Understanding the Intergenerational Cycle of Trauma and Violence: Maternal Adverse Childhood Experiences and Parent-to-Child Aggression Risk

Abstract

Adverse childhood experiences (ACEs), such as exposure to maltreatment and household dysfunction, are major risk factors for physical and mental health problems across the lifespan. While the relationship between ACEs and health outcomes is well established, what effects ACEs might have on parent-to-child aggression are less known. The negative consequences of ACEs on parental aggression can be even more pronounced with multiple exposures to different patterns of ACEs. This study examined the association between patterns of maternal ACEs and subsequent parent-child aggression risk. A diverse sample of young women (N = 329; mean age = 26.3 years) was recruited at a large, urban university medical center. Participants completed self-report measures of the ACEs Questionnaire and the Adult-Adolescent Parenting Inventory-2. Latent class analysis was used to identify classes of women with similar patterns of exposure to ACEs and to examine the associations between ACEs classes and parent-to-child aggression risk. Three latent classes, characterized by distinct patterns of maternal ACEs, were identified: Low ACEs (63% of the sample), High Parental Separation/Divorce (20%), and High/Multiple ACEs classes (17%). Women in the High/Multiple ACEs class were more likely to report higher levels of parent-to-child aggression risk (i.e., inappropriate expectations, belief in corporal punishment, lack of empathy) than those in the other classes (Wald₍₂₎ = 8.63, p = .013). Preventive interventions targeting parental attitudes and behaviors among young women exposed to ACEs may decrease the risk for further perpetuation of aggression in the next generations.

Keywords

parental aggression adverse childhood experiences parent-to-child aggression parenting practices Adult-Adolescent Parenting Inventory

Exposure to adverse childhood experiences (ACEs) is quite prevalent among US adults. For example, a recent Center for Disease Control and Prevention study of 214,157 adults in the US found that 61% of adults were exposed to at least one type of ACEs prior to age 18 years, and approximately 25% of US adults were exposed to three or more ACEs (Merrick et al., 2018). Unresolved traumatic experiences during childhood have significant and long-lasting effects on the health and behaviors of an individual throughout the lifespan. There is also a growing body of evidence of the intergenerational effects of ACEs in shaping parenting attitudes and practices (Bailey et al., 2012; Chamberlain et al., 2019; Clemens et al., 2020; Montgomery et al., 2019). The aim of the current study is to expand the existing literature by exploring how different patterns of maternal ACEs relate to parent-to-child aggression risk in a community sample of predominantly low-income, Black young women.

Maternal ACEs and Parental Aggression

It is well documented that parental attitudes about physical punishment have roots in how an individual interacted with their own parents in childhood. For example, in a sample of 1,265 African-American women in low-income communities, Chung et al. (2009) found that maternal ACEs, such as childhood physical abuse and verbal hostility, were related to women’s current use of corporal punishment. Rodriguez et al. (2018) also reported that maternal ACEs, such as experiencing physical and psychological aggression in childhood, were related to aggressive parenting attitudes and practices in a sample of 201 first-time parents. Furthermore, Deater-Deckard et al. (2003) found that adolescents who had been spanked by their mothers were more approving of this discipline method, regardless of the overall frequency, timing, or chronicity of physical discipline they had received. While previous studies have provided strong evidence for the effects of maternal ACEs on parent-to-child aggression risk, it is less known how the co-occurrence of, or patterns of maternal ACEs, may influence parent-to-child aggression risk.

Multiple and Cumulative ACEs and Parent-to-Child Aggression Risk

Given that ACEs include various types of childhood adversity by definition, emerging literature explores the impact of different types of ACEs on parent-to-child aggression risk and aggressive parenting behaviors. Bailey et al. (2012) found that maternal exposure to childhood neglect, emotional abuse, and witnessing family violence were related to hostile parenting behaviors whereas maternal exposure to physical abuse was not. In contrast, another study found that maternal history of physical and sexual abuse was related to aggressive parenting practices, but emotional abuse and witnessing intimate partner violence in childhood were not (Goodrum et al., 2019). Such mixed results may suggest that since the majority of women suffer not just one, but several types of ACEs in childhood (Costello et al., 2002; Finkelhor et al., 2011), it may be more informative to examine multiple and cumulative exposure to maternal ACEs instead of exposure to a single type of ACEs. Given the significant role, cumulative exposure to ACEs plays in lifelong health and well-being, it is critical to understand how maternal exposure to multiple ACEs is associated with parent-to-child aggression risk.

