Patterns of Adverse Childhood Experiences and the Protective Effect of out-of-School Time: A Latent Class Analysis

Background: The Adverse Childhood Experiences (ACEs) study illuminated how early stressful experiences affect long-term development, including behavioral health. However, many children with ACES demonstrate resilience. Understanding the protective factors that can buffer the negative influences of ACEs can help social workers promote child well-being, social and racial justice. Organized activities during out-of-school time (OST) support youth development, but little research examines whether OST can compensate for risks posed by different combinations of ACEs, including for adolescent behavioral health. To address this gap, this study examines the association between patterns of ACEs, adolescent behavioral health, and OST.

Methods: We drew data from the Fragile Families and Child Well-being Study. The longitudinal study recruited parent-child dyads from twenty U.S cities starting in 1998, and followed them from child birth to ages 3, 5, 9, and 15 years. We conducted latent class analysis using 10 types of childhood adversities from age three; these included the original ACEs (except sexual abuse), poverty and neighborhood disorder. Adolescent behavioral health was measured at ages 9 and 15 using the externalizing and internalizing symptoms subscales from the Child Behavior Checklist, and a social skills scale. Participation in five types of OST activities were assessed at age 9 (sports, performance, clubs, academic activities, and religious activities).

Results:

Our sample (N=3438) was 52.5% male, 47.5% Black, 28.2% Latinx, 16.6% White, and 7.7% of other or mixed racial-ethnic identities.

LCA suggested a six-class solution (entropy = .693), featuring varied patterns of ACES:

• low ACES (38.8%)
• parent divorce (32.1%)
• poverty (11.4%)
• parent conflict (4.0%)
• high abuse (7.4%)
• high ACES (6.3%)

Consistent with our hypotheses, the low ACES class generally had the most positive outcomes, while the high ACES class had the least positive outcomes. Other classes varied; for example, the parent conflict class had the highest social skills, but internalizing symptoms comparable to the high ACES group (.335 vs . 443).

When examining OST, significant associations were identified for several higher risk classes. For example, sports was associated with marginally lower externalizing symptoms for the high ACES class (B=-.06), significantly lower internalizing symptoms for the poverty class (B=-.09), and marginally higher social skills for the low ACES class (B=.076). Performance activities were associated with marginally lower externalizing symptoms (B=-.06) and significantly lower internalizing symptoms (B=-.077) for the abuse class. Religious activities were marginally associated with higher social skills for the poverty class (B=.095). Contrary to hypotheses, academic activities were associated with lower social skills for the poverty (B=-.13) and abuse classes (B=-.10).

Conclusions and Implications: Findings present several novel contributions. Rather than using a summative score of ACES, we identify specific patterns of ACES with distinct behavioral health outcomes. Such findings indicate the utility of LCA for studying ACES, and the need for methodological nuance. Likewise, the study highlights the protective effects of sports, performance and religious activities for youth with ACES. Social workers might better facilitate these normative experiences for youth.