0.27, SE = 0.06, p= <.001).

43
The direct effect (path c’) suggested a reduction in strength of the total effect when including the
mediator (parental distress; B =0.22, SE = 0.06, p= <.001). The effect of teen mother’s
maltreatment experiences significantly predicted parental distress (path a)
(B =1.45, SE = 0.56, p= <.05). Parental stress had a significant effect on offspring’s household
dysfunction (path b) (B =0.03, SE = 0.00, p= <.001). Conversely, the total effect from teen
mothers’ maltreatment and household dysfunction on their offspring’s maltreatment was not
statistically significant (B =0.01, SE = 0.03, p=0.70; B =-0.06, SE = 0.03, p = 0.05, respectively).
The mediation analysis suggested that parental distress mediated the association between teen
mother’s maltreatment and offspring’s household dysfunction (B =0.05, 95% CI [0.01, 0.09]). In
addition to the indirect effect, significant chain effects were observed. Teen mother’s household
dysfunction predicted the parental distress (B =1.40, SE = 0.52, p= <.01), which in turn was
associated with offspring’s household dysfunction (B =0.03, SE = 0.00, p= <.001).

44

Figure 2. The mediation effect of parental stress on the association between teen mothers’ and
offspring’s childhood adversity.

45

Figure 3. The domain-specific mediation model.

46
Discussion
The purpose of the current study is to better understand the intergenerational continuity
of childhood adversity among teen mothers and their offspring. First, consistent with prior
studies with other samples (Narayan et al., 2017; Thornberry & Henry, 2013), teen mother’s
childhood adversity was associated with offspring’s childhood adversity. Extending previous
studies on the “cycle of abuse” (Assink et al., 2018; Madigan et al., 2019; Widom & Wilson,
2015), our study examined the “cycle of childhood adversity”. Childhood adversities are toxic
stressors with long-term implications for intergenerational continuity of adversity (Woods-Jaeger
et al., 2018). Preventing or reducing childhood adversities could produce long-lasting benefits
across generations.
Second, when childhood adversities were divided by their two domains, the study found
evidence for the linkage between teen mother’s maltreatment and offspring’s dysfunctional
household at age 11.5. This can be explained through the detrimental impact of maternal child
maltreatment throughout the life span, since it poses significant risks for maladaptation across
the social and psychological domains of development (Cicchetti & Banny, 2014), eventually
setting up higher levels of dysfunctional family environment. Particularly, experiencing child
abuse and neglect can bring multi-problem behavior (Centers for Disease Control and Prevention
[CDC], 2016; van Duin et al., 2019). For example, maltreatment predicts later substance use and
dependence (Banducci et al., 2014), mental health problems (Afifi et al., 2021), living in poverty
(Mersky & Topitzes, 2010), intimate partner violence (Fonseka et al, 2015), criminal behavior
(Wolff et al., 2020), incarceration (Boland et al., 2020), and/or other forms of aggressive
behaviors (Kerig & Becker, 2010), which are conceptualized as factors of dysfunctional
household for offspring of teen mothers.

47
Although most previous studies found an intergenerational continuity of child
maltreatment (Bosquet Enlow et al., 2018; Renner & Slack, 2006; Schofield et al., 2013), our
study did not find the intergenerational continuity of childhood maltreatment among teen
mothers and their offspring. There may be several explanations on the discontinuity of child
maltreatment across generations. Substantial number of mothers who were maltreated did not
repeat the cycle of maltreatment (Thornberry et al., 2013). Some identifying factors may exist
that distinguish parents who maintain the cycle of maltreatment from parents who interrupt it to
shed light on the mechanisms that may amplify or attenuate intergenerational continuity of
maltreatment (Belsky et al., 2009). For example, a diathesis-stress model of ineffective parenting
(Phelps et al., 1998) posits that certain adverse experiences constitute a vulnerability that can
lead to an intergenerational cycle of problematic parenting, only when other precipitating risk
factors are present, such as psychological functioning, parenting stress and psychological
distress, family-ecology factors, or sociodemographic risks or other stressful life events (St-
Laurent et al., 2019). For example, high satisfaction with parenting role, one of the indications of
parenting stress, reduced the likelihood that maltreated parents would maltreat their children
(Thornberry et al., 2013). Also supporting this idea, higher parenting stress was linked with
greater intergenerational continuity of harsh discipline (Niu et al., 2018). In addition, certain
characteristics of teen mother’s child maltreatment may trigger the intergenerational
discontinuity of maltreatment. Prior evidence mentions the severity of maltreatment may have
shape the strength of the intergenerational continuity (Bartlett & Easterbrooks, 2015; Ben-David
et al., 2015). For example, parents who were severely abused were more likely to be abusive
with their children than moderately abused parents (Pears & Capaldi, 2001). Therefore, the
severity of maltreatment might in part matter in explaining the discontinuity of maltreatment in

48
our sample. Still, our findings provided an important first step towards understanding the impact
of teen mother’s maltreatment on the next generation’s dysfunctional household environment..
Third, our results found that teen mothers’ parental distress mediated the associations
between teen mother’s maltreatment and offspring’s household dysfunction. The effects of
adverse experiences can spread over time from one generation to the next, through a host of
mediating processes (Narayan et al., 2017). Previous work has not fully examined factors that
increase or decrease intergenerational continuity of childhood adversity. Parental distress can be
one of the risks, placing teen mothers feel less competent and supported (Erfina et al., 2019), and
more restricted in their role as a parent (Cox et al., 2008). Coupled with early motherhood,
parental feelings of elevated stress can further compromise teen mothers’ life trajectories
(Easterbrooks et al., 2011), resulting in high levels of depression (Schmidt et al., 2006; Agnafors
et al., 2019) and unstable socioeconomic conditions (Borkowski et al., 2007). Therefore, when
teen mothers experience maltreatment when young, combined with the strain of being a teen
mother, parental distress may rise, which in turn may lead their life to array of negative
circumstances.
Fourth, although an indirect effect was not found, significant paths were found among
teen mother’s experiences of childhood household dysfunction, parental distress, and offspring’s
household dysfunction. These findings are in line with previous findings. Living in a
dysfunctional family situation, including mothers using illicit drugs, experiencing intimate
partner violence between parents, or living in a financially insecure family, are at higher risk for
impaired parenting skills and behaviors (Tedgård et al., 2018). Or perhaps, teen mothers with
high levels of parental distress might perceive their child as more difficult, subsequently lack
responsiveness and affection in their parenting behaviors, and exhibit more controlling or

49
assertive parenting styles. Negative or inconsistent parenting, in turn, may account for
intergenerational transfer of family dysfunction (Thornberry et al., 2003).
Strengths and limitations
This study contributes to the relevant literature in three important ways. First, it leverages
the data from longitudinal cohort studies of teen mothers and their offspring, enabling us to
provide insight into intergenerational continuity of childhood adversity among teen mothers and
their offspring, which has not previously been fully answered. Second, the study examined the
potential mechanisms of intergenerational continuity of childhood adversity by navigating
whether teen mother’s parenting stress accounts for the intergenerational continuity of childhood
adversity. Third, the study tested domain-specific childhood adversities in order to identify the
differential effects of child maltreatment and household dysfunction across generations.
Despite these strengths, there are limitations that should be considered when interpreting
our findings. First, while the study attempted to replicate the items of the original ACEs scale,
some of the items were missing. Teen mother’s childhood adversity did not include witnessing
intimate partner violence and or living with a parent with mental health problems. Offspring’s
childhood adversity did not have an item on sexual abuse. Second, offspring’s childhood
adversities relied on teen mother’s self-report, creating potential reporting errors or biases. Third,
the current study used a longitudinal panel study involving teen mothers and their offspring,
recruited from health and social services agencies in three counties of Washington State. Since it
is not a nationally representative samples, the generalization of our findings should be carried out
cautiously.

