Association between Adverse Childhood Experience and Self-Regulation in Malaysia

Association between Adverse Childhood Experience and Self-Regulation in Malaysia

Association between Adverse Childhood Experience and Self-Regulation in Malaysia 

NG JUN KIAT

ABTRACT

The current study examined the relationship between ACEs and self-regulation. The purpose of the study is to explore the relationship between ACEs and self-regulatory problems. In this study, 282 participants were recruited. A simple linear regression was conducted. The hypothesis of this study was confirmed, as ACEs were negatively correlated with self-regulation. Future implication was discussed in the studies.

Keywords: Adverse Childhood Experiences, Self-regulation, marital status, races

ABSTRAK

Studi ini meneliti hubungan antara pengalaman masa kecil yang merugikan dan pengaturan diri. Tujuan dari penelitian ini adalah untuk mengeksplorasi hubungan antara pengalaman masa kecil yang merugikan dan masalah pengaturan diri. Salah satu manfaat potensial dari penelitian ini adalah untuk memberikan wawasan baru untuk membantu dengan mengonseptualisasikan kasus sehubungan dengan masalah pengaturan diri. Dalam studi ini, 282 peserta direkrut. Regresi linier sederhana dilakukan. Hipotesis penelitian ini dikonfirmasi, karena pengalaman masa kecil yang merugikan berkorelasi negatif dengan pengaturan diri. Hasil saat ini membantu dokter dengan konsep kasus-kasus serta pendidik dalam merancang kebijakan sebagai pendekatan trauma-informasi.

Kata Kunci: Pengalaman Kanak-kanak yang buruk, regulasi diri, kaum, status perkahwinan

INTRODUCTION

According to the Department of social welfare Malaysia, 30,343 cases of abuse were reported in Peninsular Malaysia, from 2010 to 2018 (Social Welfare Malaysia, 2021). Many cases were unreported and unaccounted for (Cheah & Choo, 2016). This includes abuses such as abandoned, neglect, physical, sexual, emotions and others. Current study wishes to explore the degree of adverse childhood experience in Malaysia to understand its relationship with self-regulation.

According to the study conducted by Felitti and his colleagues (1998), Adverse Childhood Experiences (ACEs) have been shown to have negative physical and health outcomes. ACEs consist of multiple types of abuse such as physical, emotional, sexual, neglect, bullying, the death of parents, household dysfunction, and other harmful experiences (Dube et al., 2003).  The result from the original study conducted by Felitti (1991) showed that 25% of the participants scored at least two ACEs before the age of 18. Besides, the study showed that individuals who report four or more ACEs had a four to 12-fold increase in poor self-rated health compared to an individual with zero ACEs.  The study indicated that individuals who were exposed to at least four ACEs will tend to have a higher risk for physical health and mental health while compared to an individual (Hughes et al.,2017).

Research is consistent with how individuals who experience adverse events can impact their development in later stages. One of the research indicated that when children are exposed to chronic stressful events, their neurodevelopment will be affected. In such situations, their cognitive functioning can manage negative and disruptive emotions. It also influenced their ability to regulate emotion(Substance Abuse and Mental Health Services Administration, 2018).  Individuals who grow up applying unhealthy coping methods such as substance abuse, self-harm, will likely develop physical diseases, mental illnesses and social problems. This prediction is inline with the research that shows dose relationship between adverse childhood experience and mental conditions as well as physical health. Moreover, there seem to be dose-response relationships between ACEs and health problems. Researchers have kept a record on participants over a certain period and discovered that a person’s cumulative ACEs score is linked to numerous health, social and behavioral problems developmentally (Felitti et al., 1998).

LITERATURE HIGHLIGHTS

Self-regulation is defined as the behavior of regulating one’s thoughts and feelings to engage in goal-directed actions such as organizing, controlling impulses, and solving problems (Baumeister, 1999). An individual who self-regulates can resist his or her impulses, adapt their behavior to a range of variations and change their behaviors to attain a distal goal. When people go through psychological distress, they evaluate whether the situation is out of control. Hence, in response to the situation, one is required to change or to regulate their thoughts, plans, and strategies to cope with the situation. The term self-regulation is defined generally as the effort exerted by humans to manage or change their thoughts, feelings, desires, and actions to reach higher goals (Carver & Scheier, 1998; Vohs & Baumeister, 2004). The ability and capacity to self-regulate were found to play an important role in the development of psychological well-being (Gagnon, Durand-Bush, & Young, 2016 ) because one with high self-regulatory capacity indicates that one can regulate his behavior toward the desired outcome by filtering undesired responses (De Ridder et al., 2012).

