Journal of Youth and Adolescence (2022) 51:2294–2311

https://doi.org/10.1007/s10964-022-01671-9

EMPIRICAL RESEARCH

Adolescent Mental Health and Family Economic Hardships: The

Roles of Adverse Childhood Experiences and Family Conflict
1
Sheila Barnhart ●
Antonio R. Garcia1 Nicole R. Karcher2
●

Received: 7 April 2022 / Accepted: 8 August 2022 / Published online: 23 August 2022
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022

Abstract
Rising and economically disproportionate rates of adverse mental health outcomes among children and youth warrant
research investigating the complex pathways stemming from socioeconomic status. While adverse childhood experiences
(ACEs) have been considered a possible mechanism linking socioeconomic status (SES) and child and youth
psychopathology in previous studies, less is understood about how family environments might condition these pathways.
Using data from a longitudinal, multiple-wave study, the present study addresses this gap by examining the direct
relationships between family economic status and youth internalizing and externalizing symptoms, if ACEs mediate these
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relationships, and if conflictual family environments moderate these direct and indirect relationships. The data were obtained
from 5510 youth participants [mean age at baseline = 9.52 (SD = 0.50), 47.7% female, 2.1% Asian, 10.3% Black, 17.6%
Hispanic, 9.8% Multiracial/Multiethnic, 60.2% White] and their caretakers from the baseline, 1-year, and 2-year follow up
waves. Conditional process analysis assessed the direct, indirect, and moderated relationships in separate, equivalent models
based on youth- versus caregiver-raters of ACEs and youth psychopathology to capture potential differences based on the
rater. The results of both the youth- and caregiver-rated models indicated that lower family economic status directly
predicted higher levels of externalizing symptoms, and ACEs indirectly accounted for higher levels of internalizing and
externalizing symptoms. Additionally, family conflict moderated some, but not all, of these relationships. The study’s
findings highlight that lower family economic status and ACEs, directly and indirectly, contribute to early adolescent
psychopathology, and conflictual family environments can further intensify these relationships. Implementing empirically
supported policies and interventions that target ACEs and family environments may disrupt deleterious pathways between
SES and youth psychopathology.
Keywords Child and adolescent mental health Economic adversity Family conflict Adverse childhood experiences
● ● ● ●

