Abstract

Background: The US has substantial disparities in pediatric mental and behavioral health. Prior work suggests children in language-minority households fare better despite socioeconomic disadvantage, a pattern commonly described as the immigrant paradox. Few national studies have examined whether this relationship persists after accounting for adverse childhood experiences (ACEs), a major driver of child mental health. This study assessed whether household language environment is associated with impairing mental and behavioral conditions among US children.

Methods: We analyzed pooled 2020–2022 National Survey of Children’s Health data on children ages 2–17 years. The outcome was any currently impairing mental or behavioral condition, defined by parent-reported diagnosis plus current impairment for anxiety, depression, ADHD, behavioral problems, autism, or developmental delay. Household language was categorized as English-only, bilingual, or non-English. Survey-weighted logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs), adjusting for demographics, socioeconomic factors, insurance, nativity, urbanicity, survey year, and ACE burden.

Results: One in five children had an impairing condition. Bilingual households had 62% lower odds than English-only households (aOR=0.38, 95% CI: 0.31–0.47), while non-English households showed no difference (aOR=0.96, 95% CI: 0.68–1.38), suggesting a bilingual advantage not shared across all language-minority households. ACE burden showed a strong dose-response pattern; children with 3+ ACEs had over fourfold higher odds of impairment (aOR=4.66, 95% CI: 4.14–5.24). Interaction analyses were null.

Conclusions: This study adds national evidence that bilingual household environments may protect child mental and behavioral health, while underscoring ACE burden as a key target for screening and prevention in diverse US pediatric populations. This has implications for policy and practice.