According to a model proposed by Brown (1998), behavioral self-regulation consists of seven steps: (1) receiving essential information, (2) assessing the information and associating to others and comparing them, (3) modifying change, (4) searching for alternatives, (5) formulating a plan, (6) implementing the plan and (7) assessing the effectiveness of the plan (Brown, 1998; Miller & Brown, 1991).  Self-regulatory processes are meant to be general principles of behavioral self-control.

Studies have suggested that self-regulation is a pool of skills that include the ability to monitor and control behaviors such as directing goal, deriving purposeful behavior, and problem-solving behavior (Blair & Ursache, 2011). In this case, it is suggested that self-regulation is vulnerable to the influence of stress and trauma. Studies have shown that children who experience trauma tend to be at a higher risk for developing dysregulation in areas of cognition and behavior (Dvir et al. (2014); Gould et al., 2012).

Tangney et al ( 2004) found that higher self-regulation scores correlate with low alcohol abuse score. Besides, there is research that mentioned that children who are exposed to high stress, trauma, or other distressing events will be more likely to experience overwhelming levels of stress. The stress hormones, cortisol, elevate, and induce a state of high alert and arousal in the individual which puts the individual into a highly deregulating stage (DeGangi, 2017). Symptoms of regulatory problems could include high irritability, poor self-calming, intolerance for change, a hyper-alert state of arousal, and the inability to regulate the mind (DeGangi, 2017).

According to Perfect and colleagues (2016), they suggested that youth who have experienced trauma are at significant risk for impairments across various cognitive functions, including IQ, memory, attention, and language. One who experienced trauma tends to have poorer academic performance and school-related behaviors in terms of discipline, school dropout, and attendance. Other studies suggest that ACEs increase the risk of behavior and learning problems in children (Burke et al. 2011; Freeman 2014; Hunt et al. 2017; Iachini et al. 2016), as well as physical and mental health issues in later life (Crouch et al. 2018). In addition to that, chronic hyper-stimulation of the stress system was found to affect one’s ability to plan, directing one’s behavior toward a goal, and controlling one’s impulses. 

Other studies suggest that ACEs increase the risk of behavior and learning problems in children (Burke et al. 2011; Freeman 2014; Hunt et al. 2017; Iachini et al. 2016), as well as physical and mental health issues in later life (Crouch et al. 2018). In addition to that, chronic hyper-stimulation of the stress system was found to affect one’s ability to plan, direct one’s behavior toward a goal, and control one’s impulses. ACEs such as abuse and neglect have been associated with impaired inhibitory control and delayed gratification, excessive emotional reactions, and impulsive thinking (Ford, 2009), which implies self-regulation difficulties.

RESEARCH METHODS

The objective of the present study is to investigate the relationship between ACEs and self-regulation that can provide a new perspective. Doctors and first-line helpers might be able to view one who struggles with self-regulation as a possible sign for adverse childhood experience and they can provide help accordingly.  Hence, the current research explored the (1) relationship between adverse childhood experience and self-regulation. The study was a correlational design. The predictor variable (Adverse Childhood Experience questionnaire) and the response variable (Short Self-Regulation Questionnaire) were tested. A simple linear regression test was applied to test the relationship between ACE and self-regulation. Basic Demographic questions are prepared. Adverse Childhood Experience Questionnaire and The Short The Self-Regulation Questionnaire (SRQ) were used in the study.

FINDINGS

Socio -Demographic Profile

There were 282 participants, 89 male participants (31.60%) and 193 (68.40%) female participants. There were 222 Chinese participants (78.7%), 25 Indian participants (8.9%), 18 Malay participants (6.4%), and 17 participants that fell under others (6%).   Participant's ages ranged from 20 to 57 years old with the mean age of 29.2 years (SD = 5.53). The results showed that 211 participants (74.8%) were single, 62 participants (22) were married and 9 participants (3.2%) were divorced.