Adolescent Brain Cognitive Development Study®

Introduction minors between 12 and 17 experienced a major depressive

Mental health disorders among children and youth are
increasing at alarming rates. For example, nearly 1 in 5 US
Supplementary information The online version contains
supplementary material available at https://doi.org/10.1007/s10964-
022-01671-9.
* Sheila Barnhart
Sheila.Barnhart@uky.edu
1
University of Kentucky, 619 Patterson Office Tower,
Lexington, KY 40506-0027, USA
2
Washington University School of Medicine, Box 1125, One
Brookings Drive, St. Louis, MO 63130, USA
episode between 2013 and 2019 (Bitsko et al., 2022).
Socioeconomic disparities further complicate this problem
and demonstrate that mental health outcomes worsen as
socioeconomic status (SES) declines. Additionally, adverse
childhood experiences (ACEs), which also increase with
declining SES, can jeopardize child and youth mental health
and may operate as a mechanism by which SES influences
mental health. However, relationships between SES, ACEs,
and child and youth psychopathology are complex, and how
family environments might further condition these rela-
tionships is less understood. To address this gap, this study
examined the direct and indirect relationships between SES,
ACEs, and youth psychopathology in early adolescence,
and if these relationships were moderated by conflictual
family environments.
Journal of Youth and Adolescence (2022) 51:2294–2311
SES and Mental Health
Many families in the US experience economic challenges.
In 2020, ~16.1% of American children and youth lived in
poverty (100% of the Federal Poverty Level [FPL]); when
including “near poverty” (i.e., 101–200% FPL), that per-
centage increased to 35.8% (Shrider et al., 2021). Moreover,
economic hardships can extend well into the SES spectrum.
In a nationally representative study, nearly 1 in 5 families
with children who lived beyond 200% FPL reported
experiencing material hardships (Rodems and Shaefer,
2020). Accordingly, measures that capture the broader
range of SES may be ideal because economic hardships are
not limited to those who live in or near poverty.
Socioeconomic disparities in mental health are well
documented. SES captures a family’s societal position as
determined by their economic and social capital. While
the measurement of SES can vary across studies,
household income is a robust and widely used measure in
health research (Daly et al., 2002; Peverill et al., 2021).
Children and youth in lower-SES families are more
likely to experience poorer mental health outcomes such
as internalizing and externalizing symptomology than
those in higher SES families (Peverill et al., 2021; Reiss,
2013). Further, longitudinal studies have demonstrated
socioeconomic gradients in child and adolescent psy-
chopathology over time; as SES improves, internalizing
and externalizing behaviors tend to decline (P. Miller
and Votruba-Drzal, 2017; Peverill et al., 2021; Shore
et al., 2018).
The effects of SES on mental health are especially con-
cerning because they can persist throughout child devel-
opment. For example, low SES in early childhood predicts
higher levels of later externalizing and internalizing beha-
viors (Lansford et al., 2019; A. B. Miller et al., 2021).
Moreover, early adolescence may be an especially vulner-
able time for socioeconomic threats because the incidence
of mental health disorders tends to increase during this time,
including depression (Lu, 2019) and anxiety (de Girolamo
et al., 2012). Further, in addition to the onset of puberty that
entails rapid physiological changes, early adolescence is a
critical time for brain development (Luciana, 2013),
underscoring the unique vulnerability for mental health
during this developmental period.
As a social determinant of health, SES shapes mental
health by determining the quality of living conditions,
exposures to physical and social-environmental risks, and
opportunities that affect mental health and well-being
(Flaskerud and DeLilly, 2012). Directly, lower SES can
expose children and youth to deprivation (Duncan et al.,
2017; Johnson et al., 2016). Consequently, lower-SES
families have a greater risk of housing instability and food
insecurity, which are linked to poorer mental health
2295
outcomes (Melchior et al., 2012; Sandel et al., 2018).
Families with limited economic resources may have few
residential options. Lower-income neighborhoods tend to
have higher levels of social disorganization and criminal
activity (Sackett, 2016). Additionally, SES can affect access
to resources that can promote mental health, such as good
schools and health care. Children and youth living in low-
SES families have lower odds of receiving a mental health
diagnosis and treatment (Ghandour et al., 2019).
SES is also associated with several additional variables
that influence child and youth mental health outcomes.
While the current study focuses on the relationships
between SES, ACEs, family environment, and child and
youth psychopathology, it is crucial to recognize that race,
ethnicity, and gender can relate or interact with SES and
mental health relationships. Black, Latinx, Native Amer-
ican, multiple-race children, and youth, and those living in
single-mother-headed households are more likely to live in
or near poverty compared to White non-Latinx or Asian
children, and those living in married-parent households
(Annie E. Casey Foundation. (2020); Shrider et al., 2021).
Contributions of race and ethnicity to SES relationships
with mental health are complex and not fully understood.
For example, while it has been speculated that youth
belonging to minoritized groups may be especially vulner-
able to SES effects on mental health, evidence suggests that
children who do not belong to a racial or ethnic minority
group may experience stronger effects (Peverill et al.,
2021). Additionally, gender effects on SES and youth
psychopathology are unclear. Girls have been reported to
have a higher likelihood of developing externalizing
symptoms after chronic exposure to poverty (Kim et al.,
2016), but others have not found such effects (Henninger
and Luze, 2013).
ACEs as a Mechanism Linking SES and Mental Health
ACEs are characterized as potentially traumatic experiences
that occur in childhood and adolescence, which include
child maltreatment, such as abuse and neglect, and house-
hold dysfunction including divorce/separation or death,
intimate partner violence, incarceration, substance use, and
mental illness (Felitti et al., 1998). More recently, experi-
ences such as severe illness and hospitalizations, bullying
victimization, and exposure to community violence have
also been identified as ACEs (Finkelhor, 2020). Indeed,
because ACEs entail a range of potentially traumatic
experiences that can occur within and beyond the family,
the measurement of ACEs is an essential methodological
consideration. The inclusion of sensitivity analysis when
examining intra-familial and extra-familial ACEs may
strengthen research efforts. To date, no formally agreed-
upon criteria for ACEs exist. Additionally, race/ethnicity is
2296
important to consider concerning ACEs. Nationally repre-
sentative samples in the US demonstrate lower rates of
ACEs found among White, non-Latinx children and youth
compared to those belonging to other racial and ethnic
groups (Mersky et al., 2021; Sacks and Murphey, 2018).
Lower-income populations have disproportionately
higher rates of ACEs than those living in more economic-
ally advantaged circumstances (Lacey et al., 2020; Walsh
et al., 2019). Additionally, SES demonstrates a graded
relationship with ACEs; as SES declines, ACEs increase
(Halfon et al., 2017). While some have argued that poverty
constitutes an ACE (Braveman et al., 2017; Hughes and
Tucker, 2018), others conceptualize poverty as a risk factor
for ACEs because it can contribute to conditions that
increase the risk for ACEs (Choi et al., 2019; Lacey et al.,
2020). Further, identifying poverty as an ACE could
undermine the role of SES as a social determinant of ACEs
(Taylor-Robinson et al., 2018). Additionally, while poverty
and ACEs are correlated, they can have differential risk
profiles and subsequent trajectories with child and youth
mental health (Barth et al., 2021). For instance, while
poverty is closely related to child neglect, poverty has a
differential impact on children’s development across the
lifespan compared to neglect (Barth et al., 2021). Further,
risk profiles for neglect differ from those of poverty, and
trajectories of reoccurrence may be unique between poverty
and neglect (Barth et al., 2021). For this study, poverty and
ACEs were conceptualized as related but distinct constructs,
allowing the opportunity to examine the unique roles of
SES and ACEs in youth psychopathology.
ACEs can lead to adverse mental health outcomes in
childhood and adolescence. Dose-response relationships
between ACEs and adverse psychosocial and health out-
comes have been well-documented over the past 20 years
(Anda et al., 2006; Varese et al., 2012; Young and Widom,
2014). However, most of these studies rely on retrospective
adult reporting of ACE exposures and do not focus speci-
fically on ACEs and behavioral outcomes during middle
childhood (Hunt et al., 2017). To address this gap, one
study examined the relationship between ACE exposures
and social, emotional, and behavioral problems using the
Child Behavior Checklist (CBCL) during childhood
(Greeson et al., 2014). The study’s findings showed that the
likelihood of scoring above the clinical threshold on the
CBCL increased for each additional type of trauma children
experienced (Greeson et al., 2015).
A systematic review of 5 studies examining ACE
exposure and mental, behavioral, and social outcomes
among young children ages 0–6 years demonstrated a
cumulative pattern such that those with 3 or more ACEs
had a greater risk of externalizing and internalizing beha-
viors (Liming and Grube, 2018). However, the authors
cautioned that the specificity of these behaviors was limited
Journal of Youth and Adolescence (2022) 51:2294–2311
due to different behavioral scales used in the studies.
Similarly, a longitudinal study that used a socio-
economically and racially diverse sample of children
demonstrated that exposure to ACEs in early childhood
(i.e., between ages 1 and 3 years) was linked to inter-
nalizing and externalizing behaviors at age 11 (McKelvey
et al., 2018). In a prospective study that examined a limited
range of 8 ACEs and subsequent behavior problems among
a diverse sample of over 3000 children, ACEs exposure by
age 5 was significantly related to externalizing and inter-
nalizing behaviors and diagnosis of ADHD in middle
childhood (Hunt et al., 2017).
ACEs demonstrate similar patterns with mental health in
adolescence. Experiencing at least one ACE was associated
with increased odds of depressed mood among a commu-
nity sample of US youth aged 14 and older (Meeker et al.,
2021). Similarly, a nationally representative sample of US
youth found a dose-response effect between ACE scores
and depression, anxiety, behavioral and conduct problems,
and substance use disorders (Bomysoad and Francis, 2020).
Cumulative ACE exposure by age 11–12 predicted higher
levels of internalizing and externalizing symptoms in later
adolescence among a sample of African American youth
(Hicks et al., 2020). Additionally, in a longitudinal study of
UK children and youth, ACE exposure in early childhood
was persistently related to poorer mental health in later
childhood and adolescence (Bevilacqua et al., 2021).
Few studies have investigated ACEs as a mechanism by
which SES influences child and youth mental health out-
comes. A longitudinal study of youth in the UK found that
adverse socioeconomic conditions directly predicted poorer
health outcomes, including behavioral problems, and that
these relationships were mediated by ACEs (Straatmann
et al., 2020). Another study using a large birth cohort
sample of Welsh children examined a subset of ACEs,
including childhood victimization and residing with a
household member who had a serious or common mental
health diagnosis, alcohol problems, or passed away (Low-
thian et al., 2021). The authors reported that ACEs did not
fully explain the relationship between social deprivation
and child internalizing and externalizing symptoms. Nota-
bly, the authors cited the limitation that they did not con-
duct a formal mediation analysis; instead, they evaluated
mediation by examining how the relationships between
social deprivation, birth confounders, and youth inter-
nalizing and externalizing behaviors changed when adding
ACEs to their model. A study of US children between 6 and
17 years old showed that ACEs and school engagement
mediated the pathway between SES and attention deficit
hyperactivity disorder (Nguyen et al., 2019). While the data
used in this study were nationally representative, they were
also cross-sectional and could not provide strong support
for causal modeling.
Journal of Youth and Adolescence (2022) 51:2294–2311
Although ACEs are not explicitly addressed in the family
stress model (Conger et al., 2000; Conger and Conger,
2002), this framework informs the current study’s con-
ceptualization of their role as a mediator in the SES and
mental health relationship. According to this model, low
SES drives adverse child and youth psychopathology by
increasing stress among caregivers, which, in turn, com-
promises their caregiving behaviors and strains their rela-
tionships with other family members. Accordingly, it is
possible that such processes could increase the risk of
ACEs, including household dysfunction and child mal-
treatment. Additionally, because low SES exposes children
and families to deprivation, additional ACEs such as wit-
nessing community violence may also be driven by socio-
economic circumstances such as residential options. Taken
together, empirical evidence supports that low SES has an
inverse relationship with favorable child and youth mental
health outcomes, and declines in SES relate to higher levels
of ACEs, which are also associated with adverse child and
youth mental health outcomes. Therefore, ACEs may serve
as a mechanism by which SES influences child and ado-
lescent mental health. Importantly, because these relation-
ships unfold within the family context, it is critical to
consider how the family environment may further con-
tribute to their unique interplay.
The Potential Moderating Role of Conflictual Family
Environments
Family environments are critical social contexts that con-
tribute to child and adolescent mental health. These social
contexts encompass the day-to-day experiences and inter-
actions within the family. The affective nature of family
interactions is a critical facet of the family environment and
has been linked to youth mental health outcomes. Suppor-
tive family environments are associated with more favor-
able adolescent mood and quality of life (Fosco and Lydon‐
Staley, 2020). Conversely, family environments with high
levels of conflict are associated with poorer mental health
outcomes, including internalizing and externalizing symp-
toms (Cummings et al., 2014; Francisco et al., 2016; Tim-
mons and Margolin, 2015). In such contexts, children may
perceive their home environments as threatening and dis-
engage from family interactions (Luecken, Roubinov, &
Tanaka, 2013). Because conflictual family environments are
more likely to occur among economically strained families
(Chzhen et al., 2022), it is conceivable that such environ-
ments could further intensify relationships between SES,
ACEs, and child and youth mental health.
Although the family stress model suggests that family
processes and behaviors mediate pathways between SES
and child and youth mental health, the current study adds to
this model by considering that these processes unfold
2297
within the surrounding family environment. Supportive
family environments may attenuate the adverse direct and
indirect pathways between family economic strains and
child and youth psychopathology. In a study of primarily
African American children residing in an urban setting,
cohesive family environments protected children by
diminishing the relationship between neighborhood pov-
erty and child behavior problems (Plybon and Kliewer,
2001). Conversely, family environments with high levels of
conflict could exacerbate the effects between SES and child
and youth psychopathology by diminishing family sup-
portive psychological resources that might mitigate this
damaging pathway (e.g., emotional and social support
between family members).
By reducing opportunities for family members to draw
on one another for support, harsh family environments
may not be able to avert or mitigate the harmful effects of
economic strains. Accordingly, conflictual family envir-
onments may intensify relationships between SES and
ACEs by adding additional stressors. Further, low SES
increases the risks of exposure to deprivation, community
violence, and other social environmental threats (Council
on Community Pediatrics et al., 2016; Sackett, 2016); as
such, children and youth living in unsupportive or hostile
family environments may be especially vulnerable. When
conflict dominates the home social environment, family
members may become disengaged and not be well
informed of each other’s whereabouts or activities. Con-
sequently, opportunities to protect children and youth
from SES-related environmental risks may be reduced.
Children and youth may be less inclined to seek help or
guidance from their families if they view them as
uncompassionate or supportive.
Unsupportive family environments demarked by high
levels of family conflict could also worsen the effects
between ACEs and youth psychopathology. For instance,
one way by which ACEs are believed to affect youth mental
health is through altering the stress-response system
(Dempster et al., 2021). Consequently, conflictual family
environments could intensify the relationship between
ACEs and youth psychopathology by denying opportunities
to interrupt the negatively altered stress response incurred
by ACE exposure. For example, divorce/separation is one
of the most commonly reported ACEs (Crouch et al., 2019)
and can be psychologically distressing for children and
youth (Sands et al., 2017; Størksen et al., 2006; Weaver and
Schofield, 2015). If family environments are not sources of
support but rather sources of psychological strain, they
could potentially compound the effects between parental
divorce/separation and youth psychopathology. Conversely,
a recent study found that positive family environments,
characterized as having high levels of cohesion and flex-
ibility, are associated with better emotional well-being
2298
among youth after parental divorce (Finkelstein and Gre-
belsky-Lichtman, 2022).
Among the few studies examining relationships
between SES, ACEs, family environments, and youth
mental health, measures of family interactions have com-
monly focused on parent-child relationships rather than
collective family interactions (Anderson et al., 2022;
Persram et al., 2019). For example, one study examined
how harsh parenting and parental warmth, but not family
conflict or support, moderated direct relationships between
ACEs and youth internalizing and externalizing symptoms
(Anderson et al., 2022). By examining family environ-
mental aspects that capture whole-family interactions (i.e.,
polyadic interactions) instead of dyadic interactions (e.g.,
parent/caregiver-child interactions), more could be under-
stood about how family environments moderate relation-
ships between SES, ACEs, etc. and child and adolescent
mental health. While family conflict is not a holistic view
of the family environment, it provides a broad assessment
of the relationship climate within a family. Further, family
conflict may be a malleable feature of the family envir-
onment that could be targeted in interventions to promote
child and youth outcomes.
In addition to capturing the impact of polyadic interac-
tions, it is important to consider the unique perspectives of
youth and their parents/caregivers. Recent studies, for
example, document significant differences in reporting of
aggressive behaviors (Yang et al., 2021), as well as inter-
nalizing symptoms (Ford and McCoy, 2022) between par-
ents and adolescents. Such considerations can make a
valuable contribution to the limited research that examines
the occurrence of adolescent mental health problems by
reporter (e.g., between youth and parents).
Current Study
Relationships between SES and youth mental health out-
comes are complicated and can unfold through multiple
pathways. While prior studies have examined ACEs as a
possible mechanism connecting SES to youth psycho-
pathology, they did not investigate if the family environ-
ment conditioned these relationships. To address this gap,
this study aimed to disentangle the complex interplay
between SES and youth psychopathology by examining
mediated and moderated pathways with longitudinal data
that allowed temporal ordering of the variables. The current
study was informed by and builds on the family stress
model by investigating if direct and indirect pathways
between SES, ACEs, and youth mental health outcomes are
conditioned by conflictual family environments. To carry
out this aim, family economic status was tested as a direct
predictor of youth externalizing and internalizing symp-
toms. As family economic status declined, levels of
Journal of Youth and Adolescence (2022) 51:2294–2311
internalizing and externalizing symptoms were expected to
increase (Hypothesis 1). Next, adverse childhood experi-
ences were tested as a mediator between family economic
status and youth externalizing and internalizing symptoms
(Hypothesis 2). Lastly, conflictual family environments
were tested as a moderator with the expectation that family
conflict would intensify the magnitude of the direct and
indirect relationships between family economic status,
ACEs, and youth internalizing and externalizing symptoms
(Hypothesis 3). Models were tested separately based on
youth versus caregiver reports of ACEs, internalizing, and
externalizing symptoms. Accordingly, this study will offer
more insight into whether potential differences in reporting
of externalizing and internalizing symptoms emerge
between these reporters—and if they differ with respect to
whether the intersecting pathways between SES, ACEs,
and conflictual family environments influence symptoma-
tology. While the current study centered on the main
effects of these relationships, age, race/ethnicity, gender,
and family structure were included in all models, given
their known relationships with SES, ACEs, and child and
youth mental health.
Method
Design and Settings
Data were obtained from the Adolescent Brain Cognitive
Development (ABCD) Study®, a longitudinal investiga-
tion that follows over 11,000 children and their parents/
caregivers for ~10 years. The ABCD Study is a large-
scale study longitudinally tracking 9–10-years-olds
recruited from 21 research sites across the United States.
The ABCD study assesses neuroimaging, cognitive,
behavioral, social, academic, and environmental domains.
Youth participants and their parents complete a series of
assessments and questionnaires annually (for a full review
of the study design and protocols, see (Karcher and
Barch, 2021).
Participants and Sampling
The ABCD Study used stratified sampling of schools to
recruit participants, with the first wave resulting in 11,875
children between the ages of 9 and 10 years across sites.
Epidemiological approaches informed recruitment efforts to
reduce selection bias; however, the data are not repre-
sentative of all US youth. The current data release, ABCD
Data Release 3.0 (https://doi.org/10.15154/1519007)
includes 3 waves of data: baseline (N = 11,878; data col-
lected from 2016 to 2018), 1-year follow-up (N = 11,235;
data collected from 2017 to 2020), and 2-year follow-up
Journal of Youth and Adolescence (2022) 51:2294–2311 2299