50
Conclusion and Implications
The current findings shed light on mechanisms underlying the association between teen
mother’s childhood adversity to their offspring’s childhood adversity. Efforts should focus on the
early prevention and intervention. First, prevention remains a top priority in the area of
childhood adversity research, and is the foremost implication of early adversity studies. One of
the existing childhood adversity prevention programs is the Adolescent Pregnancy Prevention
(APP; Hawkins-Anderson & Guinosso, 2014). It attempts to identify youths who may be at
higher risk of child maltreatment and household dysfunction. Then it focuses on family strength
as a way to provide continuous, progressive, and timely guidance that can encourage and support
the development of family connectedness and ameliorate the effects of family dysfunction (Hillis
et al., 2010). CDC also provides several strategies to prevent childhood adversity from
happening in the first place as well as strategies to change environments and behaviors in ways
that can mitigate the harms of childhood adversity (Centers for Disease Control and Prevention,
2019). This includes strengthening household financial security, teaching skills to help parents
and youth handle stress, manage emotions, and tackle everyday challenges, and intervening
through enhanced primary care, victim-centered services, or family-centered treatment to lessen
immediate and long-term harms.
Second, our results highlight the value of delineating maltreatment from household
dysfunction when exploring adversities. In-depth identification of teen mother’s exposure to
adversities may provide a window of opportunity for early intervention. For example, victims of
domestic violence or sexual abuse receiving victim-centered services reported less depression,
decreased feelings of distress, and increased ability to cope with their own history of childhood
adversity and access support (Campbell, 2006; Sullivan, 2012). In addition, treatment such as

51
Multisystemic Therapy (MST) have shown both short- and long-term benefits in reducing
parenting associated with maltreatment (i.e. neglect, psychological aggression, minor- to severe
assault) and strengthening protective factors such as increasing caregiver’s perceived social
support (Multisystemic Therapy Services, 2016). Particularly, MST have shown to effectively
reduce the rates of arrests and other crimes, substance use, mental health, and involvement in
gangs (van der Stouwe et al., 2014). Taken together, such approach may prevent maintaining the
cycle of teen mother’s maltreatment and offspring’s household dysfunction, by effectively
intervening maltreatment .
Third, our findings illustrated the potential value of targeting teen mother’s parenting
stress to reduce offspring’s childhood adversity exposures. Existing interventions for teen parents
often focus on decreasing both repeat pregnancy and negative parenting behaviors (Kan &
Ramirez, 2020; MacMillan et al., 2009). For example, parenting training programs (Triple P-
Positive Parenting Program) or home visitation programs have shown to improve positive
parenting and help disadvantaged mothers prevent child abuse towards children. However, the
current study highlighted the significant implications for interventions on parental distress. Since
high levels of parenting stress may affect youth developmental outcomes (Shonkoff et al., 2012),
interventions on parenting stress can lead to disrupt the cycle of intergenerational continuity of
childhood adversity among teen mothers and their offspring. Existing programs that have shown
effectiveness may be applicable. Home visiting programs, including Healthy Families America
(HFA) or Nurse Family Partnership (NFP) (Shenk et al., 2017), can be effective prevention
approaches that provide mothers with a history of child maltreatment with the resources and
skills that they need to promote the optimal development and safety of their offspring.

52
Particularly, for mothers with a history of child maltreatment (Steele et al., 2016), parenting
stress may be an important issue to address in home visiting programs.
Overall, the current study highlighted the importance of examining the intergenerational
continuity of childhood adversity among teen mothers and their offspring in order to best identify
and support teen mothers with history of adversity and to prevent the cycle of intergenerational
continuity of childhood adversity.

53
Chapter 4: The Role of Teen Mother’s Antisocial behavior, Illicit drug use, and Depression
in the Intergenerational Continuity of Childhood Adversity

Introduction
Childhood adversities can be stressful events and includes experiences of abuse, neglect,
and household dysfunction(Felitti et al., 1998). Numerous studies have shown that the
experience of multiple, chronic adverse childhood experiences (ACEs) can lead to negative
physical and mental health outcomes across the lifespan (Bright et al., 2016; Centers for Disease
Control and Prevention [CDC], 2013; Merrick et al., 2017; Nurius et al., 2015). Despite advances
in the childhood adversity literature, limited studies have investigated the intergenerational
continuity of childhood adversity exploring two domains of childhood adversity – maltreatment
vs. household dysfunction (Narayan et al., 2017; Negriff, 2020), with most studies instead
focused specifically on intergenerational child maltreatment (Assink et al., 2018; Langevin et al.,
2019; Madigan et al., 2019). In addition, mechanisms linking the intergenerational continuity of
childhood adversity have not been fully examined.
Childhood adversity has been consistently linked to mental health and substance use risks
in children and adults. Specifically, chronic and acute stress in childhood, such as child abuse
and neglect, have long-lasting consequences on negative psychological, emotional, health-related
outcomes (Van Vugt et al., 2014), as well as on well-being in emerging adulthood (Heinze et al.,
2017; Newcomb-Anjo et al., 2017). Although recent articles on these associations have linked
childhood adversity to a range of mental health and behavioral problems (Garrido et al., 2018;
Stargel & Easterbrooks, 2020; Negriff, 2020), very few studies have investigated the importance
of antisocial behavior, illicit drug use, and depression in emerging adulthood, particularly among

54
teen mothers. Since emerging adulthood is a critical developmental period between late
adolescence and young adulthood, it has been described as a period of substantial instability as
adolescents navigate an ambiguous social and subjective position and they are no longer seen as
children, but not yet defined as adults (Arnett, 2014). This particular period is characterized by
identity exploration, instability, feeling in-between, possibilities, and being self-focused (Arnett,
2014). In combination with the normative stress of navigating the developmental tasks of
emerging adulthood and adjusting to the demands of motherhood, childhood adversity
experiences can threaten development and well-being in emerging adulthood and lead to
compromised behavioral health such as antisocial behavior (Duke et al., 2010; Schilling et al.,
2007), increased use of illicit drugs (Sussman & Arnett, 2014), and depression (Giovanelli et al.,
2016; Whiteford et al., 2015). In this context, the substantial impact of teen mother’s history of
childhood adversity on antisocial behavior, illicit drug use, and depression during the emerging
adulthood of teen mothers are of particular interest. While studies have investigated teen
mother’s experience of childhood adversity (Killian-Farrell et al., 2020) and its impact on their
offspring’s development (Stargel & Easterbrooks, 2020; Yoon, 2019), no known studies have
clearly incorporated teen mother’s experience of childhood adversities and its impact on the risks
of antisocial behavior, illicit drug use, and depression in emerging adulthood as potential
mechanisms explaining the intergenerational continuity of childhood adversity.
Teen mothers with antisocial behavior, illicit drug use, and depression may have
difficulties engaging in positive parenting. Prior work has found that mothers who are depressed
or traumatized tend to be less responsive to infant cues and reported higher levels of parenting
stress (Bartlett & Easterbrooks, 2012). Specifically, empirical evidence confirmed the link
between maternal depression and elevated stress related to parenting (Cornish et al., 2006),