One well-known method of examining the effects of multiple types of ACEs is to use a cumulative score, which is the sum (or average) of the types of ACEs endorsed. Several researchers have used this cumulative risk approach to examine relations between ACEs and maternal health and parenting outcomes (Cohen et al., 2008; Khan & Renk, 2019; Lange et al., 2019). The majority of these studies have found that there is a strong dose-response relationship between ACEs and subsequent risks for aggressive parenting (i.e., an increase in total number of ACEs endorsed is associated with an increased likelihood of aggressive parenting). For example, women exposed to two or more types of ACEs were more likely to use infant spanking as a disciplinary method than those exposed to less than two ACEs (Chung et al., 2009). The limitations of the cumulative risk approach include that the use of a summed (or averaged) score assumes that each type of ACE has an equivalent effect on aggressive parenting and does not allow for an examination of whether ACEs differentially relate to outcomes.

To address the limitations of the cumulative risk approach, several researchers have used person-centered approaches, such as latent class analysis (LCA), to understand the co-occurrence of different types of ACEs. LCA identifies unobserved, qualitatively distinct groups of individuals (i.e., latent classes) based on their patterns of responses to a specific set of items (e.g., ACEs items). The identification of distinct latent classes of ACEs is important, as it can identify characteristics of a group who may be most at risk for poor outcomes (e.g., aggressive parenting) which can be used to inform prevention and treatment efforts. For example, although the cumulative risk approach suggests that intervention efforts should be targeted to those who have experienced multiple ACEs, Lanier et al. (2018) explored latent classes of ACEs in a nationally representative sample of US youth and found that youth with a history of poverty and parental mental illness were most at risk for special healthcare needs (i.e., physical, emotional, behavioral health needs). These results highlight that focusing interventions based on high levels of cumulative ACEs alone may overlook youth most at risk.

Similarly, Stargel and Easterbrooks (2020) examined relations between maternal ACEs and postpartum maternal mental health and youth behavioral problems in a sample of 407 mother-child dyads enrolled in a home visiting program. They identified four latent classes based on maternal ACEs (i.e., high household dysfunction; high abuse, moderate other risk; low risk; high multiple risk). Their results suggest that exposure to high household dysfunction and high abuse/moderate other risk are associated with risk for poor maternal mental health and youth behavioral problems comparably to those in the high multiple risk class. Thus, they recommend screening for ACEs during pregnancy to prevent the intergenerational transmission of ACEs and providing early mental health intervention. Despite the potential benefits of LCA in understanding how the complex and interconnected ACEs that women experience in childhood influence later parent-to-child aggression risk, there is little research using this particular approach in this area.

The present study examined the relationship between different patterns of maternal ACEs and parent-to-child aggression risk in a diverse community sample of young women in an urban setting. First, this study identified latent classes of women with similar patterns of ACEs. Next, we examined whether the discrete classes of women who endorsed similar patterns of ACEs exposure reported differences in parent-to-child aggression risk. Nearly one in nine women experience postpartum depression, which has implications for their parent-to-child aggression risk (O’Hara & McCabe, 2013). Therefore, the current study adjusted for demographic information and depressive symptoms postpartum in exploring the effects of patterns of maternal ACEs on parent-to-child aggression risk.

Methods

Study Sample

The sample of the present study consists of 329 women (M_age = 26.3 years, SD = 5.5 years) who were recruited at a large, urban university hospital in the Mid-Atlantic region of the US. The majority of our sample identified as African American (70.2%). Most participants reported no further educational attainment beyond high school (88.8%) and family income below $25,000 (78.4%). Additional demographic information for our sample is provided in Table 1.

Table 1.

