Adverse childhood experiences and internalizing problems and externalizing problems of students with emotional and behavioral disorders the role of PTSD symptoms and executive functioning

Since adverse childhood experiences (ACEs) seem highly prevalent for students with EBD, it is important to understand how ACEs are related to their severe internalizing problems and externalizing problems. In this study, we assessed the mediating role of post traumatic stress (PTSD) symptoms and executive functioning (EF) in the potential association between ACEs and internalizing problems and externalizing problems. Participants were 174 students with EBD (mean age 11.58 years, 85.1% boys) in five urban separate special education (SE) schools. We conducted multiple mediation modeling, examining pathways from ACEs (original and expanded framework) via PTSD symptoms and EF to behavioral problems (internalizing and externalizing problems, respectively). We used data from multiple sources, including self-reports, parent reports, and school files. Overall, PTSD symptoms and self-reported EF fully mediated the association between ACEs and internalizing problems and externalizing problems. Findings were consistent for both the ten original ACEs as for the expanded ACE framework. Teachers’ perspectives of EF did not mediate the association between ACEs and internalizing problems or externalizing problems. PTSD symptoms and self-reported EF seem to play an important role in the pathway from ACEs to internalizing problems and externalizing problems of students with EBD in separate SE schools.