The association between socio-economic disadvantage and adverse childhood experiences is one of the most consistent observations in the established literature. Although child maltreatment and household dysfunction are reported across the socio- economic spectrum, they are disproportionately reported amongst families of low SEP292.
Child maltreatment: Several family and neighbourhood indicators have been used to investigate the relationship between socio-economic disadvantage and child
maltreatment. Low family income has been associated with an increased risk of child abuse and neglect293;294. High rates of unemployment, both at the family and
neighbourhood level, have been linked to greater rates of child maltreatment94. In particular, areas with high male unemployment have a higher prevalence of child maltreatment reports than areas with low unemployment295. The established literature also indicates that there is a greater risk of abuse and neglect in families with poor social networks and low levels of social support than others296-298. At a neighbourhood level, increased levels of social support, as indicated by higher morale and community
integration, is associated with lower rates of child abuse compared to neighbourhoods with fewer social resources299.
Evidence indicates that the rates of different forms of maltreatment vary across socio- economic groups. Prevalence studies have consistently found child sexual abuse to be equally represented across all social classes295. In contrast, neglect has been found to be more prevalent in low socio-economic households compared to others300. Neglect may be linked to socio-economic disadvantage as several criteria used to define neglectful behaviour are related to material advantage, e.g. adequate nutrition, hygiene and shelter29. Some researchers have noted housing and financial insecurity are the underlying issues in families with an agency report of child neglect301;302. Others have suggested that socio-economic disadvantage is a reflection of greater overall need, and disadvantaged families are at greater risk of neglect causing an overrepresentation in caseloads302-304.
Household dysfunction is also related to socio-economic disadvantage. Rates of mental health disorders and substance abuse are higher in low-income populations compared to high-income groups, as the poorest individuals are most vulnerable to mental health problems305. At the neighbourhood level, increases in unemployment rates, proportion of the population in poverty and number of households on public assistance are
associated with increased intravenous drug use rates306. Single parent households307;308
and families with a parent in prison309 tend to be of low SEP compared to those that do not. Multiple indicators of socio-economic disadvantage have been associated with maternal harsh discipline methods45: for example low income, unstable employment and receipt of public assistance are associated with increased risk of parents smacking their children45;294;310.
Despite substantial research suggesting an association between socio-economic disadvantage and adverse childhood experiences, there is concern that reporting bias may influence study results. Socio-economically disadvantaged families may be more visible to welfare agencies, and therefore more likely to receive a report for
maltreatment or household dysfunction compared to other families303. If low SEP children are frequently reported to welfare agencies due to systematic bias, then studies will overestimate the relationship between socio-economic disadvantage and adverse childhood experiences. However, there is little evidence of systematic bias in agency reports. Instead, an American study concluded that economically disadvantaged
families were over-represented in agency reports because poverty, and conditions
associated with financial hardship, placed families at greater risk of abuse and neglect than others303.
A few theories have been developed to explain the relationship between socio-economic disadvantage and child maltreatment and household dysfunction. A widely accepted hypothesis is that factors associated with socio-economic disadvantage, such as financial hardship and unemployment, negatively impact on parenting quality by increasing parent’s vulnerability to stress94;311;312. Alternatively, children from socio- economically disadvantaged backgrounds may be more likely to experience child maltreatment or household dysfunction because parents possess fewer resources that enable them to provide adequate levels of care294. Budget constraints may limit families
access to health care and basic necessities such as shelter, food, and clothing, making good parenting more difficult294.
However, the nature and direction of the association between adverse childhood experiences and socio-economic disadvantage remains unclear. Socio-economically disadvantaged families and neighbourhoods often experience multiple, inter-related problems. Thus, as discussed, a range of indicators have been used to measure SEP313. The presence of multiple markers of socio-economic disadvantage, as well as adverse childhood experiences, has led to disjointed findings in the established literature94;314. In addition, though adverse childhood experiences and SEP are highly correlated, disentangling the relative influence, as well as direction, of specific measures is difficult315;316. Some researchers have suggested that the relationship between adverse childhood experiences and socio-economic disadvantage may be reciprocal and interdependent317;318. Families affected by child maltreatment and household
dysfunction often have multiple problems; adverse childhood experiences may be a part, or a consequence, of a broader continuum of disadvantage. The interdependent nature of SEP and adverse childhood experiences means disentangling constructs, measures and associated outcomes in research is challenging. Thus it may not be possible to separate the independent effect of adverse childhood experiences from factors associated with socio-economic disadvantage.