Descriptive Statistics of Adverse Childhood Experiences, Covariates, and Parenting Attitudes.

Variable	n/M	Valid %/SD
Adverse childhood experiences^a
Emotional abuse	58	19.8
Physical abuse	41	14.1
Sexual abuse	13	4.5
Emotional neglect	55	18.8
Physical neglect	22	7.5
Parental separation/divorce	169	57.3
Intimate partner violence exposure	30	10.5
Household alcohol/drug abuse	64	21.8
Household mental illness	30	10.2
Household incarceration	58	19.9
Maternal race/ethnicity
African American	231	70.2
Non-Hispanic White	39	11.9
Hispanic	40	12.2
Asian	4	1.2
Other	15	4.6
Educational attainment
≤high school or GED	292	88.8
>high school or GED	37	11.2
Marital status
Married or cohabiting	153	46.6
Never married, separated, divorced, or widowed	175	53.4
Family income
Under $25,000	258	78.4
$25,000–$74,999	64	19.5
Over $75,000	7	2.1
Birth order of the infant	2.00	1.14
Postpartum depression symptoms	1.87	1.64
Maternal attitudes toward parenting
AAPI-2 score	126.04	20.87
Inappropriate expectations	17.17	4.78
Lack of empathy	34.17	5.90
Belief in corporal punishment	32.30	9.96
Reversing parent-child roles	24.56	4.54
Restricting children’s power and independence	17.84	2.76

Note. GED = General Educational Development; AAPI-2 = Adult-Adolescent Parenting Inventory-2.

N and valid percentage of participants who answered affirmatively to the items.

Study Procedures

Recruitment materials invited mothers to participate in a research study exploring infant safe sleep practices and parent-child aggression risk. Inclusion criteria were at least 18 years old, English-speaking, and pregnant or having delivered a baby recently. Consenting and eligible participants were given details about the study procedures and were asked to provide written informed consent. Each participant received compensation for their time and involvement in data collection. Self-report survey data were collected either at the hospital postpartum or at participants’ homes seven days after discharge from the hospital. All study procedures were reviewed and approved by the Institutional Review Board.

Measures

Adverse childhood experiences

ACEs were measured by the Adverse Childhood Experiences Questionnaire, a 10-item measure that assesses exposure to different types of child maltreatment (physical, sexual, and emotional abuse; physical and emotional neglect) and household dysfunction (domestic violence; parental discord/divorce; household mental illness and substance abuse; incarcerated household member; Anda et al., 2006). Participants answered yes (1) or no (0) to indicate whether they had been exposed to each type of ACEs prior to age 18 years.

Parent-to-child aggression risk

Parent-to-child aggression risk was measured using the Adult-Adolescent Parenting Inventory-2 (AAPI-2), a validated scale assessing parent-to-child aggression risk associated with risk for aggressive parenting and child maltreatment (Bavolek & Keene, 2001). The AAPI-2 has 40 items measuring five subscales of parent-to-child aggression risk: inappropriate expectations of children, lack of parental empathy toward children’s needs, belief in the use of corporal punishment, reversing parent-child roles, and restricting children’s power and independence. The items (e.g., “spanking teaches children right from wrong.”) were answered on a 5-point Likert-type scale, ranging from strongly agree (1) to strongly disagree (5). The total AAPI-2 and each subscale score were calculated by summing the answers to each item. Higher scale scores represented lower parent-to-child aggression risk.

Postpartum depressive symptoms

Postpartum depressive symptoms were assessed by two Pregnancy Risk Assessment Monitoring System (PRAMS) items: “Since your new baby was born, how often have you felt down, depressed, or hopeless?” and “Since your new baby was born, how often have you had little interest or little pleasure in doing things you usually enjoyed?” (Centers for Disease Control and Prevention, 2016). The items were answered on a 5-point Likert-type scale, ranging from never (0) to always (4). A postpartum depressive symptom score was calculated by averaging the two items.

Demographic information

Demographic information gathered via a self-reported structured questionnaire included maternal age, race/ethnicity, educational attainment, marital status, family income, and infant birth order.

