Summary: Decades of research have documented the harms of Adverse Childhood Experiences (ACEs). A new study shifts the focus to Positive Childhood Experiences (PCEs) and finds that children with special health care needs are far less likely to benefit from these protective experiences. The disparity is largest for children of color and those living in poverty, underscoring the need for inclusive policies and targeted supports.
Researchers report that roughly 20% of U.S. children have at least one special health care need—conditions such as autism, diabetes, cerebral palsy, sickle cell disease, and others. This group not only experiences ACEs at higher rates but also faces a notable shortfall in exposure to PCEs, the positive, resilience-building events that help buffer the long-term effects of trauma.
Key Facts & Statistics
- The “PCE Gap”: Children with special health care needs (CSHCN) have lower odds of experiencing even a single PCE compared with children without special needs.
- Prevalence: Approximately 20% of U.S. children have at least one special health care need.
- Disproportionate Impact: Low-income families and children of color are overrepresented among CSHCN, facing both greater health complexity and reduced access to protective environments.
- Four Core PCE Domains:
- Nurturing Relationships: Supportive connections with caregivers, family members, and mentors.
- Safe, Stable Environments: Consistent, secure settings for living, learning, and play.
- Social Engagement: Regular chances for positive peer interaction and community participation.
- Emotional Competence: Opportunities to develop social-emotional skills and resilience.
- Protective Effect: PCEs serve as a biological and psychological buffer against trauma, improving school outcomes and reducing the risk of adult psychiatric and physical conditions.
Source: Arnold School of Public Health
Background
Research from the Rural Health Research Center and collaborators has long explored how childhood experiences shape long-term health, employment, relationships, and mental well-being. While much attention has focused on ACEs—such as abuse, household dysfunction, and parental separation—Positive Childhood Experiences have received less systematic examination despite their crucial role in building resilience.
Published in the Journal of Developmental and Behavioral Pediatrics, the study led by Emma Boswell analyzed national survey data to compare the prevalence of PCEs among children and youth with special health care needs (CYSHCN) and their peers. The analysis shows that CYSHCN are significantly less likely to experience PCEs across multiple domains.
“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 and doctoral student in the Department of Health Services Policy and Management. “We know PCEs offer protective effects against ACEs, so it’s critical to understand how these positive experiences are distributed—especially among vulnerable populations.”
Using data from the 2021–2022 National Survey of Children’s Health (n = 47,207), the team defined PCEs as nurturing relationships, safe and stable environments, constructive social engagement, and social-emotional competency. They used survey-weighted chi-square tests and multivariable logistic regression to compare CYSHCN with non-CYSHCN and to identify predictors of PCE exposure within the CYSHCN group.
Key findings include significantly lower adjusted odds for CYSHCN to have at least one PCE (adjusted odds ratio [aOR]: 0.35). Specific deficits were observed across domains: constructive social engagement (aOR: 0.24), nurturing relationships (aOR: 0.80), safe and stable environments (aOR: 0.75), and social-emotional competency (aOR: 0.62). Within the CYSHCN population, children of color, those experiencing greater poverty, and those with more complex conditions had the lowest likelihood of accessing most PCEs.
Implications and Recommendations
The authors emphasize the need to move beyond clinical care alone and to integrate PCEs into programs and policies that support children with special health care needs. Recommendations include:
- Designing inclusive social and recreational programs that accommodate functional limitations.
- Supporting caregivers through services that reduce household stress and improve family capacity to provide nurturing relationships.
- Ensuring schools and community spaces are accessible, equitable, and safe for CYSHCN.
- Prioritizing outreach to marginalized communities to close the PCE gap and build resilience.
Key Questions Answered
A: PCEs shape the brain’s response to stress and support the development of resilience. For children facing chronic illness or disability, consistent positive relationships and safe environments reduce biological and psychological harm linked to prolonged stress, isolation, or medical trauma.
A: Yes. The study found that children of color with special health care needs and those living in poverty face the greatest shortfalls in PCE exposure, with multiple intersectional disadvantages compounding the gap.
A: Effective strategies include inclusive program design, caregiver supports to reduce stress, school policies that promote accessibility and safety, and community efforts to foster social engagement tailored to children’s needs.
Editorial Notes
- This article was edited by a Neuroscience News editor.
- The journal paper was reviewed in full by editorial staff.
- Additional context was provided by our team to clarify findings and implications.
About this neurodevelopment research news
Author: Erin Bluvas
Source: Arnold School of Public Health
Contact: Erin Bluvas – Arnold School of Public Health
Image: Image 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. DOI: 10.1097/DBP.0000000000001451
Abstract
Positive Childhood Experiences Among Children and Youth With Special Health Care Needs
Objective:
This study evaluates the prevalence of Positive Childhood Experiences (PCEs) among children and youth with special health care needs (CYSHCN). While CYSHCN are known to face higher rates of adverse experiences, less is known about their access to PCEs, which can protect against the harms of trauma.
Methods:
The analysis used cross-sectional data from the 2021–2022 National Survey of Children’s Health (n = 47,207). Researchers compared PCE prevalence between CYSHCN and non-CYSHCN and identified predictors of PCE exposure among CYSHCN, applying Rao-Scott χ2 tests and multivariable logistic regression with survey weights.
Results:
Compared with non-CYSHCN, CYSHCN had lower adjusted odds of having at least one PCE (aOR: 0.35, 95% CI: 0.15–0.83). CYSHCN also had lower odds for specific PCE domains: constructive social engagement (aOR: 0.24, 95% CI: 0.21–0.27), nurturing relationships (aOR: 0.80, 95% CI: 0.72–0.89), safe and stable environments (aOR: 0.75, 95% CI: 0.68–0.82), and social-emotional competency (aOR: 0.62, 95% CI: 0.56–0.69). Within CYSHCN, children of color, those in greater poverty, and those with more complex needs were less likely to experience most PCEs.
Conclusion:
The findings point to an urgent need for programs that foster resilience and equitable access to Positive Childhood Experiences for children with special health care needs. Further research should refine measures of PCEs for this population and examine how PCEs can mitigate the effects of adverse experiences over the life course.