55
increased difficulty adjusting to their role as mothers (Willinger et al., 2005), decreased mother-
child interaction (Tronick & Reck, 2009), being less sensitive to child’s signals (Kemppinen et
al., 2006), and having more problems interpreting their infants’ affective communications so that
more dysfunctional interaction may occur during an interaction (Tronick & Reck, 2009). In
another study, maternal depression predicted parental distress, but not parent-child dysfunctional
interaction (Sidor et al., 2011). In addition, maternal substance misuse frequently impacted
parent-child relationships and interactions (Cataldo et al., 2019; Dyba et al., 2019), resulting in
problematic parental behavior or insecure attachment (Solis et al., 2012). Although research has
documented the significant link between childhood adversity and antisocial behavior, illicit drug
use, and depression in adulthood (Green et al., 2010; McLaughlin et al., 2012), there is a paucity
in work investigating the impact of childhood adversity with the risks of antisocial behavior,
illicit drug use, and depression in emerging adulthood as well as among teen mothers.

Teen mother’s parenting stress
Parenting stress, a negative feeling related to the demands of parenting, mother’s
perceived stress of the parenting role as well as stress related to mother-child dysfunctional
interaction, is a well-documented risk factor for offspring’s exposure to child maltreatment and
household dysfunction (Crouch et al., 2019). Parenting stress can have a direct impact on the
quality of caregiving towards their children (Bailey et al., 2012; Pereira et al, 2012) and is
associated with harsh discipline (Niu et al., 2018). Further, higher levels of parental stress may
lead to a more chaotic family environment (Bagner et al., 2009; Coldwell et al., 2008). For
example, when caregivers reported high parenting stress, their offspring were more likely to
experience childhood adversity by age 18 (Crouch et al., 2019). Around 30% of teen mothers

56
reported more parenting stress in comparison to adult mothers (Larson, 2004), since teen mothers
are more likely to experience great social and economic burden, as compared to adult mothers
(Goodman & Brand, 2011). Given the essential role of parental stress to their offspring’s
nurturing environment, it is important to examine parenting stress as the predictor for offspring’s
childhood adversity.

Two distinct domains of childhood adversity: Maltreatment vs. Household dysfunction
Childhood adversity measures comprise a broad range of adversities, ranging from
maltreatment experiences (i.e. abuse and neglect) to more general family dysfunction and discord
(i.e. parental, intimate partner violence, substance use, mental illness etc.). The majority of prior
research utilizes childhood adversity as a cumulative measure (number of adversities; Nurius et
al., 2015). Using a cumulative form of childhood adversities may be difficult to have a clinically
meaningful interpretation, since all childhood adversity items are hypothesized to be equivalent
in their impact. In addition, prior studies have utilized a single form of childhood adversity, most
commonly child maltreatment (Yoon et al., 2017), failing to clarify effects of specific domains of
childhood adversity, particularly household dysfunction, on outcomes (Masten & Narayan,
2012). Although household dysfunction is theorized to be less detrimental than child
maltreatment experiences (Higgins & McCabe, 2003), household dysfunction is necessary to
understand the family environment. Household dysfunction rarely occurs in isolation, instead co-
occuring with other types of adversities, especially in childhood (Gilbert et al, 2009). For
example, neglect occurs within a system of discord in household, such as parental substance use
in home (Hoeve et al., 2009; Ryan et al., 2013). Second, compared to child maltreatment,
household dysfunction can be an ongoing issue in that the impact of household dysfunction may

57
not be immediately apparent (Negriff, 2020). Therefore, parents with high household dysfunction
may be more difficult to intervene compared to child maltreatment. Understanding the
intergenerational continuity of childhood adversity by domain (beyond utilizing a sum score of
childhood adversity) can help clinicians build a more targeted treatment approach to meet the
needs of vulnerable families. Given the importance of both maltreatment and household
dysfunction in the long term sequalae of physical and mental health over time, the present study
sought to address relative contribution of the childhood maltreatment vs. household dysfunction
among teen mothers and their offspring.

Current study
To enhance our understanding of intergenerational continuity of childhood adversity, the
current study used a longitudinal design to examine the mechanisms influencing
intergenerational childhood adversity. Taken together, the central research questions are (a) Do
teen mothers’ antisocial behavior, illicit drug use, and depression mediate teen mother’s
childhood adversity and their offspring’s childhood adversity? and (b) Is there a link between
teen mother’s childhood adversity, mental health and behavioral problems, parenting stress, and
offspring’s childhood adversity?, (c) When childhood adversity is separated into two domains,
how does mother’s maltreatment and household dysfunction predict offspring’s maltreatment
and household dysfunction via various mechanisms?

Methods
Samples and Procedures

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Data were from the Young Women and Child Development Study (YCDS), a
longitudinal study examining a broad range of developmental outcomes involving teen mothers
and their offspring across multiple developmental time periods. Eligible participants were
adolescent girls ages 17 years old or younger who were pregnant and unmarried, and pla nning to
carry their babies to term at the time of enrollment (Lee et al., 2017). The current study used 12
waves of data to capture 1) teen mother’s childhood adversities (before age of 20.5), 2) teen
mother’s antisocial behavior, illicit drug use, and depression in emerging adulthood (teen
mother’s age: 21-23; offspring’s age: 4-6), 3) and teen mother’s parental distress and parent-
child dysfunctional interaction (teen mother’s age: 23; offspring’s age: 6), and 4) offspring’s
childhood adversity in early adolescence (age 11.5). A total of 240 teen mothers and their
offspring were included in the study. The sample retention rates were consistently high across
study years, averaging 94.6%. The sample was racially diverse (37.9% White, 32.4% African
American, and 29.7% mixed or other racial groups), and 58.3% of the analytic sample was boys.
The study was approved by the Human Subjects Review Committee at the affiliated universities.