Data Analysis

Classes of ACEs exposure were identified via LCA, using Mplus 8.0 software. The optimal number of classes was determined by fitting a series of models based on one-, two-, three-, and four-class solutions, and comparing the model fit indices, proportion of participants in the classes, and theoretical meaningfulness of the classes across the models (Nylund-Gibson & Choi, 2018). The following fit indices were evaluated: Akaike information criteria (AIC) index, Bayesian information criteria (BIC) index, sample-size adjusted BIC, Lo-Mendell-Rubin adjusted likelihood ratio test (LMR), and bootstrapped likelihood-ratio test (BLRT). Lower values of AIC, BIC, and adjusted BIC indicate a better model fit. Statistically significant LMR and BLRT indicate an improvement of the model fit after including an additional class to the model (Nylund-Gibson & Choi, 2018; Nylund et al., 2007).

Once the best-fitting model was selected, a new dataset containing the most likely class membership assignments from the unconditional model was generated. Following the manual maximum likelihood three-step approach (Asparouhov & Muthén, 2014; Nylund-Gibson et al., 2019), this dataset was then used to examine the associations between ACEs classes and parent-to-child aggression risk, controlling for demographic information and postpartum depressive symptoms. We estimated four separate models for each distal outcome: AAPI-2 score, inappropriate expectations, lack of empathy, and belief in corporal punishment. Two AAPI-2 subscales, reversing roles and restricting independence, were excluded from the final models as they were not significantly associated with ACEs class memberships at bivariate levels. In each of the models, we controlled for the covariate effects on both class membership and distal outcomes. Statistical significance of the differences in class-specific intercepts for parent-child aggression risk was determined via a Wald test (Asparouhov & Muthén, 2014).

Results

Descriptive statistics of ACEs, covariates (i.e., demographic information and postpartum depressive symptoms), and parent-to-child aggression risk are summarized in Table 1. Based on fit indices displayed in Table 2, a three-class solution was identified. The three-class model demonstrated an acceptable entropy (80%), significant LMR (p = .01) and BLRT (p = .01), and superior model fit, based on BIC and adjusted BIC. Lastly, the three-class solution yielded theoretically meaningful classes, with a sufficient number of individuals in each class (>5%–8% of the sample; Nylund-Gibson & Choi, 2018). Class 1, labeled Low ACEs (63% of the sample), was characterized by low probabilities (<.001–.335) of all ACEs. Class 2 (20% of the sample) was labeled as Parental Separation/Divorce, since this class had high probability of exposure to parental separation or divorce (.878) and low probabilities of exposure to all other ACEs (.065–.296). Furthermore, participants in Class 3 had the highest probabilities of endorsing 9 out of the 10 ACEs (.365–.985). We labeled this class as High/Multiple ACEs (see Figure 1).

Table 2.

Fit Statistics for the Unconditional Latent Class Analysis for 1 to 4 Classes.

k	AIC	BIC	Adjusted BIC	Entropy	LMRT/BLRT p-value
1	2,480.03	2,516.97	2,485.26
2	1,844.05	1,921.62	1,855.02	0.96	.00/.00
3	1,800.44	1,918.64	1,817.16	0.80	.00/.00
4	1,797.72	1,956.55	1,820.18	0.80	.59/.07

Note. k = Number of latent classes; AIC = Akaike information criterion; BIC = Bayesian information criterion; LMRT = Lo-Mendell-Rubin likelihood ratio test; BLRT = Bootstrap likelihood ratio test.

Figure 1.

Item-response probabilities for 10 adverse childhood experiences across the three classes.

Several maternal and infant demographic factors were shown to influence the likelihood of membership in different ACEs classes. For example, being non-Hispanic White was associated with a greater likelihood of membership in the High/Multiple ACEs class (OR = 2.65, p = .048), compared to the Low ACEs class. Additionally, a higher infant birth order (e.g., third child vs. first child; OR = 1.61, p = .004) and higher levels of postpartum depressive symptoms (OR = 1.68, p < .001) were associated with a greater likelihood of being in the High/Multiple ACEs class, relative to the Low ACEs class.

