The Relationship between Adverse Childhood Experiences (ACEs) and Behavioral Health Outcomes in Child-Welfare Involved Youth: A Latent Class Analysis

Background & Aims: Adverse childhood experiences (ACEs) are a public health problem due to the strong association between early life trauma and subsequent physical and behavioral health problems. Research indicates that the accumulation of ACEs, as opposed to exposure to single types of victimization, is a significant predictor of behavioral health outcomes. Children involved with the child welfare system due to maltreatment concurrently have high rates of exposure to other types of victimization beyond violence perpetrated by caregivers. However, most research with child welfare samples have focused on singular incidents of maltreatment and fails to recognize the complex interactions between multiple victimization and adversities. This study  fill gaps in the literature using a latent class approach to understand which combinations of ACEs are likely to group together and which groupings predict impairing levels of behavioral health symptoms.

Methods: Data was drawn from the National Survey of Child and Adolescent Well-Being (NSCAW II), a longitudinal, nationally representative survey of children who have been the subject of a child welfare investigation. A sub-sample was drawn of participants aged 8-17 years at the time of Wave 1 data collection for a total of 1,887 youth. First, a latent class analysis (LCA) was conducted to estimate latent sub-groups of respondents who reported similar ACE exposure. Ten indicators were used for classification including physical and emotional abuse, physical neglect, sexual victimization, peer victimization, caregiver substance misuse and mental health problem, witnessing violence in the home and community, and physical assault.  After classes were identified, the Vermunt’s three step approach was used to estimate the relationship between class membership and behavioral health problems while retaining the probabilistic nature of LCA. Behavioral health problems were measured by sub-scales of the Child Behavior Checklist.

Results: A five class solution was identified which described groups of youth who experienced significantly varied ACE exposure. Class 1 was characterized by high caregiver mental health need and had mean ACE score close to 6. Class 2 similarly had high ACE exposure, but concurrently had sexual victimization. Individuals in Class 3 had high sexual victimization and caregiver substance misuse. Children in Class 4 were exposed to significant familial maltreatment and had the highest probability of experiencing community violence. Class 5 was considered to be a low exposure group.

Children in two highest exposure groups, Class 1 and Class 2, had the highest internalizing and externalizing symptoms as compared to all other groups (p<.05). Mean symptom scores for Class 1 and Class 2 were 11 to 20 points higher than the low risk exposure groups and more than 7 points higher as compared to Class 4 which was high maltreatment. These findings suggest that children in Class 1 and Class 2 had higher scores than children exposed to maltreatment in isolation of victimization and caregiver mental health problems.

Conclusions: Overall, this study suggests heterogeneity in ACE exposure and identified ACE combination is differentially related to increased behavioral health symptoms. As classes predict varied symptoms, LCA may be a method to promote targeted intervention.