Measures
Childhood Adversity of Teen Mothers (Prior to Maternal age 20.5)
Our childhood adversity items were informed by the original ACEs study (Anda et al.,
2002; Felitti et al., 1998). In the YCDS dataset, nine items mapped onto the original 10 ACEs.
Childhood adversity of teen mothers prior to the maternal age 20.5 assessment were measured
using the following items: Exposure to: (1) emotional abuse (Put down by parents), (2) physical
abuse (did parents ever throw something at you, pushed, shoved, or slapped you?), (3) sexual
abuse (Have you ever been forced to have sexual intercourse against your will?), (4) food or

59
money insecurity (How often have you worried about having enough food for yourself; Parents
had serious money problems; Worried about having money in the past 6 months), (5) parental
divorce (Were your parents divorced?), (6) parent alcohol use (Did you ever live with an
alcoholic parent or parent figure?), (7) death of a parent, (8) foster care (Being in the foster
care), and (9) parental arrest (Were your parents arrested?) (Table 7 for more details). Each
childhood adversity exposure was coded as “1” (yes) vs. “0” (no). The total childhood adversity
score was calculated with the sum of the positively endorsed adversity items, which ranged from
0 to 9. In addition to the composite childhood adversity score, adversities are also divided into
two domains – childhood maltreatment (i.e. emotional abuse, physical abuse, sexual abuse, foster
care) and household dysfunction (i.e. food or money insecurity, divorce, parental alcohol use,
death of a parent, parental arrest) – to identify the differential impact of teen mothers’
maltreatment and household dysfunction on their offspring’s maltreatment and household
dysfunction.

Teen Mother’s Antisocial behavior, Illicit Drug Use, and Depression in Emerging Adulthood
(Teen mother’s age: 21-23; Offspring’s age: 4-6)
Antisocial behavior. Teen mother’s antisocial behavior was measured with nine items
across five waves (teen mother’s age: 21-23, offspring’s age: 4-6). Teen mothers were asked
whether they “sold drugs”, “used knife to steal”, “stole outside family”, “broke into house”,
“set fire to properties”, “in trouble with police”, “charged with a crime”, “been in jail”, and
“got into a fight” in the past 6-months. Any endorsement of the nine items at a given wave was
coded as “1”, which was summed across all five waves to capture the chronicity of antisocial
behavior across five waves (range: 0-5).

60
Illicit drug use. At each of the five wave, past month use of seven illicit drugs was
measured. Respondents were asked about the frequency of their drug use for each of the seven
types of drugs; cocaine, amphetamines, barbiturates, tranquilizer, hallucinogens, inhalant, and
narcotics. Response categories were on a 6-point Likert-type scale: never, once, 2-3 times, once a
week, 2-5 times a week, every day. Items were dichotomized (0 vs. 1) as never and ever (i.e.,
“once” or more). Any endorsement of seven types of illicit drugs at a given wave was coded as
“1”, which was summed across all five waves, indicating the chronicity of illicit drug use.
Depression. 17-items from the depression subscale of Brief Symptom Inventory (BSI)
were utilized to measure teen mother’s depression, a standardized instrument designed to assess
psychological functioning with demonstrated reliability and validity (Derogatis, 1993). Each
item was scored on a 5-point Likert-scale of distress ranging from 0 (not at all) to 4 (extremely),
which were summed to raw scores and then converted to t-scores. To assess clinical levels of
depression, meeting the clinical cutoff for depression (T-score of > 63) was coded as “1”,
otherwise the score was “0” at each wave. The endorsed dichotomized scores at each wave were
then summed across all five waves to indicate the chronicity of depression (Cronbach’s α = .82
to .85).

Parenting Stress (Teen mother’s age: 23; Offspring’s age: 6)
The current study captured two domains of parenting stress from the Parenting Stress
Index-Short Form (PSI-SF) – parental distress (PD) and parent-child dysfunctional interaction
(P-CDI) (Abidin, 2012). Another domain, difficult child (DC) was excluded in the current study,
because it captures temperament and behavior of the child that might influence the parent-child
relationship, which is not the main scope of our study. PD contains 12 items assessing the extent

61
to which parents feel competent, restricted, conflicted, supported, and/or depressed in their role
as a parent. P-CDI includes 12 items assessing parent’s feelings or disappointment, rejection
from the child, or a lack of proper bonding with their child. Both of the subscales were measured
when the offspring were 4-6 years old (average teen mother’s age: 21-23). Teen mothers used a
5-point scale to indicate the degree to which they agreed with each statement (1=Strongly agree,
2=agree, 3=not sure, 4=disagree, 5=strongly disagree). This study utilized the sum of the total
responses across 12 items for each subscale of parenting stress (Cronbach’s α = .86 and .86,
respectively).

Childhood Adversity of Offspring of Teen Mothers (Teen mother’s age: 28.4; Offspring’s age:
11.5)
Childhood adversity for offspring was also informed by the original ACEs study (Anda et
al., 2002; Felitti et al., 1998) (Table 7). For the offspring of teen mothers, childhood adversities
at age 11.5 were reported by mothers and measured using following 8 items: (1) emotional abuse
(mothers threatened to throw something at or spanked child), (2) physical abuse (mothers
pushed, grabbed, shoved, spanked, spanked with something, throw something at child), (3) food
or money insecurity (mothers worried about enough money for children; worked about having
enough money), (4) parental divorce (mothers got divorced), (5) intimate partner violence (IPV)
between teen mother and her partner (8 items from the conflict-tactics scale), (6) maternal
substance use (amount of alcohol per occasion [four or more cans or glasses] or marijuana use),
(7) maternal depression (Brief Symptom Inventory), and (8) maternal incarceration (been charged
or arrested for a Driving While Intoxicated [D.W.I] or drunk driving). Positively endorsed item
was coded as “1”, otherwise “0”. The resultant dichotomized childhood adversity items were

62
summed to form a final childhood adversity composite measure at age 11.5, which ranged from 0
to 8. Offspring’s Childhood adversities are also divided into two domains, childhood
maltreatment (i.e. emotional abuse, physical abuse) and household dysfunction (i.e. food or
money insecurity, divorce, intimate partner violence, teen mother’s substance use, teen mother’s
mental health, and parental arrest).

Covariates
Covariates included teen mother’s age (continuous), offspring’s sex (0= male, 1=
female), offspring’s race (1= White, 2= African American, 3= American Indian, 4= Asian or
Pacific Islander, 5= multiracial, 6= other), teen mother’s educational attainment at offspring’s
age 5.5 (0= < high school, 1 = > high school), and grandmother’s educational attainment (at teen
mother’s age 16.6; 0= < high school, 1 = > high school).

Analyses
The analytic strategy had three parts. First, the study tested the total effect of teen
mother’s childhood adversity on offspring’s childhood adversity. Second, the indirect effect was
tested for teen mother’s antisocial behavior, illicit drug use, and depression, and two subscales of
parenting stress (i.e. parental distress and parent-child dysfunctional interaction) to examine
whether teen mother’s antisocial behavior, illicit drug use, depression, and parenting stress
mediate the association between teen mother’s childhood adversity and offspring’s childhood
adversity. Third, the study extended the mediation model to domain-specific childhood adversity
(maltreatment vs. household dysfunction) to investigate whether there are differential pathways
depending on domains of childhood adversity. All covariates are included in each model.