Furthermore, using the three-step modeling approach, we ran four separate models examining relations between the latent classes and AAPI-2 score, inappropriate expectations, lack of empathy, and belief in corporal punishment, controlling for demographic information and postpartum depressive symptoms (Table 3). As noted above, higher scores in AAPI-2 represented lower levels of parent-to-child aggression risk. We found evidence of a significant association between class membership and AAPI-2 score (χ²_(2,313) = 8.63, p = .013). Compared to participants in the Low ACEs (M = 124.60) class, those in the High/Multiple ACEs (M = 117.86) class reported significantly lower AAPI-2 scores, indicating higher levels of parent-to-child aggression risk. Moreover, participants in the High/Multiple ACEs class reported significantly lower AAPI-2 scores than those in the Parental Separation/Divorce class (M = 130.03). There was no class difference in AAPI-2 scores between Low ACEs and Parental Separation/Divorce classes.

Table 3.

Class-Specific Intercepts for Parenting Attitudes Based on Adverse Childhood Experiences Classes Controlling for Covariates.

	Class 1: Low ACEs		Class 2: Parental Separation/Divorce		Class 3: High Multiple ACEs		Wald	p
	M	SE	M	SE	M	SE	Wald	p
AAPI-2 score	124.60*^,a	2.11	130.03**^,a	3.26	117.86^b	2.98	8.63	.013
Inappropriate expectations	17.17**^,a	0.42	17.22*^,a	0.82	14.94^b	0.61	10.41	.006
Lack of empathy	33.34**^,a	0.50	36.60**^,b	0.94	32.71^a	0.84	9.75	.008
Belief in corporal punishment	32.94**^,a	0.85	32.25^a,b	1.44	28.17^b	1.54	7.62	.022

Note. Cells with differing superscripts are statistically different from one another. AAPI-2 = Adult-Adolescent Parenting Inventory-2.

p < .05, **p < .01.

With respect to inappropriate expectations, we observed significant class differences (χ² _(2,313) = 10.41, p = .006). Whereas women in the Low ACEs (M = 17.17) and Parental Separation/Divorce (M = 17.22) classes did not differ from each other, those in the High/Multiple ACEs (M = 14.94) showed significantly higher levels of inappropriate expectations than women in the Low ACEs and Parental Separation/Divorce classes, respectively. Additionally, ACEs classes were significantly associated with lack of empathy (χ²_(2,313) = 9.75, p = .008). Women in the High/Multiple ACEs class (M = 32.71) demonstrated significantly higher levels of lack of empathy (i.e., less empathy) than those in the Parental Separation/Divorce (M = 36.60) class, whereas score differences in lack of empathy between women in the High/Multiple ACEs and Low ACEs class (M = 33.34) were not statistically significant. Lastly, results showed significant class differences in belief in corporal punishment (χ²_(2,313) = 7.62, p = .022). Compared to participants in the Low ACEs (M = 32.94) class, those in the High/Multiple ACEs (M = 28.17) class showed significantly higher levels of belief in corporal punishment. The Parental Separation/Divorce class scores on belief in corporal punishment (M = 32.25) were not significantly different from the scores of the Low ACEs and High/Multiple ACEs classes.

Discussion

The present study identified three classes of young women characterized by similar patterns of ACEs that are different from those endorsed by women in other classes. We found that young mothers who were empirically classified based on different patterns of ACEs had significant differences in parenting and child rearing attitudes. Specifically, this study found that participants in the High/Multiple ACEs class reported higher levels of parent-to-child aggression risk than those in the Low ACEs and Parental Separation/Divorce classes, controlling for postpartum depressive symptoms and demographic information. Women in the High/Multiple ACEs class, particularly, reported more inappropriate expectations of children and favorable belief in the use of corporal punishment than women in the other two classes. Additionally, mothers in the High/Multiple ACEs class reported lower levels of empathy in comparison to those in the Parental Separation/Divorce class.

