The Interrelatedness of Adverse Childhood Experiences Among High-Risk Juvenile Offenders

• Author: Michael T. Baglivio,Nathan Epps
• DOI: 10.1177/1541204014566286
• Published date: 01 July 2016
• Date: 01 July 2016
• Subject Matter: Articles

Article
Youth Violence and Juvenile Justice
2016, Vol. 14(3) 179-198
The Interrelatedness of Adverse
ª The Author(s) 2015
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Childhood Experiences Among
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DOI: 10.1177/1541204014566286
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High-Risk Juvenile Offenders
Michael T. Baglivio1 and Nathan Epps1
Abstract
The interrelatedness of adverse childhood experiences (ACEs) in 64,329 juvenile offenders was
examined. ACEs include childhood abuse (physical, emotional, and sexual), neglect (physical and
emotional), and household dysfunction (family violence, family substance use, family mental illness,
separation/divorce, and family incarceration). Prevalence ranged from 12% to 82% for each ACE. Of
youth experiencing one ACE 67.5% reported four or more additional exposures and 24.5%
exposure to six or more additional ACEs. Females have higher prevalence and multiple exposures.
ACEs are interrelated, necessitating assessment of multiple ACEs rather than one or a few. ACE
exposure differs by gender and race/ethnicity.
Keywords
adverse childhood experiences, ACE, trauma, abuse, juvenile offenders
Introduction
Adverse childhood experiences (ACEs) as a composite score were first described in 1998 in the
seminal study ‘‘Relationship of childhood abuse and dysfunction to many of the leading causes
of death in adults: The Adverse Childhood Experiences (ACE) Study’’ (Felitti et al., 1998). The
ACE concept acknowledges the complex and cumulative nature of risk factors through the process
of summing risk factors and associating the composite score with relevant outcomes developed by
Rutter (1983). Through a prospective study including 17,421 insured, well-educated, adult patients,
Felitti and colleagues identified 10 negative childhood events that positively correlate with chronic
disease in adulthood. The 10 adverse experiences are emotional abuse, physical abuse, sexual abuse,
emotional neglect, physical neglect, violent treatment toward mother, household substance abuse,
household mental illness, parental separation or divorce, and having an incarcerated household
member. Additional work has shown even higher prevalence of ACEs in special populations, such
1 Florida Department of Juvenile Justice, Bureau of Research and Planning, Tallahassee, FL, USA
Corresponding Author:
Michael T. Baglivio, Florida Department of Juvenile Justice, Bureau of Research and Planning, 2737 Centerview Drive,
Tallahassee, FL 32399, USA.
Email: Michael.Baglivio@djj.state.fl.us

