Summary: While decades of research have focused on Adverse Childhood Experiences (ACEs), a new study shifts the focus to Positive Childhood Experiences (PCEs).
The study found that children with special health care needs—approximately 20% of U.S. children—are significantly less likely to encounter these protective, resilience-building events compared to their peers. This “PCE gap” is even more pronounced for children of color and those living in poverty, highlighting a critical need for inclusive policy planning.
Key Facts & Statistics
- The “PCE Gap”: Children with special health care needs (CSHCN) have lower odds of experiencing even a single PCE compared to neurotypical or healthy children.
- Prevalence: An estimated 20% of children in the U.S. have at least one special health care need (e.g., autism, diabetes, cerebral palsy).
- Disproportionality: Low-income and minority families are overrepresented in the CSHCN population, facing a “double burden” of health complexity and reduced access to positive environments.
- The Four Pillars of PCEs:
- Nurturing Relationships: Supportive bonds with caregivers and mentors.
- Safe Environments: Stability in living, playing, and learning.
- Social Engagement: Opportunities for peer interaction and community belonging.
- Emotional Proficiency: Developing social-emotional skills and resilience.
- The Protective Effect: PCEs act as a “counteractive shield” against the trauma of ACEs, improving school success and reducing the risk of adult psychiatric conditions.
Source: Arnold School of Public Health
For decades, members of the Rural Health Research Center have been studying how childhood experiences impact long-term outcomes.
Much of this research has examined the negative effects of adverse childhood experiences (ACEs) such as divorce, abuse and household dysfunction on factors like health, employment, mental health and relationships.
Positive childhood experiences (PCE) also play an important role in lifelong health and well-being, and Center researchers have long looked at how the presence or absence of PCEs shape individuals as they grow into adults.
Published in the Journal of Developmental and Behavioral Pediatrics, one of their recent studies analyzed the prevalence of PCEs among children with special health care needs. The researchers found that members of this population were less likely to have experienced at least one PCE compared to their counterparts.
“An estimated 20% of children in the U.S. have at least one special health care need, and low-income and minority families are disproportionately represented in this group,” says Emma Boswell, lead author on the study and a doctoral student in the Department of Health Services Policy and Management.
“We know from prior research that the lived experiences of children, both adverse and positive, influence health and well-being across the lifespan and that PCEs have a protective, counteractive effects against the trauma that accompanies ACEs. It is therefore important to understand the occurrence of both types of experiences, especially for vulnerable populations.”
Children’s Health, the team identified children across the nation with a health condition that limits functioning and/or requires additional services (e.g., autism, sickle cell disease, diabetes, cerebral palsy and many others). Previous research had already shown that this group was more likely to experience most types of ACEs and more often throughout childhood – all of which increases the likelihood of risky behavior as they move into adulthood.
Because PCEs – defined as events that promote healthy development – help prevent or mitigate the effects of ACEs, Boswell and her team looked for their presence among children with special health care needs. The experiences fall into four categories: nurturing, supportive relationships; living, playing and learning in a safe, stable and equitable environment; opportunities for social engagement; and learning social-emotional proficiency.
“Earlier studies tell us that after adjusting for ACEs, children with PCEs are more likely to have better health and school success and, as adults, they are less likely to experience a psychiatric or physical condition,” Boswell says. “When looking at this particularly at-risk group, however, we found that children with special health care needs were less likely to experiences PCEs. In fact, these children had lower odds of having a single PCE, with children of color, greater poverty and more complex health needs even less likely to have them.”
The authors note that while the tracking and use of ACEs and PCEs in the development of programs and policies for children is increasing, certain groups have been left out of the conversation and planning. They recommend that children with special health care needs, alongside their caregivers and families, and other marginalized groups be included in these discussions along with ways to build resilience and foster opportunities for PCEs to improve health and well-being.
Key Questions Answered:
A: Because PCEs change the brain’s response to stress. For a child with a chronic illness or disability, the world can be inherently more stressful. PCEs—like having a reliable friend or a safe place to play—help build “resilience,” which biologically mitigates the long-term damage caused by medical trauma or social isolation.
A: Yes. The study found that the “odds” of having PCEs decrease further as intersectional factors pile up. Children of color with special health care needs and those living in greater poverty had the lowest likelihood of experiencing these vital growth events.
A: It requires moving beyond just “medical treatment.” Policy recommendations include creating inclusive social programs, supporting caregivers to reduce household stress, and ensuring that school environments are equitable and safe for children with functional limitations.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- Journal paper reviewed in full.
- Additional context added by our staff.
About this neurodevelopment research news
Author: Erin Bluvas
Source: Arnold School of Public Health
Contact: Erin Bluvas – Arnold School of Public Health
Image: The image is credited to Neuroscience News
Original Research: Closed access.
“Positive Childhood Experiences Among Children and Youth With Special Health Care Needs” by Emma Kathryn Boswell, Maushmi Patel, Taryn Farrell, and Elizabeth Crouch. Journal of Developmental & Behavioral Pediatrics
DOI:10.1097/DBP.0000000000001451
Abstract
Positive Childhood Experiences Among Children and Youth With Special Health Care Needs
Objective:
Positive childhood experiences (PCEs) are protective events against the impact of childhood trauma. Previous research has found that children and youth with special health care needs (CYSHCN) are more likely to experience adverse childhood experiences, but the prevalence of PCEs among this population has not been examined. Therefore, this study seeks to evaluate the prevalence of PCEs among CYSHCN.
Methods:
Cross-sectional data from the 2021 to 2022 National Survey of Children’s Health (n = 47,207) was used to evaluate differences in the prevalence of PCEs between CYSHCN and non-CYSHCN, and to evaluate predictors of PCE exposure among CYSHCN. Rao-Scott χ2 test and multivariable logistic regression, using appropriate survey weights, were used.
Results:
Compared with non-CYSHCN, CYSHCN had lower odds of having at least one PCE (adjusted odds ratio [aOR]: 0.35, 95% Confidence Intervals [CIs]: 0.15‒0.83), and having specific types of PCEs: having constructive social engagement (aOR: 0.24, 95% CIs: 0.21‒0.27), having nurturing and supportive relationships (aOR: 0.80, 95% CIs: 0.72‒0.89), living in a safe, stable, and equitable environment (aOR: 0.75, 95% CIs: 0.68‒0.82), and creating social and emotional competency (aOR: 0.62, 95% CIs: 0.56‒0.69). Among CYSHCN, children of color, those with greater poverty, and those with more complex needs have lower odds of experiencing most PCEs.
Conclusion:
The results of this study indicate a need for programs aimed at fostering resilience among CYSHCN. There is also a need for additional research creating better measures of evaluating PCEs among CYSHCN and examining how PCEs mitigate the effects of adverse childhood experiences in this population.