Our results build on prior studies that have found that viewing ACEs as multidimensional can provide more information regarding the relation between maternal ACEs and maternal and child outcomes. Specifically, our findings suggest that women in the High/Multiple ACEs class are at greatest risk for future parent-to-child aggression. This aligns with prior research reporting that maternal exposure to ACEs is associated with detrimental outcomes for the mother, including perinatal mental health problems (e.g., anxiety, depression; Eastwood et al., 2021; Goldstein et al., 2021; Nidey et al., 2020) and alcohol and substance abuse (Currie et al., 2020; Hughes et al., 2017; Racine et al., 2020), which further increases risk for the child, such as the use of harsh parenting/discipline practices (Chung et al., 2009; Greene et al., 2020; Oosterman et al., 2019). These results highlight the need for preventative efforts, particularly primary prevention, to reduce exposure to ACEs, as the carry-over effects on later parenting approaches increase risk for intergenerational ACEs. Perinatal health specialists and pediatricians should consider implementing a maternal ACEs screening linked with available early intervention services (e.g., mental health counseling) for mothers exposed to ACEs to reduce risk of the perpetuation of harmful parent-child aggression.

It is important to note that women in the High/Multiple ACEs class showed higher levels of parent-to-child aggression risk than those participants in the Low ACEs, even after controlling for postpartum depressive symptoms. Exposure to chronic stress or prior trauma may relate to dysregulation of the mother’s stress-response system, which result in disruptions to diurnal cortisol patterns, cortisol reactivity, and oxytocin (Corwin et al., 2013, 2015; Gunnar et al., 2009; Stuebe et al., 2013). These biological responses to stress may manifest in psychological symptoms, such as postpartum depression (Seth et al., 2016). When faced with the stress of parenting, mothers with prior exposure to childhood adversities and poor mental health, may thus be at increased risk for maladaptive handling of stress, such as parent-to-child aggression. The current findings, however, indicate that above and beyond the effects of maternal mental health, exposure to ACEs, specifically high levels of exposure to multiple types of ACEs, might have unique and independently adverse effects on parenting attitudes and behaviors. Since the present study only controlled for maternal depression, it is recommended to study how current stressful circumstances including parenting stress and other factors (e.g., substance use, trauma symptoms) may affect the consequences of maternal ACEs on parent-to-child aggression risks.

Our results also suggest that women in the High/Multiple ACEs class reported significantly higher levels of inappropriate expectations than women in the Low ACEs and Parental Separation/Divorce classes, and stronger levels of belief in the value of corporal punishment than women in the Low ACEs class. Our findings linking maternal ACEs and inappropriate expectations of children are novel as the majority of prior research has not focused on this particular connection. One study has previously found a significant relation between maternal ACEs and maternal reports of their child displaying poor self-regulation and/or behavioral difficulties (Lange et al., 2019). Specifically, for every additional type of ACE endorsed, the average score of child difficulties increased by 3.69. These reports of difficulties may be an indication of inappropriate expectations, but this was not specifically examined. Having appropriate expectations toward children is important because parents who have unrealistic beliefs about children’s developmental capacities may be especially at risk of engaging in neglect of their children (Thompson et al., 2014); inappropriate and/or unrealistic expectations of children also influence how parents interpret their child’s behavior (e.g., deliberately difficult, disobedient), which increases risk for parent-child aggression and physical abuse (Rodriguez, 2016; Rodriguez & Wittig, 2019).

According to social cognitive theory (SCT), parenting attitudes and behaviors are often learned in a social context to achieve a life goal and frequently influenced by outcome expectancies, which can be defined as a belief about the likely outcomes of certain parenting behaviors (Bandura, 1986). Therefore, in SCT, aggressive parenting behaviors might be learned within a dynamic and reciprocal interaction between parents and children, and parents’ past experiences with their own parents heavily influence parenting expectancies and behaviors. Prior research has, indeed, found that parents who experienced corporal punishment as children were more likely to view corporal punishment as an acceptable form of discipline (Deater-Deckard et al., 2003) and were more likely to use corporal punishment in the future (Chung et al., 2009; Vittrup, 2006). Our findings of the significant relation between the High/Multiple ACEs class and favorable attitudes toward corporal punishment is consistent with findings from Chung et al. (2009). Chung et al. (2009) found a dose-response, such that the number of ACEs endorsed by mothers was significantly and positively associated with higher scores on the attitudes toward corporal punishment subscale of the AAPI. Additionally, a systematic review focusing on relations between parental ACEs, parenting behaviors, and child psychopathology, found that there is a connection between parental ACE exposure and harsh discipline practices, including physical punishment (Rowell & Neal-Barnett, 2021). Thompson et al. (2014) also found that among over 13,000 caregiver-child dyads maternal attitudes toward corporal punishment influenced their children’s attitudes toward corporal punishment, highlighting the potential intergenerational transmission of harsh discipline and parent-to-child aggression.