Table 1 Sample description parent/caregiver on the Parent Demographics Survey (Barch

Baseline variables % SE et al., 2018). Models examined family economic status data
from the baseline assessment.
Gender (% female) 47.6 0.01
Race/Ethnicity Child and youth psychopathology
Asian 2.1 0.002
Black 10.3 0.004 To assess parent/caregiver reports of youth psychopathol-
Hispanic 17.6 0.005 ogy, the current study utilized the internalizing and exter-
Multiracial/Multiethnic 9.8 0.004 nalizing scale raw scores from the parent/caregiver-reported
White 60.2 0.007 Child Behavior Checklist (CBCL). The CBCL is a 118-item
Mean SD Range assessment for children aged 4–16 years old (Achenbach,
Age 9.97 0.62 9.00–10.92 2009). Items are rated on a scale of 0 (not true) to 2 (very
Family economic status 4.70 2.91 0.12–16.58 true or often true). CBCL scales shows excellent internal
1-Year Follow-Up Variables consistency (internalizing: 0.91, externalizing: 0.92) and
Family conflict criterion-related validity (Achenbach et al., 2012). The
Parent/Caregiver-Rated Family 2.40 1.90 0–9 CBCL is one of the most widely used dimensional assess-
Conflict ments of childhood psychopathology (Barch et al., 2018).
Youth-Rated Family Conflict 1.79 1.82 0–9 Youth-reported psychopathology was assessed at the
Adverse Childhood Events (ACE) 2-year follow-up using an abbreviated form of the Youth
Parent/Caregiver-Rated ACE 0.99 1.55 0–15 Self Report, the child-rated Brief Problem Monitor (BPM)
Youth-Rated ACE 2.32 2.21 0–17 (Achenbach et al., 2011). The BPM includes 19 items rated
2-Year Follow-Up Variables on a 0 (not true) to 2 (very true or often true) scale. Internal
Internalizing symptoms consistency of the BPM Internalizing (0.78) and Externa-
Parent/Caregiver-Rated 4.90 5.60 0–50 lizing (0.86) scales are satisfactory. BPM shows excellent
Internalizing correspondence with the CBCL, as well as convergent
Youth-Rated Internalizing 1.74 2.19 0–9 validity with mental health diagnoses (Piper et al., 2014).
Externalizing symptoms The CBCL and BPM asked raters to report on
Parent/Caregiver-Rated 3.83 5.40 0–46 current psychopathology (i.e., within the past 6 months).
Externalizing Models examined CBCL and BPM data from the 2-year
Youth-Rated Externalizing 2.04 1.99 0–9 follow-up.
% percent, SE standard error, SD standard deviation
ACEs

(N = 6571; data collected from 2018 to 2021). Complete
data were included in analyses (n = 5510, see Table 1 for
demographic characteristics; see Supplemental Table 1 for
comparison of included and missing data samples; see
Supplemental Figs. 1, 2 for analyses including missing data,
with results remaining consistent). These data were acces-
sed from the National Institutes of Mental Health Data
Archive (see Acknowledgments; see Supplement for study-
wide exclusion details).
Study Variables
SES
As a proxy for SES, family economic status was calculated
by dividing the parent/caregiver-reported total household
income by the FPL for a given household size at baseline
(Gonzalez et al., 2020). A higher value indicated higher
family economic status. The gross household income and
the number of individuals in the family were reported by the
The PhenX Adverse Life Events scale (Grant et al., 2004;
Tiet et al., 2001) measures ACEs separately completed by
youth and parents/caregivers in the ABCD Study. The
Adverse Life Events scale is a valid and reliable measure
widely used to examine ACEs (Grant et al., 2004; Tiet et al.,
2001). This computerized instrument includes 25 questions
about events over the past year that the youth experienced
and had little to no control over, such as the death of a
parent, witnessing a crime, or losing a friend (Grant et al.,
2004; Tiet et al., 2001). Following the endorsement of
ACEs, the reporter (i.e., the parent/caregiver or youth) is
asked whether this was a positive or negative event. For the
current study, ACEs were calculated as the summation of
items judged by the reporter as negative, similar to Tiet
et al. (2001) (i.e., parent/caregiver-reported ACEs were
used in parent/caregiver models and youth-reported ACEs
in youth models). In this study, the internal consistency
among youth raters was 0.62 and 0.58 for parent/caregiver
raters. This measure was obtained during the 1-year follow-
up visit in the ABCD study.
2300
Family conflict
The Family Conflict Scale (FCS), a subscale from the Moos
Family Environment Scale, is a summation of nine self-
report questions about conflicts in the home (Moos and
Moos, 1994). An example question is, “Family members
rarely become openly angry.” This scale was also derived
from PhenX and modified for the ABCD protocol (Zucker
et al., 2018). Items are rated with either 0 “False” or 1
“True” and scored so that a higher score suggests more
conflict within the family environment. Both the youth and
parent/caregiver separately completed the FCS. In this
study, internal consistency was 0.78 for youth reports and
0.66 for the parent/caregiver reports. Models examined FCS
data from 1-year follow-up.
Covariates
The current study included covariates linked to youth
psychopathology in prior studies (Peverill et al., 2021). All
analyses included gender (identifying as male or female),
age, and race/ethnicity (in ABCD, coded as a 5-level
variable: Asian, Black, Hispanic, Multiracial/Multiethnic,
White). Follow-up models examined whether results
remained consistent when including an index of family
structure (i.e., whether the parent/caregiver has a partner or
not). Models analyzed covariate data from the baseline
assessment.
Analytic Approach
Conditional process path analyses were employed to test
direct, indirect, moderated, and conditional process rela-
tionships between the predictor and outcome variables
(Hayes, 2017) (see Supplemental Table 2 for a correlation
table of all variables of interest). Path analyses offer a
flexible approach that simultaneously examines multiple
relationships between model variables instead of step-
wise approaches like regressions (Schumacker and
Lomax, 2010). Each path model examined the evidence
for the hypothesis that (a) ACEs indirectly link the
association between family economic status and both
internalizing and externalizing psychopathology, and that
(b) family conflict moderates this indirect link, with evi-
dence for these models being ascertained through sig-
nificant path coefficients (i.e., p values < 0.05; note the
index of moderated mediation was calculated as the dif-
ference in the indirect effect at one standard deviation
above the mean for family conflict minus the indirect
effect at one standard deviation below the mean for family
conflict). Because parents/caregivers and youth hold
unique perspectives contributing to their subjective
assessments of the variables examined in the current
Journal of Youth and Adolescence (2022) 51:2294–2311
study, models were conducted separately based on par-
ents/caregiver and youth reports.
For both parent/caregiver and youth reports, a series of
models using the lavaan package in R (Rosseel, 2012).
First, the researchers simultaneously fit two moderated
mediation analyses (see Fig. 1). The first examined the
evidence for parent/caregiver-rated ACEs at 1-year follow-
up, indirectly linking the association between baseline
family economic status with 2-year follow-up parent/care-
giver-rated internalizing symptoms. This model also
examined evidence of moderation, including whether par-
ent/caregiver-rated family conflict measured at 1-year fol-
low-up showed significant interactions with any of the
associations in the model (i.e., whether parent/caregiver-
rated family conflict moderated the link between family
economic status with ACEs, ACEs with parent/caregiver-
rated internalizing symptoms, or link between family eco-
nomic status with youth-rated internalizing symptoms). The
second model replicated the first, but with the outcome of
parent/caregiver-rated externalizing symptoms instead of
internalizing symptoms. The researchers also examined
these models using youth-rated ACEs, family conflict, and
symptoms (see Fig. 2). Sensitivity analyses were conducted
in a series of follow-up models to determine whether results
remained consistent when only including non-family-
related ACEs and whether any results were attributable to
the overlap in the constructs of ACEs, family economic
status, and family conflict. A model with a principle-
component analysis (PCA)-derived family environment
measure was examined for youth-rated models. For this
PCA-derived measure, family conflict, parental monitoring,
and parental acceptance were examined (note, parent/care-
giver-reported versions of these other family environment
measures were not administered; see Supplement for
information on these additional measures). The first com-
ponent was retained for this measure (each first component
explained >53% of the total variance).
Results
Overall, the models aimed to examine the extent to which
the association between family economic status at baseline
and parent/caregiver-rated youth psychopathology at 2-year
follow-up was indirectly linked through adverse childhood
events at 1-year follow-up. Further, the researchers exam-
ined whether this indirect effect was moderated by
increased levels of family conflict at 1-year follow-up. See
Table 1 for sample characteristics. Model fit indices for both
the internalizing and externalizing models provided evi-
dence of acceptable fit (Table 2). Model results are orga-
nized and described by the rater (e.g., Parent/Caregiver or
Youth) in the subsequent section.
Journal of Youth and Adolescence (2022) 51:2294–2311
Fig. 1 Parent/Caregiver-rated Model. This figure demonstrates results
for moderated mediation model simultaneously modeling parent/
caregiver-rated internalizing symptoms and parent/caregiver-rated
externalizing symptoms. This model examined evidence that the
indirect effect of family economic status on psychopathology through
adverse childhood events is conditional on family functioning, as
Parent/Caregiver-Reported Psychopathology
The parent/caregiver-reported internalizing symptoms
model at the 2-year follow-up was initially examined
(Fig. 1). As expected, lower family economic status was
associated with higher levels of ACEs, and ACEs were
positively associated with higher levels of internalizing
symptoms. Additionally, lower family economic status was
associated with increased internalizing symptoms. The data
also confirmed the mediation hypothesis such that the
indirect effect relationship between family economic status,
ACEs, and internalizing symptoms was statistically sig-
nificant (Table 3). Further, concerning moderation, family
economic status interacted with family conflict to predict
ACEs, such that the association between family economic
status and ACEs was stronger at higher levels of conflict.
Additionally, family economic status also interacted with
family conflict to predict youth internalizing symptoms,
such that the association between family economic status
and internalizing symptoms was stronger at higher levels of
conflict (unexpectedly, there was no substantial evidence to
support that family conflict moderated the association
2301
measured by family conflict. Results are depicted as standardized
regression coefficients. Indirect effects are reported with bootstrapped
95% accelerated bias-corrected confidence intervals. b = standardized
regression coefficient. All covariates included in the model were
measured at baseline
between ACEs and internalizing symptoms, p = 0.45).
Finally, there was evidence for moderated mediation,
whereby the indirect effect of ACEs between family eco-
nomic status to internalizing symptoms was stronger at
higher levels of conflict (b = 0.043, 95% CI = 0.025, 0.060,
p < 0.001).
Next, in terms of the associations when examining par-
ent/caregiver-reported externalizing symptoms, the asso-
ciations were consistent with those found when examining
internalizing symptoms (Fig. 1). As hypothesized, lower
family economic status was associated with increased youth
externalizing symptoms. Additionally, lower family eco-
nomic status was associated with higher levels of ACEs,
and higher levels of ACEs were associated with higher
externalizing symptoms. Indirect effects between family
economic status, ACEs, and externalizing symptoms were
statistically significant as expected (Table 3). Consistent
with the hypothesis, there was also evidence of moderation.
Family economic status interacted with family conflict to
predict ACEs, such that the association between family
economic status and ACE was stronger at higher levels of
conflict. Family economic status also interacted with family
2302
Fig. 2 Youth-rated Model. This figure demonstrates results for mod-
erated mediation models simultaneously modeling youth-rated inter-
nalizing symptoms and youth-rated externalizing symptoms. This
model examined evidence that the indirect effect of family economic
status on psychopathology through adverse childhood events is
conflict to predict youth externalizing symptoms. The
association between family economic status and externa-
lizing symptoms was stronger at higher levels of conflict.
Contrary to the hypothesis, there was no evidence for family
conflict moderating the association between ACE and
externalizing symptoms (p = 0.79). However, there was
evidence for moderated mediation, such that the indirect
effect of ACEs between family economic status to exter-
nalizing symptoms was stronger at higher levels of conflict
(b = 0.036, 95% CI = 0.018, 0.054, p < 0.001). Importantly,
these results remained consistent with including family
structure (i.e., single, married; Supplemental Fig. 3) or
including only ACEs that were not related to the familial
environment (e.g., excluding family-specific ACEs) in the
models (Supplemental Fig. 4).
Youth-Reported Psychopathology
The youth-reported internalizing symptoms model at
2-year follow-up was subsequently examined (Fig. 2).
Lower family economic status was directly associated with
higher levels of ACEs. Further, higher levels of ACEs
were associated with increased internalizing symptoms, as
Journal of Youth and Adolescence (2022) 51:2294–2311
conditional on family functioning, as measured by family conflict.
Results are depicted as standardized regression coefficients. Indirect
effects are reported with bootstrapped 95% accelerated bias-corrected
confidence intervals. b = standardized regression coefficient. All
covariates included in the model were measured at baseline
expected. However, unexpectedly, lower family economic
status was not strongly associated with higher levels of
internalizing symptoms. Concerning indirect effects (Table
3), the relationship between family economic status,
ACEs, and internalizing symptoms was statistically sig-
nificant. There was evidence of moderation, with family
economic status interacting with family conflict to predict
ACEs. This interaction showed that the association
between family economic status and ACEs was stronger at
higher levels of conflict (as with parent/caregiver-rated
symptoms, there was no strong evidence that family con-
flict moderated associations between ACEs and inter-
nalizing symptoms, p = 0.06). However, unlike
observations with parent/caregiver-rated model, there was
no strong evidence that family conflict moderated the
association between family economic status and inter-
nalizing symptoms (p = 0.55). Finally, there was evidence
for moderated mediation, such that the indirect link of
ACEs between family economic status to internalizing
symptoms was stronger at higher levels of conflict
(b = 0.018, 95% CI = 0.005, 0.031, p = 0.005).
Next, in terms of the associations when examining
youth-reported externalizing symptoms, the associations
Journal of Youth and Adolescence (2022) 51:2294–2311 2303

