Exploring the Relationship Between Adverse Childhood Experiences and Internalizing and Externalizing Symptoms among Jordanian Adolescents: A Network Analysis Approach

The extensive presence of adverse childhood experiences (ACEs) in children has been established through documentation. Still, the detailed connections between specific types of ACEs and psychiatric symptoms have not yet been comprehensively understood. A network analysis approach has not been undertaken to study how ACEs affect internalizing and externalizing symptoms among high school students in Jordan. The research investigates how ACEs lead to internalizing and externalizing symptoms through network analysis, which helps reveal the complex interconnections between these factors. A total of 517 high school student participants (mean age: 14.47 +/- 2.25) and their parents completed the modified list of ACEs and Child Behavior Checklist (CBCL) self-report measures. The Extended Bayesian Information Criterion (EBIC) and Directed Acyclic Graph (DAG) were used for unidirectional and directional methods. The network analysis identified key nodes and connections within internalizing, externalizing, and ACE symptoms. YSR.35 (Worthless) had the highest strength centrality among internalizing symptoms (0.89), while YSR.41 (Impulsive) (0.77) and ACE.3 (Physical abuse) (0.68) ranked highest for externalizing and ACE items, respectively. Centrality measures highlighted ACE.1 (Loss of a parent) as the most influential node (betweenness = 3.738, closeness = 2.664, strength = 2.866), followed by YSR.29 (Fears) (strength = 1.938) and YSR.104 (Talks too much) (betweenness = 1.921). The DAG results, generated using the iamb algorithm with bootstrapping (1,000 iterations), showed higher levels of ACE's predicated Affective Problems and symptoms. In conclusion, these findings underscore the need for more targeted and timely interventions to prevent the emergence of more complex disorders in the future. Ultimately, the implications of this research can contribute to the development of more effective preventive and therapeutic interventions to reduce the impact of ACEs on mental health.