Collectively, our findings related to inappropriate expectations and attitudes toward corporal punishment suggest there is additive risk for parent-to-child aggression (e.g., corporal punishment use) based on stress and inappropriate expectations, which emphasizes the need to identify ways to lower risk for parent-to-child aggression among mothers with prior exposure to childhood adversity. Thus, it is important that future research explores whether prevention programs providing education on typical child development, realistic expectations for children’s behavior, and the potential developmental harm from corporal punishment prospectively improves parental expectations of children, prevents the use of corporal punishment, and lowers the risk for parent-to-child aggression and child maltreatment.

In the present study, we found that underlying patterns of ACEs were differentially associated with empathy. Those who were classified into the High/Multiple ACEs class had less empathy toward children than those in the Parental Separation/Divorce class. However, the literature surrounding the link between ACEs exposure and empathy is scarce and inconclusive. For example, in a sample of 11,000 high-risk youth entering the juvenile justice system, there was a significant and negative relationship between ACEs and empathy. Higher ACE scores were associated with lower levels of empathy, even after adjusting for several covariates (Narvey et al., 2021). In contrast, other studies have found that exposure to ACEs was not associated with empathy after controlling for demographic information (e.g., gender, age, race; Chapple et al., 2021) and was even associated with higher levels of empathy (Greenberg et al., 2018; Lim & DeSteno, 2016). Understanding the connection between specific ACEs, such as parental separation/divorce, and empathy is important as multiple studies have linked lower levels of parental empathy to higher risk for parent-to-child aggression, including forms of child abuse (Perez-Albeniz & de Paul, 2004; Rodriguez, 2013; Thompson et al., 2014).

Notably, the current findings on the relation between the patterns of maternal ACEs and subsequent parent-child aggression risk are based on a sample of mothers recruited from a large, urban university medical center, who were predominantly Black, low-income, and low-education. The US Health Resources and Services Administration reported that 9 of the 12 localities served by this medical center are designated as Medically Underserved Areas, which often have limited primary care providers, high infant mortality, and high poverty rates (Health Resources and Services Administration, n.d.). Thus, interpreting the findings of the present study requires a nuanced understanding of not only how maternal ACEs influence parent-child aggression risk and parenting attitudes, but also the root causes behind maternal ACEs. The racial/ethnic, economic, and educational backgrounds of the study population from which our results were drawn, suggest that any ACEs prevention initiatives and parenting training programs serving women and families in urban settings, need to incorporate a focus on racial equity to enhance its prevention efforts. Although it is beyond the scope of the current study, the findings of the present study unquestionably suggest that promoting racial equity in education and advancing racial equity in health care cannot be separated from any societal efforts to prevent ACEs and other childhood adversities. Therefore, embedding racial equity within and across all levels of prevention efforts is necessary to break the cycle of intergenerational trauma and to mitigate the negative effects of maternal ACEs on parenting attitudes and practices, particularly among women with a history of ACEs.

