Positive Childhood Experiences Can Moderate the Impact of Adverse Childhood Experiences on the Developmental Trajectory of Sleep Quality Among Adolescents.
Zhang L, Li C, et al. • Stress and health : journal of the International Society for the Investigation of Stress • 2026
ACEs exposure adversely affects the development of sleep quality among adolescents, while PCEs can moderate this effect, with moderate to high levels of PCEs exposure (3-7 PCEs) significantly buffering the adverse effects of ACEs on sleep quality development.
Key Findings
Results
Adolescents with high ACE levels exposure had significantly higher odds of poor sleep quality development.
Adolescents with a pattern of 'high ACE levels' exposure had OR: 3.74 (95% CI: 2.02–6.91) for poor sleep quality development.
A positive dose-response relationship was found between ACEs exposure and risk of poor sleep quality development.
Study included 877 adolescents with mean age 11.31 ± 1.63 years, 51.1% boys.
The study was based on the Anhui Child & Adolescent Healthy Growth Cohort.
Logistic regression analyses were used to determine the effects of ACEs exposure on sleep quality trajectories.
Results
Adolescents with high PCE levels exposure had significantly lower odds of poor sleep quality development.
Adolescents with a pattern of 'high PCE levels' had OR: 0.50 (95% CI: 0.31–0.80) for poor sleep quality development.
This indicates that higher PCE exposure was associated with approximately half the odds of poor sleep quality development compared to lower PCE exposure.
Logistic regression analyses were conducted to determine the effects of PCEs exposure on sleep quality trajectories.
Results
Moderate to high levels of PCE exposure significantly moderated the adverse effects of ACEs on sleep quality development.
PCE exposure of 3–7 PCEs was found to significantly moderate the adverse effects of ACEs on sleep quality development.
Interaction analyses were performed to explore the moderating role of PCEs on the impact of ACEs.
The moderating effect suggests PCEs can buffer, but the threshold requires moderate to high levels (3–7 PCEs).
Methods
Latent class growth analysis (LCGA) identified distinct developmental trajectories of sleep quality among adolescents.
LCGA was applied to capture the developmental trajectory of sleep quality across the cohort.
Trajectories were classified into groups, with one group characterized as 'poor development of sleep quality.'
The study followed adolescents in the Anhui Child & Adolescent Healthy Growth Cohort longitudinally.
A total of 877 adolescents were included in the trajectory analyses.
Results
The study found that both ACEs and PCEs independently and interactively influence the developmental trajectory of adolescent sleep quality.
ACEs exposure was associated with higher risk of poor sleep quality development with a dose-response pattern.
PCEs exposure was associated with lower risk of poor sleep quality development.
Interaction between ACEs and PCEs showed PCEs can buffer the negative impact of ACEs when PCE levels are moderate to high (3–7 PCEs).
These findings highlight the urgency of early screening and intervention for ACEs and the importance of promoting PCEs in early life.
What This Means
This research examined how both negative and positive childhood experiences affect the way sleep quality develops in adolescents over time. Using data from 877 children and teenagers in China (average age around 11), researchers tracked sleep quality trajectories and found that children exposed to more adverse childhood experiences (ACEs)—such as abuse, neglect, or household dysfunction—were significantly more likely to follow a poor sleep quality developmental path. Specifically, those with high ACE exposure were nearly four times as likely to have poor sleep quality development compared to those with fewer ACEs, and this risk increased as the number of ACEs increased.
Importantly, the study also found that positive childhood experiences (PCEs)—such as supportive relationships, feeling safe, or having opportunities for play and learning—were associated with better sleep quality development. Children with high levels of PCEs had about half the odds of poor sleep quality development. Crucially, when children had both ACEs and PCEs, moderate to high levels of PCEs (3 to 7 positive experiences) were able to significantly reduce the harmful effect of ACEs on sleep, suggesting PCEs can act as a buffer or protective factor.
This research suggests that addressing childhood adversity alone may not be sufficient—actively promoting positive experiences in children's lives may be equally important for protecting their sleep health as they grow. The findings point to the value of early screening for adverse experiences and implementing programs that foster supportive, nurturing environments for children, as these positive experiences may help counteract some of the damage done by difficult early-life circumstances.
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Zhang L, Li C, Wang J, Geng H, Su W, Wang X, et al.. (2026). Positive Childhood Experiences Can Moderate the Impact of Adverse Childhood Experiences on the Developmental Trajectory of Sleep Quality Among Adolescents.. Stress and health : journal of the International Society for the Investigation of Stress. https://doi.org/10.1002/smi.70181