Table 1: Descriptive Analysis of Demographics

	N	%
Age 18 - 24 years old 25 - 29 years old 30 - 34 years old 35 - 39 years old 40 - 44 years old 45 years old and above Gender              Male              Female	44 127 64 34 9 4 89 193	15.6 45 22.7 12.1 3.2 1.4 31.6 68.4
Ethnicity Chinese Malay Indian Others	222 25 18 17	78.7 8.9 6.4 6
Marital Status Single Married Divorced	211 62 9	74.8 22 3.2
Living Situation Alone Roommate/spouse Children parents Others	53 67 23 125 14	18.8 23.8 8.2 44.3 5.0
Monthly Household Income Below RM 2000 RM 2000-RM 4000 RM 4000-RM 6000 RM 6000- RM 8000 RM10000- RM 12000 RM12000- RM 14000 RM15000- RM 20000 RM 20000 and above	28 96 54 41 28 7 17 11	9.9 34.0 19.1 14.5 9.9 2.5 6.0 3.9
Highest Qualification             High School Diploma Bachelor Masters Vocational Doctor	9 21 176 59 14 3	3.2 7.4 62.4 20.9 5.0 1.1

Table 2 Reliability Statistics and Pearson Product-Moment Correlations of Adverse Childhood Experience and Short Self-Regulation

Variable	n	M	SD	1	2
1.ACEs	282	1.35	1.86	-	-.269**
2.SSR	282	104.72	14.41	-.269**	-

*Significant p<0.05

For the first hypotheses, participants’ response on the Adverse Childhood Experience (ACEs) was calculated by summing up their respective scores. Also, participants’ response on Short Self-Regulation was calculated by summing up their respective scores after reverse coding the selected items. Higher scores on SSR indicated a higher level of self-regulation capacity. Correlation analyses were run for ACEs and SSR to test the first hypothesis. The descriptive statistics and the findings of the correlational test are presented in Table 2. According to table 2, there was a significant negative correlation between Adverse Childhood Experience and Short Self-Regulation, r (282) = -.269, p<.001. The lower the score of Adverse Childhood Experience, the higher your level of self-regulation capacity.

DISCUSSION AND IMPLICATIONS OF THE STUDY

The purpose of this research was to explore the relationship between Adverse Childhood experience and Short Self-Regulation. The investigation was carried out to examine if Short Self-Regulation can be affected or influenced by the Adverse Childhood Experience.

Results from Table 1 showed that a significant negative correlation was found between Adverse Childhood Experience and Short Self-Regulation. In other words, people who experienced a higher levels of ACEs were more likely to have a lower level of self-regulation capacity. This is consistent with the suggestions from previous literature that study the effects of trauma and maltreatment on self-regulation (Van Der Kolk, 1994; Alessandri, 1991; Georgia. A, 2017; Perfect et al., 2016 & Lackner et al., 2018).

According to Miller and Brown (1998), a model of regulation was proposed. It is mentioned that self-regulation is affected due to deficits at any of the seven steps mentioned below. In such a situation, it is proposed that one will receive relevant information, evaluate the information and compare it to norms, trigger change, search for options, formulate a plan, implement the plan and assess the plan’s effectiveness. However, when one is exposed to ACEs, this process is likely to be interrupted and affected (Van Der Kolk, 1994; Alessandri, 1991; Georgia, 2017; Perfect et al., 2016 & Lackner et al., 2018).

Results suggest a similar assumption stated by Georgia (2017) that one who was exposed to trauma will likely struggle with self-regulation. It is aligned with one of the theories that mention one who is exposed to such a situation will be subjected to an overwhelming level of stress. Hence, the stress hormones, cortisol, elevate, and create a state of high alert and arousal, resulting in low levels of self-regulation (Goergia, 2017). This chronic hyperstimulation is associated with adverse conditions in childhood and adolescence. As such, chronic hyper-stimulation of the stress system was found to affect one’s ability to plan, direct one’s behavior toward a goal and control one’s impulses (Karen.K & Jerrold.M, 2014). Hence, it is aligned with the assumption that adverse childhood experience is connected to the disruption of the process of self-regulation which involves the seven steps.

Once one is exposed to the adverse childhood experience, one is likely to be subjected to an overwhelming level of stress. When this occurs, the stress hormone, cortisol, will create a high level of arousal and affect the ability to self-regulate such as receiving relevant information, evaluating and comparing to the norms, triggering change, search for options, formulating a plan, and assessing the effectiveness of the plan. Studies have shown consistent observation as exposure to adverse childhood experience is linked to structural impairments in areas involved in cognitive and emotional functioning such as the prefrontal cortex and limbic system (Pears et al., 2010; Sapolsky, 2005). In this situation, one will likely experience regulatory problems such as poor self-regulation, intolerance for change, unable to follow through a plan, and inability to regulate the mind (Georgia. A, 2017). It is consistent with the results presented from this study, which indicate that adverse childhood experience is negatively correlated with self-regulation.