Limitations and Future Directions

Our results should be interpreted in light of several limitations. First, our study was cross-sectional in nature; therefore, we cannot infer causal relationships between underlying patterns of ACEs and parent-to-child aggression risk. Second, our measurement of ACEs was retrospective, which may have created some inaccuracy in mother’s recollection of adverse life events they were exposed to as children. We also utilized a self-report measure of parent-to-child aggression risks (i.e., AAPI-2), which may be impacted by mothers’ social desirability bias. Analyzing the relations between class membership and parent-to-child aggression in separate analyses may have resulted in spurious findings. We conducted separate analyses due to sample size considerations; however, whether the subscales of the AAPI-2 (i.e., inappropriate expectations, lack of empathy, belief in corporal punishment) are correlated and jointly explain variance should be explored in future studies with larger sample sizes. Additionally, although the aim of our study focused on using LCA to identify underlying patterns of ACEs, future studies should compare the utility of cumulative risk scores and latent classes of parental ACEs in predicting future parenting behaviors. Furthermore, the sample was drawn from a large, urban, university hospital in the southeastern United States. The results found in this study may not be generalizable to other samples and/or populations given the person-centered approach used in the current analysis (i.e., LCA). Lastly, although the present study contributes to diversity by identifying the patterns of maternal ACEs among a sample of predominantly Black/African American, low-income women, this study was limited in data about women’s sexual/gender identity, residential status, and caregiving status.

Building on our findings and the limitations, researchers should continue to examine relations between exposure to different forms of childhood adversity and parent-to-child aggression risk in order to inform preventative interventions that can improve outcomes for parents exposed to ACEs and, in turn, psychosocial outcomes for their children. Prospective, longitudinal studies that can examine how childhood adversity experiences influence adult outcomes, including parent-to-child aggression, are necessary to establish causal relations. These longitudinal methods should also be used to determine whether providing ACEs screening early in the prenatal period to identify those most at risk (e.g., those who experience multiple ACEs) combined with targeted parental education interventions regarding child development effectively lowers risk for parent-to-child aggression over time. Additionally, studies should assess and account for the influence of additional stressors that may occur in adulthood, such as intimate partner violence and identity-based violence, that may also impact risk for parent-to-child aggression. Future studies should also consider using a multi-informant approach to assess parent-to-child aggression. Reports by children and/or partners regarding parent-to-child aggression can be used to determine whether reports are congruent with self-assessment approaches. Finally, future research should replicate our study, specifically the LCA, across multiple samples to determine whether the same classes are identified. If so, this builds confidence that the patterns of ACEs identified are potentially generalizable to other samples/populations.

Conclusion

Our study highlights the importance of examining underlying patterns of ACEs exposure and how different patterns of ACEs may be significantly associated with differences in risk for parent-to-child aggression. Our results suggest that membership within a subgroup characterized by high/multiple ACEs is significantly associated with increased risk for parent-to-child aggression; whereas membership within a subgroup characterized by low ACEs or high parental divorce/separation is not. Therefore, addressing exposure to high levels of multiple ACEs is an important preventative focus. Further research that examines patterns of exposure to ACEs, particularly patterns that involve high levels of exposure to multiple ACEs, and how they relate to parent-to-child aggression is needed to inform targeted intervention and prevention efforts.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article: This work was supported by the Virginia Department of Social Services (FAM 17-084 to SHS). The authors have indicated that they have no potential conflicts of interest to disclose.

ORCID iDs

Sunny H. Shin

Camie A. Tomlinson

Author Biographies

Sunny H. Shin, PhD, is an Associate Professor in the VCU School of Social Work and Department of Psychiatry. His research interests include early intervention and prevention of childhood trauma and drug prevention among trauma-exposed youth. Shin’s research currently focuses on developing and testing theoretical models that explain the developmental mechanisms that link childhood traumatic experiences to parental attitudes and behaviors.

Camie A. Tomlinson, MSW, is a doctoral candidate at VCU School of Social Work. Broadly, her research interests include promoting the mental health of youth involved in the child welfare system. She focuses on identifying factors that impact the relation between childhood adversity and mental health outcomes, and the developmental mechanisms through which these factors impact long-term mental health.

Devin Nelson-Hence, BA, is a graduate student at VCU. Her research interests are behavioral health and educational inequality.

Gabriela Ksinan Jiskrova, PhD, is a postdoctoral fellow in Masaryk University, Research Center for Toxic Compounds in the Environment. She received a PhD in Family Sciences at the University of Kentucky and is currently working on community-engaged and mental health-focused projects.

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