63
Multiple fit indexes were used to evaluate the model fit, including comparative fit index (CFI)
>.95 (Hu & Bentler, 1999), root-mean-square error of approximation (RMSEA) <.05, and
standardized root mean square residual (SRMR) <0.08 (Hu & Bentler, 1999). 95% confidence
interval of the indirect effects was obtained with 5000 bootstrap (Preacher & Hayes, 2008).
Analyses were conducted in Mplus version 8.5. Missing data were managed with full
information likelihood estimation, a recommended way to address missingness (Schlomer et al.,
2010).
64

Tabl
e 7
Table 7. Childhood Adversity Constructs and Measures (YCDS Cohort 1)
Category of Childhood
Exposure
Original ACEs Items Teen Mother’s
Childhood Adversity Items
Offspring’s
Childhood Adversity Items
Maltreatment
Emotional abuse (Did a parent or other adult in the
household) often or very often swear at,
insult, or put you down? Act in a way that
made you afraid that you might be
physically hurt?
Put down by parents (Conflict-tactics scale) Threatened to
throw or something or to spank child
Physical abuse (Did a parent or other adult in the
household) often or very often push, grab,
shove, or slap you? Hit you so hard that
you had marks or were injured?
Parents ever throw something at you,
pushed, shoved, or slapped you?
(Conflict-tactics scale) Pushed, grabbed,
or shoved the child; spanked the child;
spanked the child with something; threw
something at child
Sexual abuse (Did an adult or person at least 5 years
older ever…) Touch or fondle you or
have a touch their body in a sexual way/
Try to have oral, anal, or vaginal sex with
you
Have you ever been forced to have sexual
intercourse against your will?
-
Foster care - Being in the foster care -
Household dysfunction
Food or money insecurity - How often have you worried about
having enough food for yourself?;
Parents had serious money problems;
Worried about having money in the past
6 months
Worried about enough food for children,
worried about having enough money
Divorce Were your parents were ever separated or
divorced?
Were your parents divorced? Got divorced
Intimate partner violence (Was your mother or stepmother)
sometimes, often or very often pushed,
grabbed, slapped, or had something
thrown at her? Kicked, bitten, hit with a
fist, or hit with something hard? Ever
repeatedly hit over at least a few
minutes? Threatened with or hurt by, a
knife or gun?
- (Conflict-tactics scale) Threatened to hit
or throw something at you? Actually
thrown something at you? Pushed,
grabbed, shoved, or slapped
Parental substance use Live with anyone who was a problem
drinker or alcoholic or who used street
drugs?
Did you ever live with an alcoholic
parent or parent figure?
Amount of alcohol per occasion (4 or
more cans of alcohol: heavy episodic
drinking) by mothers or maternal pot use
Death of a parent Death of a parent -
Parental mental health Was a household member depressed or
mentally ill? Did a household member
attempt suicide?
- Brief Symptom Inventory
Incarceration Did a household member go to prison? Were your parents arrested? Mother was arrested (including for
driving under the influence)

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Results
Sample characteristics and distribution of exposure to childhood adversity
Table 8 shows the frequencies of childhood adversities for teen mothers and their
offspring. For teen mothers, 95% responded to have experienced at least one type of adversity
before age of 20.5. In addition, 34.6% of the total sample experienced at least four types of
adversities. For the offspring, 65.5% experienced at least one type of adversity, and 8.9%
experienced more than four types of adversities at 11.5 years old. The mean scores (SD) for
mental health and behavioral problem items are: antisocial behavior 1.24 (1.54), illicit drug use
0.35 (0.90), and depression 0.97 (1.36), with all of the items ranging from 0 to 5. The mean score
for parental distress was 27.32 (SD=8.49, range 12-49) and for parent-child dysfunctional
interaction was 20.62 (SD=6.91, range 12-46).

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Table 8. Descriptive Statistics of Analysis Variables (N = 240)
Measures n (%) or M (SD) Range
Child sex (N = 233)
Male 137 (58.3)
Female 96 (40.9)
Child’s race and ethnicity (N = 219)
White 83 (37.9)
African American 72 (32.4)
American Indian 11 (5.0)
Asian/Pacific Islander 10 (4.6)
Black or White 15 (6.8)
Hispanic 13 (5.9)
Others 16 (7.3)
Teen mother’s education (N = 233)
a

< High school 116 (49.8)
> High school 117 (50.2)
Grandmother’s education (N = 227)
b

< High school 65 (28.6)
> High school 162 (71.4)
Teen mother’s childhood adversity prior to age 20.5 (N = 240)
0 childhood adversity 12 (5.0)
1 childhood adversity 43 (17.9)
2 childhood adversity 53 (22.1)
3 childhood adversity 49 (20.4)
> 4 childhood adversity 83 (34.6)
Offspring’s childhood adversity at age 11.5 (N = 233)
0 childhood adversity 77 (34.5)
1 childhood adversity 69 (30.9)
2 childhood adversity 38 (17.0)
3 childhood adversity 19 (8.5)
> 4 childhood adversity 20 (8.9)
Mental health and behavioral problems at age 21-23
(offspring’s age 4-6; N=237)

Antisocial behavior
c
1.24 (1.54) 0-5
Illicit drug use
d
0.35 (0.90) 0-5
Depression
e
1.65 (1.65) 0-5
Parenting Stress Index at age 23 (offspring’s age= 5.0)
Parental distress (N=214) 27.32 (8.49) 12-49
Parent-child dysfunctional interaction (N=215) 20.62 (6.91) 12-46
Note. The cutoff score for childhood adversity is 1 = > 3 childhood adversities vs. 0 = ≤ 3
childhood adversities
a
Teen mothers’ education (teen mother’s age = 22.4; offspring’s age = 5.5)
b
Grandmother’s education (teen mother’s age = 16.6)
c
Nine items indicating the number of times involved in antisocial behaviors [sold drugs, used
knife to steal, broke into house, set fire to property etc.] in the past 6-months (0=Never vs. 1=at
least once in five waves)
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d
Frequency of using seven types of illicit drug use [cocaine, amphetamines, barbiturates,
tranquilizer, hallucinogens, inhalant, narcotics] in the past month (0=Never vs. 1=at least once in
five waves)
e
Clinical cutoff using 17-items from the Brief Symptom Inventory (BSI) [T-score of >63]
68

