Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Cecelia Valrie

Second Advisor

Marcia Winter

Third Advisor

Caroline Cobb

Fourth Advisor

Hermine Maes

Fifth Advisor

Jessica Salvatore


Despite a strong literature base relating childhood adversity to pain, the biological mechanisms underlying these associations remain unclear. Theoretical and preliminary empirical evidence supports allostatic load as a potential biological mechanism, though prior studies investigating associations between childhood adversity and elevated allostatic load and/or between elevated allostatic load and poorer pain outcomes have primarily focused on adult populations and individual allostatic load indicators rather than a comprehensive index. Thus, the current study built upon prior literature by testing longitudinal relationships between childhood adversity and multiple biological indicators spanning across physiological systems (i.e., comprehensive allostatic load index) and pediatric pain outcomes (i.e., pain intensity and pain-related disability) within the nationally representative sample of early adolescents from the ABCD study. Allostatic load index was hypothesized as a mediator explaining the relationship between childhood adversity and poor pediatric pain outcomes (i.e., pain intensity and pain-related disability). The current study found childhood adversity in year 1 was significantly related to increased pain intensity and pain related disability in year 2, but not in year 3. Allostatic load did not significantly mediate the relationship between childhood adversity and pediatric pain outcomes. Future research should explore other biological mechanisms (e.g., epigenetic mechanisms) that may link childhood adversity to pediatric pain-related outcomes. Future research investigating allostatic load within a pediatric population should also consider the influence of key developmental stages (e.g., middle childhood, adolescence) to inform the selection of biological indicators as well as consider the type, duration and timing of adversity.


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