were similar to those found when examining internalizing associated with increased youth externalizing symptoms.
symptoms (Fig. 2). As with internalizing symptoms, lower Concerning indirect effects, the relationship between family
family economic status was associated with higher levels of economic status, ACEs, and externalizing symptoms was
ACEs, and higher levels of ACEs were associated with statistically significant (Table 3). Again, consistent with the
higher externalizing symptoms. Unlike youth-reported hypothesis, there was evidence of moderation. Family
internalizing symptoms, lower family economic status was economic status interacted with family conflict to predict
ACEs, with the association between family economic status
and ACEs being stronger at higher levels of conflict. As
Table 2 Model fit indices
with youth-reported internalizing symptoms, there was no
Model Fit index Estimate strong evidence of family conflict moderating associations
Parent/Caregiver- between ACEs and externalizing symptoms (p = 0.42), nor
reported model was there strong evidence that family conflict moderated the
χ2df χ21 = 28.342** association between family economic status with externa-
RMSEA (CI) 0.074 lizing symptoms (p = 0.58). Although numerically, the
(0.067–0.081) indirect effect of ACEs between family economic status and
CFI 0.983 externalizing symptoms was stronger at higher levels of
TLI 0.900 conflict, this moderated mediation effect was not statisti-
SRMR 0.031 cally significant (b = 0.009, 95% CI = −0.003, 0.022,
R2 for Internalizing 0.088 p = 0.16).
Symptoms Importantly, models remained consistent when including
R2 for ACEs 0.073 family structure (i.e., single, married; Supplemental Fig. 5).
R2 for Externalizing 0.132 However, for youth-reported models that included either (a)
Symptoms only ACEs that were related to the non-familial environment
Youth-reported model (e.g., excluding family-specific ACEs; Supplemental Fig. 6)
χ2df χ21 = 60.423** or (b) a PCA-derived family environment score that included
RMSEA (CI) 0.104 other indices of family environment (e.g., parental monitor-
(0.091–0.117) ing, parental acceptance; Supplemental Fig. 7), while the
CFI 0.967 major of results replicated, family economic status no longer
TLI 0.925 strongly interacted with family conflict to predict ACEs.
SRMR 0.024
R2 for Internalizing 0.088
Symptoms
Discussion
R2 for ACEs 0.082
R2 for Externalizing 0.141 SES can influence youth psychopathology in multiple ways.
Symptoms
While prior studies have investigated the role of ACEs as a
**p < 0.001 mechanism by which SES affects mental health, less is