Mediation Effects
Figure 4 shows the mediation model depicting the hypothesized mechanism underlying
teen mother’s overall childhood adversity to their offspring’s childhood adversity at age 11.5.
The model fit was good (X
2
(20) = 56.65, p=0.001, RMSEA=0.01, CFI=0.84, SRMR=0.05), and
accounted for 23.4% of the variance in offspring’s childhood adversity. The total effect of teen
mother’s childhood adversity on offspring’s childhood adversity (path c) without any mediator
was significant (B = 0.14, SE = 0.05, p < .01). After the mediators were included, the direct
effect (path c’) indicated a reduction in magnitude of the coefficient representing the association
between teen mothers’ childhood adversity and offspring’s childhood adversity, specifically with
teen mothers’ antisocial behavior (B = 0.04, SE = 0.05, p > .10). The effect of teen mother’s
childhood adversity significantly predicted antisocial behavior (path a;
B =0.27, SE = 0.06, p < .001). Antisocial behavior was associated with offspring’s childhood
adversity (path b; B =0.17, SE = 0.06, p < .05). Results of the mediation analysis confirmed the
mediating role of antisocial behavior in the association between teen mothers’ childhood
adversity and their offspring’s childhood adversity (B =0.04, 95% CI [0.01, 0.08]).
Further probing the mediation model by the two domains of childhood adversity (Figure
5) showed good model fit (X
2
(20) = 48.65, p=0.001, RMSEA=0.05, CFI=0.92, SRMR=0.04)
and it accounted for 12.6% of the variance in offspring’s maltreatment and 31.4% for offspring’s
household dysfunction. The total effect of teen mother’s maltreatment on offspring’s household
dysfunction was significant (path c; B =0.28, SE = 0.06, p= <.001). The direct effect (path c’)
indicated a reduction in the strength of the direct effect when including maternal antisocial
behavior (B =0.17, SE = 0.06, p= <.01). Teen mother’s childhood maltreatment experiences
predicted their antisocial behavior during emerging adulthood (path a; B =0.26, SE = 0.09, p=
69

<.01); in turn antisocial behavior had a significant impact on offspring’s household dysfunction
(path b; B =0.12, SE = 0.05, p= <.05). The mediation analysis suggested that teen mother’s
antisocial behavior mediated the association between teen mother’s maltreatment and offspring’s
household dysfunction (B =0.11, 95% CI [0.00, 0.07]).
Additional significant path in the intergenerational continuity of childhood adversity was
also observed for both composite childhood adversity model (Figure 4) and domain-specific
model (Figure 5). Teen mother’s childhood adversity experiences was statistically associated
with their depression (B =0.21, SE = 0.05, p= <.001), which in turn predicted parental distress
(B =2.49, SE = 0.42, p= <.001). Consecutively, parental distress predicted offspring’s childhood
adversity (B =0.02, SE = 0.06, p= <.05). In the domain-specific model, both teen mother’s
maltreatment and household dysfunction histories were statistically associated with their
depression (B =0.20, SE = 0.08, p= <.05; B =0.22, SE = 0.08, p= <.05, respectively), which in
turn predicted offspring’s household dysfunction (B =0.19, SE = 0.05, p= <.01) and parental
distress (B =2.48, SE = 0.42, p= <.001), with parental distress also predicting household
dysfunction (B =0.02, SE = 0.00, p= <.05).

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Figure 4. The mediation effect of teen mothers’ antisocial behavior, illicit drug use, depression,
and parental stress on the association between teen mothers’ and offspring’s childhood adversity.

Note: Dotted lines represent statistically significant at p-value *p<.05, **p<.01, ***p<.001 for
unstandardized coefficient

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Figure 5. The domain-specific mediation model.
Note: Dotted lines represent statistically significant at p-value *p<.05, **p<.01, ***p<.001 for
unstandardized coefficient

72

Discussion
The current study examined the intergenerational continuity of childhood adversity
experiences among teen mothers and their offspring. The study explored whether teen mother’s
antisocial behavior, illicit drug use, and depression in emerging adulthood function as
mechanisms underlying the association between teen mother’s childhood adversity and
offspring’s childhood adversity. Further, childhood adversity for both teen mothers and their
offspring was explored by two domains: maltreatment and household dysfunction.
First, while previous studies investigated mothers’ history of childhood maltreatment as a
risk factor for their offspring’s maltreatment during childhood (Berlin et al., 2011), the current
study highlighted the detrimental impact of teen mother’s childhood maltreatment experiences
on their offspring’s dysfunctional household experiences in early adolescence. The findings
suggested that maternal child maltreatment experiences increase the likelihood teen mothers
heading households with higher levels of dysfunction, including living in poverty (Borja et al.,
2019; Currie & Widom, 2010; Mersky & Topitzes, 2010), having substance use and dependence
problems (Brady & Sinha, 2005), or reporting divorce or separation (Font & Maguire-Jack,
2016), intimate partner violence (Fonseka et al, 2015; Mair et al., 2012; Widom et al., 2014),
and/or having an incarcerated household member (Roos et al., 2016). This dysfunction can have
deleterious effects on their offspring (Plant et al., 2017; Roberts et al., 2004). Although previous
work has shown the within-domain continuity, our findings contradict those previous findings.
Despite evidence of intergenerational continuity of maltreatment, a substantial number of studies
also argue that parents who were maltreated in childhood do not always perpetuate the cycle of
maltreatment (Thornberry et al., 2012). Instead, other factors including parental psychological
distress (i.e. mental health) or family-ecological factors (i.e. unemployment, low level of parental
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education, economic hardships, social support) might attenuate or amplify the risk of
intergenerational continuity of maltreatment (Dixon et al., 2009; Drake & Johnson-Reid, 2014;
Leifer et al., 2004; Stith et al., 2009; Thornberry & Henry, 2013). As our findings indicate, teen
mothers’ mental health and behavioral problems may further explain the link between teen
mother’s maltreatment history and their offspring’s exposure to dysfunctional family
environment.
Second, in consistent with the substantial research evidence linking childhood
maltreatment to later mental health problems (Widom et al., 2007) and behavioral risks (Garrido
et al., 2018; Hunt et al., 2017), such as substance use (Young-Wolff et al., 2018) and antisocial
behavior (Wolff et al., 2020), our findings suggest that teen mother’s antisocial behavior may
function as a mediator underlying the association between teen mother’s maltreatment and their
offspring’s household dysfunction. Although childhood adversities were linked to increased
antisocial behavior (Yazgan et al., 2020), previous work has not investigated the role of
antisocial behavior in the intergenerational continuity of childhood adversity among teen
mothers and their offspring.
Links between teen mother’s childhood adversity, depression, parental distress, and
offspring’s household dysfunction were found. Extending prior studies reporting
intergenerational continuity of childhood adversity, the current study findings suggested that teen
mother’s depression and parental distress in emerging adulthood serve as pathways underlying
the intergenerational continuity of teen mother’s childhood adversity (i.e. maltreatment and
household dysfunction) and offspring’s household dysfunction. Exposure to childhood
maltreatment can compromise healthy development across critical domains (Cicchetti, 2016),
with detrimental effects persisting into adulthood (Norman et al., 2012). Teen mother’s
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maltreatment not only produced a negative path towards teen mother’s depression in emerging
adulthood (Van Veen et al., 2013; Li et al., 2016), but maternal depression also had a linked path
to parenting stress (i.e. parental distress, parent-child dysfunctional interaction), which had
consequences extending to the next generation. Particularly, greater early maltreatment
experiences may have long-term dose-response relationships with depression (Cohen et al.,
2019; van Vugt et al., 2014) in emerging adulthood. In addition, depression, a well-known risk
factor for being engaged in more hostile and disengaged parenting, can impact teen mother’s
stress and relationships issues that could in turn affect their parenting practices (Abidin, 2012).
This is partly in line with prior work with adult mothers, which found that childhood trauma was
a significant predictor of parenting stress, and that this relationship was mediated by maternal
depression (Ammerman et al., 2013). Teen mother’s depression may impact their emotional
expressions related to their parenting and parental feelings of incompetence (Sepa et al., 2004).
This result indicates the importance of identifying teen mother’s depression in their emerging
adulthood to support them during early parenthood. Additionally, partly in line with previous
work (Crouch et al., 2019), our study findings revealed that parental distress increased
offspring’s adversity experiences, including dysfunctional households. Our finding adds to the
existing literature and suggest a need to address parental distress among teen mothers –
managing parental distress could decrease the level of childhood adversity, particularly
dysfunctional family environment, experienced by the offspring of teen mothers. The link
between parental distress and childhood adversity, particularly household dysfunction, might
help inform ways to identify families in crisis and develp more targeted program delivery.
Moreover, current findings highlight the importance of understanding the development of
teen mothers in emerging adulthood, a significant stage of developmental transition between late
75

