Positive Parenting Matters in the Face of Early Adversity

Am J Prev Med. 2019 Apr;56(4):530-539. doi: 10.1016/j.amepre.2018.11.018. Epub 2019 Feb 14.


Introduction: A negative relationship between adverse childhood experiences and both physical and mental health in adulthood is well established, as is the positive impact of parenting on child development and future health. However, few studies have investigated unique influences of adverse childhood experiences and positive parenting together within a large, diverse early childhood sample.

Methods: The study used data on all children aged 0-5 years (n=29,997) from the National Survey of Children's Health 2011/2012 to examine effects of positive parenting practices and adverse childhood experiences on early childhood social-emotional skills and general development. All analyses were performed in 2017 and 2018.

Results: More than a third of the sample reported experiencing at least one adverse childhood experience. More than a fourth (26.7%) met study criteria for social-emotional deficits, and 26.2% met criteria for developmental delay risks. The number of adverse childhood experiences exhibited negative marginal associations with social-emotional deficits and developmental delay risks, whereas the number of positive parenting practices showed independent protective effects. Risks associated with an absence of positive parenting were often greater than those of four or more adverse childhood experiences, even among no/low adversity families. The population attributable fractions for social-emotional deficits and developmental delay risks were 17.3% and 13.9% (translating to prevalence reductions of 4.5% and 3.6%) when adopting all positive parenting practices and 4.5% and 7.2% (prevalence reductions of 1.2% and 1.9%) when eliminating adverse childhood experiences.

Conclusions: The number of adverse childhood experiences was associated with both social-emotional deficits and developmental delay risks in early childhood; however, positive parenting practices demonstrated robust protective effects independent of the number of adverse childhood experiences. This evidence further supports promotion of positive parenting practices at home, especially for children exposed to high levels of adversity.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adverse Childhood Experiences*
  • Child Development*
  • Child Health*
  • Child, Preschool
  • Cross-Sectional Studies
  • Developmental Disabilities / etiology
  • Developmental Disabilities / prevention & control*
  • Developmental Disabilities / psychology
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Mental Health
  • Parent-Child Relations
  • Parenting / psychology*
  • United States