Table 3 Indirect effect estimates

Indirect effect b Lower 95% CI Upper 95% CI t p

Parent/Caregiver models
Overall −0.054 −0.07 −0.039 −6.81 <0.001
Conditional
1 SD Below −0.012 −0.022 −0.003 −2.472 0.01
Average −0.035 −0.045 −0.025 −7.175 <0.001
1 SD Above −0.055 −0.07 −0.039 −6.79 <0.001
Youth Models
Overall −0.045 −0.062 −0.029 −5.441 <0.001
Conditional
1 SD Below −0.009 −0.017 −0.002 −2.391 0.02
Average −0.028 −0.036 −0.02 −6.563 <0.001
1 SD Above −0.045 −0.062 −0.029 −5.421 <0.001
b standardized beta, CI confidence interval, t t-statistic, p p value
2304
understood about how family environments might further
contribute to the complex interplay between SES, ACEs,
and youth psychopathology within the family context. To
address this gap, the current study tested direct and indirect
relationships between SES, ACEs, and youth psycho-
pathology and if family conflict moderated (i.e., intensified)
these relationships. To examine whether results generalize
across reporters, potential differences in parent/caregiver
and youth perceptions of internalizing symptoms were
accounted for by running separate models based on the rater
of the dependent variable (i.e., youth-rated versus parent/
caregiver-rated internalizing and externalizing symptoms).
Results support that mediated and moderated pathways
varied by outcome and reporter.
Family Economic Status, ACEs, and Internalizing
Behaviors
The study’s first hypothesis was supported by the caregiver-
rated model such that lower levels of family economic
status predicted higher levels of youth internalizing symp-
toms. Conversely, the youth-rated model did not support
this relationship. In this study, the parent/caregiver pro-
vided data on family economic status in the youth-reported
and parent/caregiver models. Thus, it is possible that this
finding may be due to the same reporter (i.e., the parent/
caregiver) providing data on family economic status and
internalizing symptoms, thereby resulting in stronger
associations between these constructs.
Consistent with prior research (Lacey & Minnis, 2020;
Walsh et al., 2019), lower levels of family economic status
were significantly predictive of higher levels of ACEs, and
higher levels of ACEs were predictive of internalizing
behaviors for both youth- and parent/caregiver-rated
models. Because low SES can expose families to depri-
vation, it may be that as family economic status declines,
conditions that foster ACEs may intensify. As suggested
by the family stress model, when parents/caretakers are
overwhelmed by the stress resulting from economic strain,
they may be unable to provide their children with ade-
quate emotional, social, and material support, resulting in
neglect. Consequently, some youth may react to these
conditions by developing internalizing behaviors (Stange
et al., 2014).
Results supported the second hypothesis by demon-
strating evidence of significant indirect effects, with ACEs
accounting for a portion of the relationship between family
socioeconomic status and internalizing symptoms for both
the parent/caregiver and youth reported models. Accord-
ingly, this finding suggests that when lower SES exposes
families to economic hardships, effects can cascade through
families via ACEs to affect youth outcomes. For instance,
economically strained parents/caregivers may have an
Journal of Youth and Adolescence (2022) 51:2294–2311
increased risk of engaging in harmful caretaking behaviors
such as harsh parenting (Choi et al., 2019) and a higher risk
of child maltreatment (Conrad-Hiebner and Byram, 2020).
Consequently, low SES may produce conditions where
ACEs are more likely to occur, leading to youth inter-
nalizing symptoms.
Family Economic Status, ACEs, Internalizing
Behavior, and Family Conflict
Family conflict strengthened the relationship between
family economic status and youth internalizing symptoms
only in the parent/caregiver-rated model. Conversely, the
relationship between family economic status and ACEs
interacted with family conflict for both the parent/caregiver-
and youth-rated models. These interactions were char-
acterized by the associations between lower levels of family
economic status with increased levels of ACEs being
strengthened by higher levels of family conflict. It is
important to note that in the parent/caregiver-rated model,
the conditional effect of family conflict remained consistent
when examining only non-familial ACEs (e.g., witnessing a
crime, losing a friend). Family environments with high
levels of conflict can add an additional layer of stress for
children and youth (Francisco et al., 2016). In turn, these
taxing conditions could amplify the effects that youth were
already enduring from their family’s economic circum-
stances and ACE exposure. Further, these youth may not
receive the buffering effects that supportive family envir-
onments can offer (Plybon and Kliewer, 2001). Thus, they
may not be obtaining family-based relief to assuage the
impacts of lower SES.
The hypothesis that family conflict would intensify the
direct relationship between ACEs and youth internalizing
behaviors was not supported in the parent/caregiver- or
youth-rated models. Since internalizing symptoms include
withdrawing from social interactions or disengaging from
family interactions when conflict escalates (Luecken,
Roubinov, & Tanaka, 2013), youth might be inclined to
avert the additive harmful effects resulting from their dis-
cordant family environments. Further, it may be that while
family conflict does not moderate the effect between ACEs
and youth internalizing behaviors, other family environ-
mental features that were not captured in the current study
may magnify or assuage the relationship between ACEs
and youth internalizing behaviors. For instance, the present
study examined family conflict from a polyadic perspective
of multiple family relationships. Family environment
effects on relationships between SES and youth inter-
nalizing behaviors may be more nuanced with specific
family member interactions, such as parent/caregiver-child
relationships, sibling-sibling relationships, or other rela-
tionship constellations.
Journal of Youth and Adolescence (2022) 51:2294–2311
Lastly, the mediated relationship between family eco-
nomic status, ACEs, and internalizing behaviors was mod-
erated by family conflict for the youth- and parent/
caregiver-rated models. Accordingly, this finding suggests
that when levels of family conflict increase, ACE’s indirect
effects between family economic status and youth inter-
nalizing symptoms are strengthened. This finding highlights
how conflictual family environments can further aggravate
the mediated effects that unfold between family economic
status, ACEs, and youth internalizing symptoms.
Family Economic Status, ACEs, and Externalizing
Behavior
Family economic status directly predicted externalizing
symptoms in both the youth- and parent/caregiver-rated
models. Additionally, the path coefficients appeared larger
for externalizing symptoms than internalizing symptoms,
which is consistent with the findings from a recent meta-
analysis study that reported SES associations were stron-
ger with externalizing symptoms than internalizing
(Peverill et al., 2021). Additionally, lower levels of family
economic status predicted higher levels of ACEs. Because
low SES can expose families to material deprivation and
poor community conditions (Johnson et al., 2016), it may
drive the conditions that lead to ACEs and youth exter-
nalizing problems.
The current study’s results provided evidence for sig-
nificant indirect effects supporting the second hypothesis.
ACEs accounted for a portion of the relationship between
family economic status and youth externalizing symptoms.
It may be that lower SES increases the risk of exposure to
ACEs, and youth subsequently respond with increased
externalizing symptomology. Declining levels of SES can
put children at risk for ACEs such as child maltreatment
which is linked with externalizing symptoms in children
(Wiggins et al., 2015). Additionally, lower SES may limit
families to residing in communities with higher levels of
social disorganization, consequently increasing their risk for
ACEs, such as witnessing community crime and violence.
A study examining community violence and trajectories of
psychopathology among urban adolescents found that they
were more likely to develop externalizing symptoms than
internalizing symptoms (Taylor et al., 2018).
Family Economic Status, ACEs and Externalizing
Behavior and Family Conflict
Similar to the pattern observed in the internalizing models,
the significant conditional effects of family conflict on the
relationship between family economic status and externa-
lizing symptoms were only supported in the parent/care-
giver-rated model. While it can only be speculated, these
2305
findings may suggest that parents/caregivers may be more
likely than youth to detect the impact of prolonged stress on
family dynamics and externalizing symptoms or observe
how dysfunctional family dynamics exacerbate the rela-
tionship between financial stress and externalizing symp-
toms (de Maat et al., 2021; Mackler et al., 2015). Other
studies have also reported discrepancies in youth psycho-
pathology by reporter, further underscoring the complexity.
A cross-sectional analysis of the ABCD data revealed dis-
crepancies in the parent versus adolescent reporting of
anhedonia and depressed mood (Ford and McCoy, 2022). In
another recent study, Yang et al. (2021) reported that while
parents reported more aggressive behaviors when their
children were younger (11.5 years), trends reversed by the
time they reached 15 years of age. These findings, coupled
with our discrepant reporting of the impact of conflictual
family environments, urge future scholars to rely upon
qualitative inquiry to understand why, in some cases,
caregivers differed from adolescents regarding the effects of
conflictual family environments.
As hypothesized, for both parent/caregiver-rated and
youth-rated models, higher levels of family conflict
strengthened relationships between lower levels of family
economic status and higher levels of ACEs, consistent with
the internalizing model. It may be that, in the context of
family environments demarked by higher levels of conflict,
associations between SES and trauma are magnified
because of weakened family support that might have
otherwise mitigated SES risks for ACEs. Further, negative
or aggressive family communication patterns entailed by
conflictual family environments may strengthen the asso-
ciation between family economic status and ACEs by
contributing additional stress, which then compounds the
SES effect on ACEs. Contrary to the study’s hypothesis,
family conflict did not moderate the relationship between
ACEs and externalizing symptoms in either the youth- or
parent/caregiver-rated models. It is possible that family
conflict does not serve as a moderator in this relationship.
Instead, family conflict may function as a mechanism
between ACEs and internalizing behaviors. Future research
should investigate this competing hypothesis.
Limitations
The current study’s findings should be interpreted with the
following limitations. First, as with all secondary data
analyses, the original study from which the data originates
was not designed to address the hypotheses proposed in the
current study; however, the variables examined provided
quality proxies. The data available in the present study
limited the assessment of family environments to only
negative attributes; thus, positive characteristics of family
environments (e.g., cohesion) could not be examined.
2306
Additionally, the present study did not control for baseline
ACEs or psychopathology. Including baseline ACEs and