adolescence and young adulthood. Our findings are consistent with prior literature on emerging
adulthood in general, as characterized by peak levels of risk-taking behaviors – antisocial
behavior (Tuvblad et al., 2011) – and depression (Lee et al., 2020; Rohde et al., 2013).
Especially, due to the changes in the average age of getting married and increasing level of
education (Schwartz, 2016), a large gap has developed between the end of adolescence and the
beginning of adulthood. For these reasons, it is important to investigate characteristics in
emerging adulthood as a new transition to the adulthood period. Since emerging adulthood can
be a turbulent time for many youths, increased preventive attention is warranted. How teen
mothers traverse this particular developmental period is dependent upon various factors (Woods
et al., 2018) including earlier life experiences or family environment (Masten et al., 2005, 2006).
Childhood adversities may disrupt normal development processes (McLaughlin, 2016) and
increase the risk of poor adult adjustment (Schilling et al., 2007), promoting individuals engage
in a wide variety of health-compromising behaviors (Schwartz & Petrova, 2019), such as illicit
drug use (National Institute of Drug Abuse, 2017) and mental health problems (Rohde et al.,
2013). Therefore, recognizing and attending to the escalation in mental health and behavioral
problems that occur during the emerging adulthood is warranted for teen mothers.
Currently existing mental health and social service delivery models primarily focus on
either child or adult populations (Woods et al., 2018). Individuals who were in the child-serving
services before the age of 18 are transferred directly to adult-services after 18 years old.
Considering the importance of the transition period, emerging adulthood, currently existing
service models may not effectively address the challenges that teen mothers may face during
their emerging adulthood. Therefore, a program specifically tailored for emerging adulthood
should be considered. Namely, positive youth development (PYD) interventions may be an
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effective intervention strategy that can be tailored for teen mothers in their emerging adulthood.
PYD interventions aim to prevent the escalation of mental health and risk behaviors, and support
adolescents to acquire competence, self-efficacy, sense of belongingness, and empowerment
(Bowers et al., 2010), drawing upon the strengths of young individuals (Ciocanel et al., 2017).
Some studies have reported positive effect of PYD intervention on violence (Durlak et al., 2010),
health, and well-being (HM Government, 2010). For teen mothers particularly, the California
Department of Public Health’s Maternal, Child, and Adolescent Health Program (MCAH)
developed the Adolescent Family Life Program Positive Youth Development (AFLP PYD), a
PYD program tailored for parenting teens with a specific focus on services related to health and
health care, social and emotional support, and education and employment. Although some
limitations exist in the AFLP PYD program, the overall quality of the intervention in the AFLP
PYD program was high (Asheer et al., 2020).

Strengths and limitations
Three study limitations should be considered when interpreting our findings. First,
although the current study attempted to replicate the original ACEs items, some of the items
were missing. For teen mothers, intimate partner violence and parental mental health problems
were not measured. For offspring, sexual abuse was not assessed. Second, offspring’s childhood
adversities relied on teen mother’s self-report. This may cause potential reporting errors or
biases. Third, the generalization of the findings should be cautiously considered, since the
analysis sample is not nationally representative.
Despite noted limitations in this research, the findings from the current study contribute
to the literature in three important ways. First, the work leverages data from longitudinal cohort
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studies of teen mothers and their children, enabling us to provide insight into intergenerational
continuity of childhood adversity among teen mothers and their offspring, which has not been
fully answered. Second, the study examined whether teen mother’s antisocial behavior, illicit
drug use, depression, and parenting stress account for the intergenerational continuity of
childhood adversity. Third, the study tested domain-specific childhood adversities in order to
identify the differential effects of child maltreatment and household dysfunction across
generations.

Conclusions and Implications
This study extends the prior work on intergenerational continuity of childhood adversity
by focusing on potential mechanisms. A mediation effect of antisocial behavior was found in the
intergenerational continuity of childhood adversity among teen mothers and their offspring.
Specifically, teen mother’s antisocial behavior in emerging adulthood mediated the association
between teen mother’s maltreatment and offspring’s household dysfunction. In addition,
depression and parental distress explained the paths linking teen mothers’ and their offspring’s
childhood adversity. There are several implications of our findings. First, from a clinical
perspective, identifying teen mothers with the history of child maltreatment needs to be
prioritized and necessary resources (i.e. mental health services) should be provided to reduce the
risk of adversity exposure in their offspring. For example, existing early childhood interventions
on maltreatment typically aim at either preventing child maltreatment in families without a
history of maltreatment or reducing repetitive occurrence of child maltreatment in families (van
der Put et al., 2018). Such approaches may be applicable and effective to teen mothers who have
the history of maltreatment.
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Second, factors such as antisocial behavior and depression of teen mother during the
emerging adulthood appear to be relevant to the intergenerational link between teen mothers’
maltreatment history and their offspring’s household dysfunction. Promoting healthy transition
among teen mothers in their emerging adulthood through interventions is needed, in order to
eradicate the deleterious impact of mothers’ child maltreatment experiences on their offspring.
Even among well-designed interventions, little is known about the mechanisms that link
programs to their prevention effects (Mersky et al., 2011).
From a research perspective, continued efforts to uncover mechanisms associated with
the intergenerational continuity of child maltreatment and household dysfunction are necessary.
Ultimately, a greater understanding of these intergenerational mechanisms will inform
researchers and practitioners of the specific factors that could be targeted effectively in
preventive interventions aiming to break the cycle of childhood adversity across generations.
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Chapter 5: Conclusions and implications