On another hand, it is mentioned by Perfect and colleagues (2016) that one who experiences trauma is at significant risk for behavioral problems such as being distractive, inability to direct their behavior, inability to focus, inability to plan, and so on. These problems can be the most basic layer or problem adding up to other problems such as mental health issues in later life (Crouch et al. 2018). This observation is consistent with the results shown in the current study.

Results derived from the current study are consistent with studies that indicated exposure to trauma or adverse childhood experience are linked to issues related to self-regulation in regards to directing one’s behavior, impaired inhibitory control, delayed gratification, and impulsive thinning (Ford, 2009). Hence, the relationship between adverse childhood experience and self-regulation in later life is established.

Building on top of it, results have suggested that those who experienced more adverse experiences in childhood (Adverse Childhood Experience) will experience higher levels of self-regulation in later life. Lackner’s study (2018) showed that adolescents who were exposed to ACEs were associated with lower levels of self-regulation in adolescence. In addition to that, the current study showed that those who experienced Adverse Childhood Experience were associated with a lower level of self-regulation even in later life. This suggested that adverse childhood experience has a long effect on one’s self-regulation. One is more likely to continue to struggle with self-regulation even after entering into ages between 20 and 40.

On a side note, results have also indicated that participants who reported to be married have significant lower Adverse Childhood Experiences compared to participants who are divorced. One of the researches conducted by Kermyt (2017) has shown that ACEs have increased the likelihood of being divorced or in a separated relationship.  Kermyrt (2017) has argued this result is consistent with the acceleration theory. Adverse Childhood experience influence adult marital marriage (Ellis, 2004).

As an attempt to explore, the results also suggest that Chinese have a significantly lower level of Adverse Childhood Experiences as compared to participants who reported as others. One of the explanations is that “other” ethnic groups are the more disadvantaged and economically less affluent quarters of Malaysian society (Ahmad, 2015). This could result in higher childhood adversities. In other words, due to the disadvantaged and economically less affluent backgrounds, they are susceptible to adverse childhood experiences. According to Mental Health Performance Report Malaysia (2016), other Bumiputeras (41.1%) and others (33.2%) have the highest prevalence for Mental Health among Malays (28.2%), Chinese (24.2%) and Indians (29.8%). At the same time, Ahmad and his team (2015) have conducted a study to understand the trends and factors associated with the mental health problem in Malaysia. The results have shown that for the category of other and other Bumiputera, the prevalence of mental health problems have the highest percentage compared to Malay, Indian and Chinese. A strong relationship has been found between adverse childhood experience and mental illness (Venter, Demyttenaere & Bruffaets, 2013). Hence, it is worth to look into the situation and reasons that make this particular group more susceptible to ACEs.  

This study can help the clinician to conceptualize cases. One who struggles with self-regulation may be perceived to have more than just an attitude problem or behavioral problem. The current study sheds light on the link between adverse childhood experience and self-regulation. Hence, clinicians can conceptualize the case by considering possible ACEs that he or she might have experienced, as adverse childhood experience is linked with self-regulation in later life. In addition to that, clinicians can consider the possible reason for the struggle in managing stress. It is because the one who is exposed to adverse childhood experience is likely to subject to a high level of stress. In-depth research can be carried out on the mediation effect of perception of stress on the relationship between adverse childhood experience and self-regulation to further the understanding of the mechanisms that affect the self-regulation. The current study has established the relationship between adverse childhood experience and self-regulation in later life. Hence, further study in this area can explore the role of stress perception on the relationship between adverse childhood experience and self-regulation. Moreover, they can also explore brain research on the participants who were identified to be exposed to adverse childhood experiences.

CONCLUSION

This study attempted to link the relationship between adverse childhood experience and self-regulation in later life. The result has suggested that adverse childhood experience is linked with self-regulation. Particularly, adverse childhood experience is negatively correlated with self-regulation in later life. Assumptions have been confirmed. In this situation, theories are consistent with the results. Those who are exposed to adverse childhood experiences are linked to lower self-regulation capacity.

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Profil Penulis:

Ng Jun KiatPhD student

Universiti Kebangsaan Malaysia

p126658@siswa.ukm.edu.my