mental health is an important way to determine whether
changes from baseline are associated with these other
factors (e.g., income). However, in the current paper, the
authors were not exclusively interested in examining
changes in these variables. Future work should examine
more causal models and longitudinal changes in these
variables. Lastly, the measure of family economic status
used in this study may not capture the full extent of each
family’s financial conditions as it was centered on
income-to-needs.
Despite these limitations, the current study contributes to
the literature in multiple ways. First, family environments
encompass dynamic interactions and relationships between
family members. However, research in this arena has tra-
ditionally focused on assessments of dyadic relationships
(e.g., parent/caregiver-child, caregiver-caregiver) and less
on polyadic dynamics (Anderson et al., 2022; Persram et al.,
2019). The measure of conflictual family environments in
this study captured the perceptions of polyadic dynamics
because of its focus on whole family interactions. Second,
to the best of the researchers’ knowledge, prior research
examining the interplay between family economic status,
ACEs, and adolescent mental health has not examined the
potential moderating effect of family conflict. While con-
flictual environments did not moderate all of the hypothe-
sized specific pathways proposed in this study, it supports
the work for future studies to test competing theories that
would examine if conflictual family environments might
mediate those pathways. Additionally, one of the common
limitations in studies of SES and mental health relationships
is the reliance on cross-sectional data (Devenish et al.,
2017); the current study used longitudinal data to support
potential causal relationships. Lastly, the present study
uniquely adds to the study of direct, indirect, and moderated
relationships between SES and child and youth mental
health outcomes by testing separate but identical models
based on parent/caregiver and youth reports of ACEs,
internalizing and externalizing symptoms, and family con-
flict. In doing so, results from the present study justify
expanding the family stress model to account for the fact
that (a) ACEs may indirectly influence the relationship
between SES and youth psychopathology, and (b) con-
flictual family environments may play a moderating role in
this indirect association, as well as strengthening associa-
tions between SES and youth psychopathology.
The current study offers several insights for future
directions in research and practice. First, more research is
warranted to examine how positive or appreciative family
environment indicators might condition relationships
between SES, ACEs, and youth mental health differently.
Second, because the present study did not include poverty
Journal of Youth and Adolescence (2022) 51:2294–2311
as an ACE, findings may elucidate the unique effects of
family economic status within the interplay of ACEs, youth
psychopathology, and conflictual family environments.
Results from this study supported that ACEs may partially
explain the linkage between lower SES and early adolescent
psychopathology. To that end, future efforts should be
devoted to implementing empirically supported interven-
tions designed to reduce ACEs, especially among families
who endure economic hardships. Third, given that some of
relationships examined in the present study varied by
reporter (i.e., youth and parent/caregiver), future research
should examine how the unique perspectives of parents/
caregivers, children, and youth could further contribute to
understanding the complex interplay between SES and
youth mental health outcomes. Qualitative studies may be
better suited to examine how and under what conditions
these perspectives uniquely shape the meanings of such
variables. Additionally, while gender, race/ethnicity, and
family structure were included in the study’s model as
covariates, future studies should investigate their role in the
relationships between SES, ACEs, and youth psycho-
pathology, given that these features may have intersectional
relationships with mental health and well-being. Lastly,
family economic status was measured in this study to cap-
ture income-to-needs; future research should consider
examining additional dimensions of SES, including struc-
tural variables (e.g., neighborhood economic conditions).
Conclusion
Pathways between SES and youth mental health outcomes
are complex. Although a paucity of studies cite ACEs as a
potential mechanism by which SES influences youth mental
health outcomes, longitudinal research investigating these
relationships within the context of family environmental
conditions was lacking. The present study sought to address
this gap by investigating if ACEs mediated the relationship
between family SES and early adolescent internalizing and
externalizing symptoms and if conflictual family environ-
ments moderated these relationships. Additionally, these
relationships were examined by using separate models based
on parent/caregiver and youth reports of ACEs, internalizing
and externalizing symptoms, and family environment. As
expected, ACEs mediated the relationship between family
economic status and youth internalizing and externalizing
symptoms for both youth- and parent/caregiver-rated mod-
els. Further, results provided some evidence that conflictual
family environments moderated the overall model’s indirect
effects. Specifically, the mediating effect of ACEs on the
relationship between family SES and youth internalizing and
externalizing symptoms were exacerbated during higher
levels of family conflict. Given that conflictual environments
Journal of Youth and Adolescence (2022) 51:2294–2311
can intensify the effects of economic strain on ACEs, it is
recommended that trauma-informed interventions focus on
mitigating subjective strains and bolstering familial support
and networks. Lastly, some differences in specific individual
moderated pathways based on parent/caregiver versus youth
reports were observed, highlighting the need for more
research that illuminates the voices of diverse reporters.
Irrespective of differences, findings from the present study
support the need for clinicians to gather input from multiple
reporters to fully understand how each family member per-
ceives the impact of ACEs, economic strain, and conflict.
These efforts may play a key role in enhancing familial
strengths and resiliency and in turn, impart positive mental
health outcomes in early adolescence.
Acknowledgements The ABCD Study is supported by the National
Institutes of Health and additional federal partners under award
numbers U01DA041022, U01DA041028, U01DA041048, U01DA04
1089, U01DA041106, U01DA041117, U01DA041120, U01DA04113
4, U01DA041148, U01DA041156, U01DA041174, U24DA041123,
U24DA041147, U01DA041093, and U01DA041025. A full list of sup
porters is available at https://abcdstudy.org/federal-partners.html. A
listing of participating sites and a complete listing of the study
investigators can be found at https://abcdstudy.org/Consortium_
Members.pdf. ABCD consortium investigators designed and imple-
mented the study and/or provided data but did not necessarily parti-
cipate in analysis or writing of this report. This paper reflects the views
of the authors and may not reflect the opinions or views of the NIH or
ABCD consortium investigators. The ABCD data repository grows
and changes over time. The ABCD data used in this report came from
https://doi.org/10.15154/1519007.
Authors’ Contributions S.B. led the conceptualization of the study,
directed efforts in its design and coordination, interpretation of the
data, and drafted the paper and paper revisions; A.G. participated in
the design, assisted in interpretation of the data, and assisted in drafting
the paper and paper revisions; N.K. participated in the design, per-
formed the statistical analysis, assisted in interpretation of the data, and
helped to draft the paper and paper revisions. All authors read and
approved the final paper.
Funding This work was supported by National Institute of Mental
Health (K23MH121792-01 to N.R.K.).
Data Sharing and Declaration Data used in the preparation of this
article were obtained from the Adolescent Brain Cognitive Develop-
ment (ABCD) Study (https://abcdstudy.org), held in the NIMH Data
Archive (NDA). This is a multisite, longitudinal study designed to
recruit more than 10,000 children age 9–10 and follow them over
10 years into early adulthood. The ABCD data used in this report came
from https://doi.org/10.15154/1519007.
Compliance with Ethical Standards
Conflict of Interest The authors declare no competing interests.
Ethical Approval All procedures were approved by the IRB for each of
the ABCD sites. All procedures comply with the ethical standards of the
relevant national and institutional committees on human experimenta-
tion and with the Helsinki Declaration of 1975, as revised in 2008.
2307
Informed Consent Parents provided written informed consent and all
children provided assent.
References
Achenbach, T. M. (2009). The Achenbach system of empirically based
assessment (ASEBA): Development, findings, theory, and appli-
cations. Burlington, VT: University of Vermont Research Center
for Children, Youth and Families.
Achenbach, T. M., McConaughy, S. H. Ivanova, M. Y., & Rescorla, L.
A. (2011). Manual for the ASEBA brief problem monitor (BPM).
Burlington, VT: ASEBA, 33.
Achenbach, T. M., Rescorla, L. A., & Ivanova, M. Y. (2012). Inter-
national Epidemiology of Child and Adolescent Psychopathology
I: diagnoses, Dimensions, and Conceptual Issues. Journal of the
American Academy of Child and Adolescent Psychiatry, 51(12),
1261–1272. https://doi.org/10.1016/j.jaac.2012.09.010.
Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C.,
Perry, B. D., Dube, S. R., & Giles, W. H. (2006). The enduring
effects of abuse and related adverse experiences in childhood: A
convergence of evidence from neurobiology and epidemiology.
European Archives of Psychiatry and Clinical Neuroscience,
256(3), 174–186. https://doi.org/10.1007/s00406-005-0624-4.
Anderson, A. S., Siciliano, R. E., Henry, L. M., Watson, K. H., Gruhn,
M. A., Kuhn, T. M., Ebert, J., Vreeland, A. J., Ciriegio, A. E.,
Guthrie, C., & Compas, B. E. (2022). Adverse childhood
experiences, parenting, and socioeconomic status: associations
with internalizing and externalizing symptoms in adolescence.
Child Abuse & Neglect, 125, 105493. https://doi.org/10.1016/j.
chiabu.2022.105493.
Annie E. Casey Foundation. (2020). Children in poverty by race and
ethnicity in the United States. Annie E. Casey Foundation. https://
datacenter.kidscount.org/data/tables/44-children-in-poverty-by-ra
ce-and-ethnicity#detailed/1/any/false/1729,37,871,870,573,869,
36,868,867,133/10,11,9,12,1,185,13/324,323.
Barch, D. M., Albaugh, M. D., Avenevoli, S., Chang, L., Clark, D. B.,
Glantz, M. D., Hudziak, J. J., Jernigan, T. L., Tapert, S. F.,
Yurgelun-Todd, D., Alia-Klein, N., Potter, A. S., Paulus, M. P.,
Prouty, D., Zucker, R. A., & Sher, K. J. (2018). Demographic,
physical and mental health assessments in the adolescent brain
and cognitive development study: Rationale and description.
Developmental Cognitive Neuroscience, 32, 55–66. https://doi.
org/10.1016/j.dcn.2017.10.010.
Barth, R. P., Berrick, J. D., Garcia, A. R., Drake, B., Jonson-Reid, M.,
Gyourko, J. R., & Greeson, J. K. P. (2021). Research to Consider
While Effectively Re-Designing Child Welfare Services.
Research on Social Work Practice, 10497315211050000. https://
doi.org/10.1177/10497315211050000.
Bevilacqua, L., Kelly, Y., Heilmann, A., Priest, N., & Lacey, R. E.
