A Scoping Review on ACEs Studies Using Latent Class Analysis: Measures, Scales, and Findings

Background: Adverse Childhood Experience (ACE) studies reveal profound impacts of individuals’ childhood adversities on life outcomes. Most ACEs studies have adopted a cumulative risk approach assuming each adversity equivalently contributes to human development. This approach is not beyond reproach as evidence suggests some ACEs are more detrimental, such as sexual abuse. Viewing ACEs as cumulative risks obscure the heterogeneity of different types of ACEs and their consequences, making actional interventions impossible. A new approach, Latent Class Analysis (LCA), has emerged to address these concerns by identifying underlying sub-groups of people who experience different patterns of ACEs. LCA can yield mutually exclusive latent classes to indicate unique ACEs exposure profiles and related consequences. However, the existing ACEs studies conducted by LCA barely produce comparable results because researchers include different ACEs indicators in their analysis which substantially determines their findings on the classes of ACEs. Therefore, a scoping review of LCA ACEs studies can inform the field by showing:

1. What ACEs indicators were included.
2. What instruments were used to assess ACEs.
3. What different patterns of ACEs classes were identified by the current body of research.

Methods: Using the EBSCO database, we conducted a peer-reviewed journal article search on ACEs studies using LCA from 2012-2022. We used “Adverse Childhood Experiences” for title search and “Latent Class Analysis” for abstract search. After removing duplicates of the original 107 results, we did an entire article review for 43 studies. Four of these studies either did not include LCA or had a failed LCA in which results were not discussed. Therefore, a total of 39 articles were included in this review.

Results: Most of the articles relied on the original ten types of ACEs proposed by Felitti and colleagues, which are family-level adversities such as child maltreatment and household dysfunction. Still, we found substantial variations of included indicators among studies. For example, some researchers expanded the original ACEs scale to include school and peer violence, community violence, poverty, discrimination, and collective violence such as witnessing wars. On the other hand, some studies omitted original ACEs items such as child maltreatment ACEs. The scales researchers used to assess ACEs also varied. In addition to the original ACEs questionnaire, the Conflict Tactic Scale, Childhood Trauma Questionnaire, Juvenile Victimization Scale, and Adverse Childhood Experiences International Questionnaire were also commonly used as survey instruments. As a result, the latent classes of ACEs identified by existing studies were diverse.

Conclusions: There is no uniform paradigm in the current ACEs studies to indicate which experiences should be considered ACEs. The absence of uniformity will cause difficulties in comparing and replicating research findings, especially for studies conducted by LCA. We call for a more explicit rationale proposed by ACEs researchers when including different ACEs indicators in their studies, so the field may potentially reach consensus on salient ACEs that warrant examination.