Childhood adversity is concerning because of the direct impact it has on the affected
individuals and then their offspring. Previous studies have examined the within-generation
impact of childhood adversity, as well as the impact of childhood adversity across generations.
For example, childhood adversity has significant long-term dose-response effects on the
developmental outcomes of children and adolescents (Fava et al., 2019), including externalizing
behaviors (Hunt et al., 2017). Despite the advances in the childhood adversity literature, studies
are limited in several different ways. First, findings on the “time dimension” of childhood
adversity have been mixed and inconclusive (Harpur et al., 2015; Dunn et al., 2018). Second, the
intergenerational impact of childhood adversity has received less attention (Narayan et al., 2017;
Negriff, 2020), with most existing studies have focused on child maltreatment only (Schofield et
al., 2013). Third, limited studies have investigated the potential mechanisms explaining the
intergenerational continuity of childhood adversity. Fourth, two domains of childhood adversity
– maltreatment vs. household dysfunction – have not been fully incorporated in the relevant
studies. The current dissertation incorporated three distinct, but related studies to address these
gaps in the previous works.
Chapter 2 of this study sought to examine the timing and duration of childhood adversity
and externalizing behavior at age 17, among the offspring of teen mothers. Results show that
offspring’s externalizing behavior at age 17 was largely explained by exposure to childhood
adversity in early adolescence (age 11.5), compared to both other developmental periods and the
accumulation of the childhood adversity for seven waves (ages 5.5-16). Further, exposure to
child maltreatment at age 11.5 predicted higher externalizing behavior at age 17, while
household dysfunction at age 11.5 did not predict adolescent’s externalizing behavior. Since
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early adolescence is known to be a sensitive period of development (Knudsen, 2004), the events
youth experience during this transition period (i.e. transition from elementary to middle school)
may be significant, influencing developmental outcomes later in adolescence. Therefore, adverse
experiences during this time may be significant and require extra support, given the risk of
externalizing behavior in late adolescence (Bos et al., 2018). Particularly, interventions geared
toward child maltreatment are necessary. Taken together, this approach might enable us to
identify a developmental period with heightened vulnerability for externalizing behavior.
Chapter 3 of the study examined the potential mechanisms of intergenerational continuity
of childhood adversity among teen mothers and their offspring. Specifically, teen mothers’
parental distress and parent-child dysfunctional interaction were the hypothesized mechanisms
linking the childhood adversity across generations. There were three major findings to be noted.
First, teen mother’s childhood adversity predicted offspring’s increased level of childhood
adversity. In particular, teen mother’s maltreatment had a significant impact on their offspring’s
household dysfunction at age 11.5. Second, teen mother’s parental distress mediated the
association between teen mother’s maltreatment and offspring’s household dysfunction. Third,
additional pathways were found among teen mother’s household dysfunction, parental distress,
and offspring’s household dysfunction. Childhood adversities are toxic stressors with long-term
implications for intergenerational continuity of adversity (Shonkoff et al., 2012). Therefore,
preventing or reducing the impact of childhood adversity could produce long-lasting benefits
across generations. From the viewpoint of prevention and intervention of teen mother’s
childhood adversity experiences, examining the domain-specific effects of childhood adversity
within- and across generations may be important in order to stop the progression of adverse
pathways to poor outcomes (Finkelhor et al., 2011). In addition, the current study called attention
81

to the importance of parental distress, as it mediates the intergenerational continuity of childhood
adversity among teen mothers and their offspring. Engaging in teen mother’s parental distress as
intervention targets may be necessary, to prevent the cycle of intergenerational risk of childhood
adversity.
Chapter 4 focused on teen mothers’ developmental consequences of childhood adversity
in their emerging adulthood – antisocial behavior, illicit drug use, and depression– as potential
mediators, which may also be linked to teen mother’s parenting stress. Two findings are
noteworthy. First, teen mother’s antisocial behavior mediated the link between teen mother’s
maltreatment and offspring’s household dysfunction. Second, additional pathways of teen
mother’s maltreatment, household dysfunction, depression, parenting stress, and offspring’s
household dysfunction were found. Extending the findings from chapter 3, the current study put
more emphasis on teen mother’s antisocial behavior, illicit drug use, and depression in emerging
adulthood, a significant stage of developmental transition from late adolescence to young
adulthood, assuming that teen mothers with the risk of antisocial behavior, illicit drug use, and
depression in emerging adulthood may be more likely to endure a multitude of additional risks
that may confer further vulnerability for the next generation (Rieder et al., 2019). In addition,
pathways from teen mother’s childhood adversity to depression, parental distress, and offspring’s
childhood adversity inform the significance of intervening mental health problems and parental
distress in emerging adulthood, in order to break the cycle of childhood adversity across
generations.
A number of important implications emerged from these results. First, identifying a
developmental period with heightened vulnerability is important, because childhood adversity
during early adolescence is found to be particularly disruptive among offspring born to teen
82

mothers. Second, in order to break the cycle of intergenerational continuity of childhood
adversity among teen mothers and their offspring, we may need to first delineate maltreatment
and household dysfunction. Future research should continue to investigate the effects of specific
domains of childhood adversity on across-generation childhood adversity outcomes, in order to
allow service providers gather more complete evidence about the salience of each domain of
childhood adversity and make evidence-based decisions on interventions. Third, promoting
healthy transition of teen mothers in their emerging adulthood is critical. Our findings indicate
that intergenerational continuity of childhood adversity was mediated either by teen mothers’
parental distress or antisocial behavior in emerging adulthood. Intervention strategies for teen
mothers with childhood adversity should account for the negative effects of childhood adversity,
since it can extend beyond a single generation via complex mechanisms (Larkin et al., 2012;
Leitch, 2017; Lomanowska et al., 2017). Therefore, addressing the consequences of childhood
adversities in emerging adulthood among mothers may prevent childhood adversity in the next
generation. Teen mother’s mental health, behavioral problems, and parenting stress in emerging
adulthood, such as antisocial behavior, illicit drug use, depression, and parental distress may be
factors underlying the intergenerational continuity of childhood adversity. One of the possible
interventions is the Incredible Years (IY), offering regular support to at-risk families including
first-time young mothers or families (Pontoppidan, 2015). The program has shown clinically
significant improvement on youth conduct problems in previous studies (Barth et al., 2005),
particularly among maltreated families (Hughes & Gottlieb, 2004; Webster-Stratton & Reid,
2005) and maternal depression (Leijten et al., 2019). It also targets promoting and improving
social development, cohesion and positive relationships across the life course for youth at greater
risk of adversity (Ford et al., 2020). Given the complex nature of childhood adversity and the
83

intergenerational continuity, more intensive interventions as well as broader contextual factors
may be necessary to prevent childhood adversity across generations.

84

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Asset Metadata

Creator Yoon, Yoewon (author)

Core Title Childhood adversity across generations and its impact on externalizing behavior

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Philosophy

Degree Program Social Work

Publication Date 04/19/2021

Defense Date 03/04/2021

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag childhood adversity,externalizing behavior,household dysfunction,intergenerational continuity,maltreatment,OAI-PMH Harvest,teen mothers

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Lee, Jungeun Olivia (committee chair), Cederbaum, Julie A. (committee member), Saxbe, Darby (committee member)

Creator Email yoewonyo@usc.edu,yoon0124@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-447469

Unique identifier UC11668451

Identifier etd-YoonYoewon-9495.pdf (filename),usctheses-c89-447469 (legacy record id)

Legacy Identifier etd-YoonYoewon-9495.pdf

Dmrecord 447469

Document Type Dissertation

Rights Yoon, Yoewon

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

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