(2021). Adverse childhood experiences and trajectories of inter-
nalizing, externalizing, and prosocial behaviors from childhood to
adolescence. Child Abuse & Neglect, 112, 104890. https://doi.
org/10.1016/j.chiabu.2020.104890.
Bitsko, R. H., Claussen, A. H., Lichstein, J., Black, L. I., Jones, S. E.,
Danielson, M. L., Hoenig, J. M., Davis Jack, S. P., Brody, D. J.,
Gyawali, S., Maenner, M. J., Warner, M., Holland, K. M., Perou,
R., Crosby, A. E., Blumberg, S. J., Avenevoli, S., Kaminski, J.
W., & Ghandour, R. M., Contributor. (2022). Mental Health
Surveillance Among Children—United States, 2013-2019.
MMWR Supplements, 71(2), 1–42. https://doi.org/10.15585/
mmwr.su7102a1.
Bomysoad, R. N., & Francis, L. A. (2020). Adverse Childhood
Experiences and Mental Health Conditions Among Adolescents.
Journal of Adolescent Health, 67(6), 868–870. https://doi.org/10.
1016/j.jadohealth.2020.04.013.
2308
Braveman, P., Heck, K., Egerter, S., Rinki, C., Marchi, K., & Curtis,
M. (2017). Economic Hardship in Childhood: A Neglected Issue
in ACE Studies. Maternal and Child Health Journal, 22(3),
308–317. https://doi.org/10.1007/s10995-017-2368-y.
Choi, J.-K., Wang, D., & Jackson, A. P. (2019). Adverse experi-
ences in early childhood and their longitudinal impact on later
behavioral problems of children living in poverty. Child Abuse
& Neglect, 98, 104181. https://doi.org/10.1016/j.chiabu.2019.
104181.
Chzhen, Y., Howarth, C., & Main, G. (2022). Deprivation and intra-
family conflict: children as agents in the Family Stress Model.
Journal of Marriage and Family, 84(1), 121–140. https://doi.org/
10.1111/jomf.12791.
Conger, K. J., Rueter, M. A., & Conger, R. D. (2000). The role of
economic pressure in the lives of parents and their adolescents:
The Family Stress Model. In L. Crockett & R. Silbereisen (Eds),
Negotiating adolescence in times of social change. (pp.
201–223). Cambridge University Press. https://doi.org/10.1017/
CBO9780511600906.014.
Conger, R. D., & Conger, K. J. (2002). Resilience in Midwestern
Families: Selected Findings from the First Decade of a Pro-
spective, Longitudinal Study. Journal of Marriage and
Family, 64(2), 361–373. https://doi.org/10.1111/j.1741-3737.
2002.00361.x.
Conrad-Hiebner, A., & Byram, E. (2020). The temporal impact of
economic insecurity on child maltreatment: a systematic review.
Trauma, Violence, & Abuse, 21(1), 157–178. https://doi.org/10.
1177/1524838018756122.
Gitterman, B. A., Flanagan, P. J., Cotton, W. H., Dilley, K. J.,
Duffee, J. H., Green, A. E., Keane, V. A., Krugman, S. D.,
Linton, J. M., McKelvey, C. D., & Nelson, J. L., Council on
Community Pediatrics. (2016). Poverty and Child Health in the
United States. Pediatrics, 137(4), e20160339. https://doi.org/10.
1542/peds.2016-0339.
Crouch, E., Probst, J. C., Radcliff, E., Bennett, K. J., & McKinney, S.
H. (2019). Prevalence of adverse childhood experiences (ACEs)
among US children. Child Abuse & Neglect, 92, 209–218. https://
doi.org/10.1016/j.chiabu.2019.04.010.
Cummings, E. M., Koss, K. J., & Davies, P. T. (2014). Prospective
relations between family conflict and adolescent maladjustment:
security in the family system as a mediating process. Journal of
Abnormal Child Psychology, 43(3), 503–515. https://doi.org/10.
1007/s10802-014-9926-1.
Daly, M. C., Duncan, G. J., McDonough, P., & Williams, D. R.
(2002). Optimal indicators of socioeconomic status for health
research. American Journal of Public Health, 92(7), 1151–1157.
https://doi.org/10.2105/ajph.92.7.1151.
de Girolamo, G., Dagani, J., Purcell, R., Cocchi, A., & McGorry, P. D.
(2012). Age of onset of mental disorders and use of mental health
services: needs, opportunities and obstacles. Epidemiology and
Psychiatric Sciences, 21(1), 47–57. https://doi.org/10.1017/
S2045796011000746.
de Maat, D. A., Jansen, P. W., Prinzie, P., Keizer, R., Franken, I. H.
A., & Lucassen, N. (2021). Examining Longitudinal Relations
Between Mothers’ and Fathers’ Parenting Stress, Parenting
Behaviors, and Adolescents’ Behavior Problems. Journal of
Child and Family Studies, 30(3), 771–783. https://doi.org/10.
1007/s10826-020-01885-0.
Dempster, K. S., O’Leary, D. D., MacNeil, A. J., Hodges, G. J., &
Wade, T. J. (2021). Linking the hemodynamic consequences of
adverse childhood experiences to an altered HPA axis and acute
stress response. Brain, Behavior, and Immunity, 93, 254–263.
https://doi.org/10.1016/j.bbi.2020.12.018.
Devenish, B., Hooley, M., & Mellor, D. (2017). The Pathways
Between Socioeconomic Status and Adolescent Outcomes: a
systematic review. American Journal of Community Psychology,
Journal of Youth and Adolescence (2022) 51:2294–2311
59(1/2), 219-221,223-224,230-238. https://doi.org/10.1002/ajcp.
12115. SciTech Premium Collection; Social Science Premium
Collection.
Duncan, G. J., Magnuson, K., & Votruba-Drzal, E. (2017). Moving
Beyond Correlations in Assessing the Consequences of Poverty.
Annual Review of Psychology, 68(1), 413–434. https://doi.org/10.
1146/annurev-psych-010416-044224.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz,
A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Rela-
tionship of Childhood Abuse and Household Dysfunction to
Many of the Leading Causes of Death in Adults: the Adverse
Childhood Experiences (ACE) Study. American Journal of
Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/
S0749-3797(98)00017-8.
Finkelhor, D. (2020). Trends in Adverse Childhood Experiences
(ACEs) in the United States. Child Abuse & Neglect, 108,
104641. https://doi.org/10.1016/j.chiabu.2020.104641.
Finkelstein, I., & Grebelsky-Lichtman, T. (2022). Adolescents in
Divorced Families: the Interplay of Attachment Patterns, Family
Environment, and Personal Characteristics. Journal of Divorce &
Remarriage, 63(2), 120–149. https://doi.org/10.1080/10502556.
2021.1993017.
Flaskerud, J. H., & DeLilly, C. R. (2012). Social determinants of
health status. Issues in Mental Health Nursing, 33(7), 494–497.
https://doi.org/10.3109/01612840.2012.662581.
Ford, S. H., & McCoy, T. P. (2022). Minding the Gap: Adolescent and
Parent/Caregiver Reporter Discrepancies on Symptom Presence,
Impact of Covariates, and Clinical Implications. Journal of
Pediatric Health Care, 36(3), 225–230. https://doi.org/10.1016/j.
pedhc.2021.09.010.
Fosco, G. M., & Lydon‐Staley, D. M. (2020). Implications of Family
Cohesion and Conflict for Adolescent Mood and Well‐Being:
examining Within‐ and Between‐Family Processes on a Daily
Timescale. Family Process, 59(4), 1672–1689. https://doi.org/10.
1111/famp.12515.
Francisco, R., Loios, S., & Pedro, M. (2016). Family Functioning and
Adolescent Psychological Maladjustment: the Mediating Role of
Coping Strategies. Child Psychiatry & Human Development,
47(5), 759–770. Psychology and Behavioral Sciences Collection.
Ghandour, R. M., Sherman, L. J., Vladutiu, C. J., Ali, M. M., Lynch,
S. E., Bitsko, R. H., & Blumberg, S. J. (2019). Prevalence and
Treatment of Depression, Anxiety, and Conduct Problems in US
Children. The Journal of Pediatrics, 206, 256–267.e3. https://doi.
org/10.1016/j.jpeds.2018.09.021.
Gonzalez, M. R., Palmer, C. E., Uban, K. A., Jernigan, T. L.,
Thompson, W. K., & Sowell, E. R. (2020). Positive Economic,
Psychosocial, and Physiological Ecologies Predict Brain Struc-
ture and Cognitive Performance in 9–10-Year-Old Children.
Frontiers in Human Neuroscience, 14. https://www.frontiersin.
org/article/10.3389/fnhum.2020.578822.
Grant, K. E., Compas, B. E., Thurm, A. E., McMahon, S. D., &
Gipson, P. Y. (2004). Stressors and Child and Adolescent Psy-
chopathology: measurement issues and prospective effects.
Journal of Clinical Child and Adolescent Psychology, 33(2),
412–425. https://doi.org/10.1207/s15374424jccp3302_23.
Greeson, J. K. P., Briggs, E. C., Layne, C. M., Belcher, H. M. E.,
Ostrowski, S. A., Kim, S., Lee, R. C., Vivrette, R. L., Pynoos, R.
S., & Fairbank, J. A. (2014). Traumatic Childhood Experiences in
the 21st Century: Broadening and Building on the ACE Studies
With Data From the National Child Traumatic Stress Network.
Journal of Interpersonal Violence, 29(3), 536–556. https://doi.
org/10.1177/0886260513505217.
Greeson, J. K. P., Garcia, A. R., Kim, M., & Courtney, M. E. (2015).
Foster Youth and Social Support: The First RCT of Independent
Living Services. Research on Social Work Practice, 25(3),
349–357. https://doi.org/10.1177/1049731514534900.
Journal of Youth and Adolescence (2022) 51:2294–2311
Halfon, N., Larson, K., Son, J., Lu, M., & Bethell, C. (2017). Income
Inequality and the Differential Effect of Adverse Childhood
Experiences in US Children. Child Well-Being and Adverse
Childhood Experiences in the US, 17(7, Supplement), S70–S78.
https://doi.org/10.1016/j.acap.2016.11.007.
Hayes, A. F. (2017). Introduction to mediation, moderation, and
conditional process analysis: a regression-based approach. New
York: Guilford Press.
Henninger, W. R., & Luze, G. (2013). Moderating effects of gender on
the relationship between poverty and children’s externalizing
behaviors. Journal of Child Health Care, 17(1), 72–81. https://
doi.org/10.1177/1367493512447532.
Hicks, M. R., Kernsmith, P., & Smith-Darden, J. (2020). The Effects
of Adverse Childhood Experiences on Internalizing and Exter-
nalizing Behaviors among Black Children and Youth. Journal of
Child & Adolescent Trauma, 14(1), 115–122. https://doi.org/10.
1007/s40653-020-00316-y.
Hughes, M., & Tucker, W. (2018). Poverty as an Adverse Childhood
Experience. North Carolina Medical Journal, 79(2), 124. https://
doi.org/10.18043/ncm.79.2.124.
Hunt, T. K. A., Slack, K. S., & Berger, L. M. (2017). Adverse
childhood experiences and behavioral problems in middle child-
hood. Child Abuse & Neglect, 67, 391–402. https://doi.org/10.
1016/j.chiabu.2016.11.005.
Johnson, S. B., Riis, J. L., & Noble, K. G. (2016). State of the art
review: poverty and the developing brain. Pediatrics, 137(4),
e20153075. https://doi.org/10.1542/peds.2015-3075.
Karcher, N. R., & Barch, D. M. (2021). The ABCD study: under-
standing the development of risk for mental and physical health
outcomes. Neuropsychopharmacology, 46(1), 131–142. https://
doi.org/10.1038/s41386-020-0736-6.
Kim, P., Neuendorf, C., Bianco, H., & Evans, G. W. (2016). Exposure
to Childhood Poverty and Mental Health Symptomatology in
Adolescence: A Role of Coping Strategies. Stress and Health,
32(5), 494–502. https://doi.org/10.1002/smi.2646.
Lacey, R. E., Howe, L. D., Kelly-Irving, M., Bartley, M., & Kelly, Y.
(2020). The Clustering of Adverse Childhood Experiences in the
Avon Longitudinal Study of Parents and Children: are Gender and
Poverty Important? Journal of Interpersonal Violence,
0886260520935096. https://doi.org/10.1177/0886260520935096.
Lacey, R. E., & Minnis, H. (2020). Practitioner Review: Twenty years
of research with adverse childhood experience scores - Advan-
tages, disadvantages and applications to practice. Journal of
Child Psychology and Psychiatry, 61(2), 116–130. https://doi.
org/10.1111/jcpp.13135.
Lansford, J. E., Malone, P. S., Tapanya, S., Tirado, L. M. U., Zelli, A.,
Alampay, L. P., Al-Hassan, S. M., Bacchini, D., Bornstein, M. H.,
Chang, L., Deater-Deckard, K., Giunta, L. D., Dodge, K. A., Oburu,
P., Pastorelli, C., Skinner, A. T., Sorbring, E., & Steinberg, L.
(2019). Household income predicts trajectories of child internalizing
and externalizing behavior in high-, middle-, and low-income
countries. International Journal of Behavioral Development, 43(1),
74–79. https://doi.org/10.1177/0165025418783272.
Liming, K. W., & Grube, W. A. (2018). Wellbeing Outcomes for
Children Exposed to Multiple Adverse Experiences in Early
Childhood: a Systematic Review. Child and Adolescent Social
Work Journal, 35(4), 317–335. https://doi.org/10.1007/s10560-
018-0532-x.
Lowthian, E., Anthony, R., Evans, A., Daniel, R., Long, S., Ban-
