Adverse Childhood Experiences and Health-Risk Behaviors in Vulnerable Children

Background and Purpose: Previous studies have found a direct association between adverse childhood experiences (ACEs) and health-risk behaviors in adults and adolescents. Few, if any studies, however, have examined this association among children, particularly those youth at high risk of engaging in health risk behaviors. Our study was aimed at extending previous research by examining the association between ACEs and health-risk behaviors among an extremely high-risk sample of preadolescents in foster care. We were also interested in examining whether age, sex, and race/ethnicity moderated the association between ACEs and health-risk behaviors. 

Methods: All 9-11-year-old children who entered foster care in a large, Western metro area were recruited each summer between 2002 and 2011 for a randomized controlled trial (RCT) of a preventive intervention. Children were eligible for the study if: 1) they had been court-ordered into foster care due to maltreatment within the preceding year, 2) they remained in foster care at the time of the baseline interview, and 3) their cognitive functioning was sufficient to comprehend the interview questions. Ninety-one percent of children meeting eligibility requirements were interviewed, which included participants enrolled in the RCT (n = 425) and participants who did not take part in the RCT and received a baseline interview only (n = 90). The current study examined data collected from baseline interviews (pre-randomization) of 515 children. Youth were interviewed about their engagement in violence, substance use, and delinquency. A multi-informant ACEs score was derived based on participants’ exposure to six adverse experiences (physical abuse, sexual abuse, community violence, caregiver transitions, school transitions, and removal from a single parent household). Hierarchical multiple logistic regression analyses examined the relationship between ACEs and risk behaviors and the potential moderating effects of age, sex, and race/ethnicity. 

Results: Ninety percent of children reported exposure to at least one ACE. Non-Caucasian and older children experienced significantly more ACEs. ACE scores were predictive of risk behaviors after controlling for age, sex, and race/ethnicity. Each additional ACE predicted a nearly 50% increase in the likelihood of violence and delinquency and an 86% increase in the likelihood of substance use. Although males and older youth were more likely to engage in risk behaviors, none of the demographic characteristics moderated the ACE-risk behavior association. 

Conclusions and Implications: Consistent with studies involving adults and adolescents, we found a direct association between ACEs and children’s engagement in health-risk behaviors. These findings are noteworthy as they suggest that even within a group of children that has, by definition, been exposed to adverse experiences, ACEs are linearly associated with risk behaviors. Health-risk behaviors among adolescents are pervasive, costly, and when not addressed, often result in acts of increasing severity that persist into adulthood. While evidence-based programs to prevent these behaviors exist, the early identification of children most vulnerable may increase the return on investment of these programs. Our results suggest that ACE exposure can be used to identify preadolescent children at greatest risk of engaging in risk behaviors and those who would potentially benefit the most from preventive interventions.