Abstract Title Adverse Childhood Experiences and Temporal Discounting in Older Adults

Background Traumatic events experienced in the first 18 years of life, known as adverse childhood experiences (ACEs), are associated with an increased burden of chronic disease. ACEs have been shown to impact brain regions associated with impulsivity and may play an important role in an individual’s ability to delay reward. Temporal discounting is the tendency to prefer more immediate rewards over delayed gratification, and higher discounting has been implicated in poor chronic disease management. To better understand how adversity early in life could complicate chronic disease management, we examined the association between ACEs and temporal discounting in older adults. We hypothesized that a higher total number of ACEs will have a greater effect on future temporal discounting.

Methods We conducted a cross-sectional analysis of self-reported ACEs and temporal discounting using previous cohort data in the Rush Alzheimer’s Disease Center on 834 participants 65 years and older (mean age 80, 86% white, 12.4% African American, 76% female). ACEs were measured with a 16-item trauma questionnaire and summed into a total ACE score (composite measure z- score) and five categories (principal component analysis): family separation/problems, emotional neglect, financial need, parental violence, and parental intimidation. Small scale (α) and large scale (A) temporal discounting was measured at baseline and assessed via a standard preference elicitation protocol of a 7-question binary choice task between smaller immediate versus larger delayed rewards. Cross-sectional analysis was conducted using R Statistical Software, ANOVA, and Poisson regression.

Results Higher total ACE scores were significantly associated with steeper temporal discounting: A (β = 0.077, SE = 0.028, p = 0.006) and α (β = 0.0022, SE = 0.0010, p < 0.001). Among ACE categories, parental violence showed the strongest effects on both A (β = 0.090, SE = 0.027, p = 0.001) and α (β = 0.0022, SE = 0.00070, p = 0.002) and was dose-dependent with a 14.8% (A; p-value < 0.001) and 15.4% (α; p-value = 0.001) increase in discounting per unit of parental violence. Race was also associated with discounting, while years of higher education, male sex, and high global cognition had protective effects.

Conclusion These findings suggest that ACEs, particularly parental violence, are associated with diminished ability to delay gratification in later life. This supports the hypothesis that early adversity has a significant and dose-dependent effect on temporal discounting. Further studies are warranted to further explore these implications on health behaviors and chronic disease management and to inform interventions.