dyopadhyay, A., John, A., Bellis, M. A. & Paranjothy, S. (2021).
Adverse childhood experiences and child mental health: an
electronic birth cohort study. BMC Medicine, 19(1), 172. https://
doi.org/10.1186/s12916-021-02045-x.
Lu, W. (2019). Adolescent depression: national trends, risk factors,
and healthcare disparities. American Journal of Health Behavior,
43(1), 181–194. https://doi.org/10.5993/AJHB.43.1.15.
2309
Luciana, M. (2013). Adolescent brain development in normality and
psychopathology. Development and Psychopathology, 25(4 Pt
2), 1325–1345. https://doi.org/10.1017/S0954579413000643.
Luecken, L. J., Roubinov, D. S., & Tanaka, R. (2013). Childhood
family environment, social competence, and health across the
lifespan. Journal of Social and Personal Relationships, 30(2),
171–178. https://doi.org/10.1177/0265407512454272.
Mackler, J. S., Kelleher, R. T., Shanahan, L., Calkins, S. D., Keane, S.
P., & O’Brien, M. (2015). Parenting Stress, Parental Reactions,
and Externalizing Behavior From Ages 4 to 10. Journal of
Marriage and Family, 77(2), 388–406. https://doi.org/10.1111/
jomf.12163.
McKelvey, L. M., Edge, N. C., Mesman, G. R., Whiteside-Mansell,
L., & Bradley, R. H. (2018). Adverse experiences in infancy and
toddlerhood: Relations to adaptive behavior and academic status
in middle childhood. Child Abuse & Neglect, 82, 168–177.
https://doi.org/10.1016/j.chiabu.2018.05.026.
Meeker, E. C., O’Connor, B. C., Kelly, L. M., Hodgeman, D. D.,
Scheel-Jones, A. H., & Berbary, C. (2021). The impact of adverse
childhood experiences on adolescent health risk indicators in a
community sample. Psychological Trauma: Theory, Research,
Practice, and Policy, 13(3), 302–312. https://doi.org/10.1037/tra
0001004.
Melchior, M., Chastang, J.-F., Falissard, B., Galéra, C., Tremblay, R. E.,
Côté, S. M., & Boivin, M. (2012). Food Insecurity and Children’s
Mental Health: a prospective birth cohort study. PLOS ONE, 7(12),
e52615. https://doi.org/10.1371/journal.pone.0052615.
Mersky, J. P., Choi, C., Plummer Lee, C., & Janczewski, C. E. (2021).
Disparities in adverse childhood experiences by race/ethnicity,
gender, and economic status: Intersectional analysis of a nation-
ally representative sample. Child Abuse & Neglect, 117, 105066.
https://doi.org/10.1016/j.chiabu.2021.105066.
Miller, A. B., Machlin, L., McLaughlin, K. A., & Sheridan, M. A.
(2021). Deprivation and psychopathology in the Fragile Families
Study: a 15-year longitudinal investigation. Journal of Child
Psychology and Psychiatry, 62(4), 382–391. https://doi.org/10.
1111/jcpp.13260.
Miller, P., & Votruba-Drzal, E. (2017). The Role of Family Income
Dynamics in Predicting Trajectories of Internalizing and Exter-
nalizing Problems. Journal of Abnormal Child Psychology, 45(3),
543–556. https://doi.org/10.1007/s10802-016-0181-5.
Moos, R. H., & Moos, B. S. (1994). Family Environment Scale
manual (3rd ed.). Palo Alto, CA: Consulting Psychologists Press.
Nguyen, M. N., Watanabe-Galloway, S., Hill, J. L., Siahpush, M.,
Tibbits, M. K., & Wichman, C. (2019). Ecological model of
school engagement and attention-deficit/hyperactivity disorder in
school-aged children. European Child & Adolescent Psychiatry,
28(6), 795–805. https://doi.org/10.1007/s00787-018-1248-3.
Persram, R. J., Scirocco, A., Della Porta, S., & Howe, N. (2019).
Moving Beyond the Dyad: broadening Our Understanding of
Family Conflict. Human Development, 63(1), 38–70. https://doi.
org/10.1159/000501880.
Peverill, M., Dirks, M. A., Narvaja, T., Herts, K. L., Comer, J. S., &
McLaughlin, K. A. (2021). Socioeconomic status and child psy-
chopathology in the United States: a meta-analysis of population-
based studies. Clinical Psychology Review, 83, 101933. https://doi.
org/10.1016/j.cpr.2020.101933.
Piper, B. J., Gray, H. M., Raber, J., & Birkett, M. A. (2014). Relia-
bility and validity of brief problem monitor, an abbreviated form
of the child behavior checklist. Psychiatry and Clinical Neu-
rosciences, 68(10), 759–767.
Plybon, L. E., & Kliewer, W. (2001). Neighborhood Types and
Externalizing Behavior in Urban School-Age Children: tests of
Direct, Mediated, and Moderated Effects. Journal of Child and
Family Studies, 10(4), 419–437. https://doi.org/10.1023/A:
1016781611114.
2310
Reiss, F. (2013). Socioeconomic inequalities and mental health
problems in children and adolescents: a systematic review.
Social Science & Medicine, 90, 24–31. https://doi.org/10.1016/j.
socscimed.2013.04.026.
Rodems, R., & Shaefer, H. L. (2020). Many of the kids are not alright:
material hardship among children in the United States. Children
and Youth Services Review, 112, 104767. https://doi.org/10.1016/
j.childyouth.2020.104767.
Rosseel, Y. (2012). lavaan: an R Package for Structural Equation
Modeling. Journal of Statistical Software, 48(2), 1–36. https://
doi.org/10.18637/jss.v048.i02.
Sackett, C. (2016). Neighborhoods and Violent Crime. Evidence
Matters, Summer. https://www.huduser.gov/portal/evidence.html.
Sacks, V., & Murphey, D. (2018). The prevalence of adverse
childhood experiences, nationally, by state, and by race or
ethnicity. Child Trends. https://www.childtrends.org/publica
tions/prevalence-adverse-childhood-experiences-nationally-sta
te-race-ethnicity.
Sandel, M., Sheward, R., Ettinger de Cuba, S., Coleman, S. M.,
Frank, D. A., Chilton, M., Black, M., Heeren, T., Pasquariello,
J., Casey, P., Ochoa, E., & Cutts, D. (2018). Unstable Housing
and Caregiver and Child Health in Renter Families. Pedia-
trics, 141(2), e20172199. https://doi.org/10.1542/peds.2017-
2199.
Sands, A., Thompson, E. J., & Gaysina, D. (2017). Long-term
influences of parental divorce on offspring affective disorders:
a systematic review and meta-analysis. Journal of Affective
Disorders, 218, 105–114. https://doi.org/10.1016/j.jad.2017.
04.015.
Schumacker, R. E., & Lomax, R. G. (2010). A Beginner’s Guide to
Structural Equation Modeling (3th ed.). Psychology Press.
https://doi.org/10.4324/9781410610904.
Shore, L., Toumbourou, J. W., Lewis, A. J., & Kremer, P. (2018).
Review: Longitudinal trajectories of child and adolescent
depressive symptoms and their predictors – a systematic review
and meta-analysis. Child and Adolescent Mental Health, 23(2),
107–120. https://doi.org/10.1111/camh.12220.
Shrider, E. A., Kollar, M., Chen, F., Semega, J., & U. S. Census
Bureau. (2021). Income and Poverty in the United States: 2020.
Current Population Reports (Current Population Reports, pp.
60–273). U.S. Government Publishing Office. https://cps.ipums.
org/cps/resources/poverty/PovReport20.pdf.
Stange, J. P., Hamilton, J. L., Abramson, L. Y., & Alloy, L. B.
(2014). A Vulnerability-Stress Examination of Response Styles
Theory in Adolescence: Stressors, Sex Differences, and Symp-
tom Specificity. Journal of Clinical Child & Adolescent Psy-
chology, 43(5), 813–827. https://doi.org/10.1080/15374416.
2013.812037.
Størksen, I., Røysab, E., Holmen, T. L., & Tambs, K. (2006). Ado-
lescent adjustment and well-being: Effects of parental divorce and
distress. Scandinavian Journal of Psychology, 47(1), 75–84.
https://doi.org/10.1111/j.1467-9450.2006.00494.x.
Straatmann, V. S., Lai, E., Law, C., Whitehead, M., Strandberg-
Larsen, K., & Taylor-Robinson, D. (2020). How do early-life
adverse childhood experiences mediate the relationship
between childhood socioeconomic conditions and adolescent
health outcomes in the UK. Journal of Epidemiology and
Community Health, 74(11), 969. https://doi.org/10.1136/jech-
2020-213817.
Taylor, J. J., Grant, K. E., Zulauf, C. A., Fowler, P. J., Meyerson, D.
A., & Irsheid, S. (2018). Exposure to Community Violence and
the Trajectory of Internalizing and Externalizing Symptoms in a
Sample of Low-Income Urban Youth. Journal of Clinical Child
& Adolescent Psychology, 47(3), 421–435. https://doi.org/10.
1080/15374416.2016.1152553.
Journal of Youth and Adolescence (2022) 51:2294–2311
Taylor-Robinson, D. C., Straatmann, V. S., & Whitehead, M. (2018).
Adverse childhood experiences or adverse childhood socio-
economic conditions. The Lancet Public Health, 3(6),
e262–e263. https://doi.org/10.1016/S2468-2667(18)30094-X.
Tiet, Q. Q., Bird, H. R., Hoven, C. W., Moore, R., Wu, P., Wicks, J.,
Jensen, P. S., Goodman, S., & Cohen, P. (2001). Relationship
Between Specific Adverse Life Events and Psychiatric Disorders.
Journal of Abnormal Child Psychology, 29(2), 153–164. https://
doi.org/10.1023/A:1005288130494.
Timmons, A. C., & Margolin, G. (2015). Family Conflict, Mood, and
Adolescents’ Daily School Problems: moderating Roles of
Internalizing and Externalizing Symptoms. Child Development,
86(1), 241–258. https://doi.org/10.1111/cdev.12300.
Varese, F., Smeets, F., kker, M., Lieverse, R., Lataster, T., Viecht-
bauer, W., Read, J., van Os, J., & Bentall, R. P. (2012). Child-
hood Adversities Increase the Risk of Psychosis: A Meta-analysis
of Patient-Control, Prospective- and Cross-sectional Cohort Stu-
dies. Schizophrenia Bulletin, 38(4), 661–671. https://doi.org/10.
1093/schbul/sbs050.
Walsh, D., McCartney, G., Smith, M. & Armour, G. (2019). Rela-
tionship between childhood socioeconomic position and adverse
childhood experiences (ACEs): a systematic review. Journal of
Epidemiology and Community Health, 73(12), 1087. https://doi.
org/10.1136/jech-2019-212738.
Weaver, J. M., & Schofield, T. J. (2015). Mediation and Moderation
of Divorce Effects on Children’s Behavior Problems. Journal of
Family Psychology, 29(1), 39–48. https://doi.org/10.1037/fa
m0000043.
Wiggins, J. L., Mitchell, C., Hyde, L. W., & Monk, C. S. (2015).
Identifying early pathways of risk and resilience: the codeve-
lopment of internalizing and externalizing symptoms and the role
of harsh parenting. Development and Psychopathology, 27(4pt1),
1295–1312. https://doi.org/10.1017/S0954579414001412. Cam-
bridge Core.
Yang, P., Schlomer, G. L., Lippold, M. A., & Feinberg, M. E. (2021).
Longitudinal discrepancy in adolescent aggressive behavior pro-
blems: differences by reporter and contextual factors. Journal of
Youth and Adolescence, 50(8), 1564–1581. https://doi.org/10.
1007/s10964-021-01431-1.
Young, J. C., & Widom, C. S. (2014). Long-term effects of child
abuse and neglect on emotion processing in adulthood. Child
Abuse & Neglect, 38(8), 1369–1381. https://doi.org/10.1016/j.
chiabu.2014.03.008.
Zucker, R. A., Gonzalez, R., Feldstein Ewing, S. W., Paulus, M. P.,
Arroyo, J., Fuligni, A., Morris, A. S., Sanchez, M., & Wills, T.
(2018). Assessment of culture and environment in the Adoles-
cent Brain and Cognitive Development Study: rationale,
description of measures, and early data. Developmental Cog-
nitive Neuroscience, 32, 107–120. https://doi.org/10.1016/j.
dcn.2018.03.004.
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Sheila Barnhart PhD, MSW is an Assistant Professor at the
University of Kentucky College of Social Work, Lexington, KY.
Her research interests include child and family health and well-being,
Journal of Youth and Adolescence (2022) 51:2294–2311 2311

poverty, resilience, maternal health and well-being, and neighborhood in the child-serving systems, and racial and socioeconomic barriers in
and community promotive factors of child, adolescent, and family the child welfare system.
health and wellness.

Nicole R. Karcher PhD, is a Postdoctoral Fellow, Department of

Antonio R. Garcia PhD, MSW is an Associate Professor at the Psychiatry, Washington University in St. Louis School of Medicine,
University of Kentucky College of Social Work, Lexington, KY. His St. Louis, MO. Her research interests include neural, cognitive,
research interests include child welfare, child and adolescent well- genetic, and environmental factors underlying risk for and
being, adverse childhood experiences, mental health service delivery development of psychotic disorders across the lifespan.