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Youth Violence and Juvenile Justice 14(3)
as children of alcoholics (Dube, Anda, Felitti, Croft, et al., 2001) and juveniles with justice system
involvement (Baglivio, Epps, Swartz, Huq, & Hardt, 2014), than those found for the mostly middle-
class original ACE Study population.
A person’s cumulative ACE score is expressed as the total number of the reported 10 ACEs. Each
ACE is measured in a binary yes–no fashion such that an affirmative response to each ACE
‘‘counts’’ as 1 point. For example, a positive response for sexual abuse would score 1 point whether
there were 1 or 100 incidents and regardless of the duration or severity of the abuse. The ACE score
ranges from 0 (not having been exposed to any of the traumas/abuses) to 10 (having been exposed to
all of them). Prior ACE studies have indicated a dose–response relationship between ACE scores
and negative outcomes, with higher ACE scores correlating most strongly with negative outcomes
(Brown et al., 2009; Felitti et al., 1998).
The concept of a composite ACE score is central to the understanding of the effect of ACEs,
as it is now clearly evident from empirical evaluation that ACEs are common, highly interre-
lated, and exert a powerful cumulative impact on human development (Anda, Butchart, Felitti,
& Brown, 2010; Dong et al., 2004). This ‘‘cumulative stressor approach’’ based on the co-
occurrence and cumulative impact of these exposures necessitates the examination of them as
a collective composite. The customary approach of examining one or only a few adverse expo-
sures misses the broader interrelated context in which they occur. The use of the ACE score as a
measure of the cumulative traumatic stress exposure during childhood is consistent with the lat-
est understanding of the effects of traumatic stress on neurodevelopment (Anda et al., 2006,
2010).
Life Course Perspective
Sampson and Laub (1990) describe trajectories and transitions as two central concepts of the life
course perspective. Trajectories are defined as pathways or lines of development over the life span,
referring to long-term patterns of behavior. These trajectories are marked by the sequencing of
meaningful life events and transitions, with transitions being specific life events that develop over
shorter time spans (such as single to married or getting arrested). Transitions may typically result in a
change in status or social identity. How an individual adapts to and copes with life events is crucial
to the ultimate outcome where different adaptations and coping styles may lead to different life tra-
jectories. Sampson and Laub (1990, p. 610) note the life course perspective ‘‘implies both a strong
connection between childhood events and experiences in young adulthood, and that transitions or
turning points can modify life trajectories – they can ‘‘redirect paths.’’ Life course criminology,
then, is principally concerned with pathways, and how transitions affect trajectories with respect
to offending, and/or in the lives of offending populations. Prevalence studies, briefly reviewed
below, showing at-risk and offending youth having more abuse/neglect exposure, place ACE in the
risk factor prevention paradigm of developmental and life course criminology (Farrington, 2003). As
such, risk factor research’s primary focus is not on establishing causality and explanations but on
finding correlations (Farrington, 2000).
From a life course perspective, implications of high ACE scores on both proximal and distal neg-
ative outcomes are well documented in the medical literature (Anda et al, 2006, 2010). Higher ACE
scores are associated with significantly increased odds of developing some of the leading causes of
death in adulthood, such as heart disease, cancer, chronic lung disease, skeletal fractures, and liver
disease. Prior studies have shown the odds of having one of those above-mentioned negative health
outcomes in adulthood are up to 12 times higher for children who have experienced four or more
ACEs, in comparison to children without such exposure (Felitti et al., 1998).
Examining more proximal outcomes, higher cumulative ACE scores have been shown to increase
the odds of smoking, heavy drinking, intravenous drug use, incarceration, and morbid obesity, with

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Baglivio and Epps
181
greater risk also for poor educational and employment outcomes and recent involvement in violence
(Bellis, Lowey, Leckenby, Hughes, & Harrison, 2014). ACEs account for a 20–70% increased like-
lihood of mid-adolescence alcohol use initiation (Dube et al., 2006), and a dose–response relation-
ship has been found between ACE score and a history of suicide attempts (Dube, Anda, Felitti,
Chapman, et al., 2001). High ACE scores have been linked to a number of sexual risk behaviors such
as having 50 or more sexual partners, intercourse before age 15 (Hillis, Anda, Felitti, & Marchbanks,
2001), and becoming pregnant as a teenager (Hillis et al., 2004). ACE scores have more recently
been identified with immediate negative consequences such as chromosome damage (Shalev
et al., 2013) and functional changes to the developing brain (Anda et al., 2010; Cicchetti, 2013;
Danese & McEwen, 2012; Teicher et al., 2003).
However, there is a gap in the literature with regard to the prevalence and interrelatedness of
ACEs in offending populations, specifically a juvenile offending population. The prior work
reviewed earlier illustrates the ACE cumulative stressor composite score concept has implications
over a person’s entire life course. Maltreated children are vulnerable to a range of complications
over the life course, including social, health-related, and behavioral problems, including criminal
offending. Furthermore, studies reporting gender and racial differences in ACEs for special popula-
tions, such as juvenile offenders, are also scarce. We attempt to address that gap by examining the
interrelatedness of ACEs in a diverse sample of over 60,000 of the highest risk juvenile offenders
across an entire diverse state. To that end, this study is structured as follows: first, we very briefly
describe the prior work on individual ACEs and justice-involved youth and the limited examination
of cumulative ACE scores with that population. Next, we examine the prevalence of ACEs in the
current sample of juveniles as well as the prevalence of additional ACEs, given the presence of any
specific ACE. Third, we present the odds of having each additional ACE, given the presence of any
specific ACE. Finally, we examine the prevalence of ACEs by gender and race/ethnicity, followed
by a discussion of the findings, policy implications, and directions for future work.
Adverse Childhood Experiences and Adolescents
Recent studies have begun to examine the impact of childhood abuse/maltreatment (in a cumulative
ACE score context) on behaviors in adolescent samples as opposed to retrospective recall of child-
hood abuse in adult samples. Examining the effects of maltreatment on early alcohol use in seventh
through twelfth graders, Hamburger and colleagues found students...