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Abstract
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Adverse childhood experiences (ACEs) refer to the following 10 childhood experiences researchers have identified as risk factors for chronic disease in adulthood: emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, violent treatment towards mother, household substance abuse, household mental illness, parental separation or divorce, and having an incarcerated household member. ACEs were first described in 1998 by Felitti, Anda and colleagues with the publication of the seminal study, "Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study" (Felitti et al., 1998). Through a prospective study co-piloted with Dr. Robert Anda of the Centers for Disease Control and Prevention (CDC), including 17,421 insured, well-educated, adult patients, these researchers were able to identify the 10 childhood experiences, just mentioned, that positively correlate with chronic disease in adulthood (Stevens, 2012). While the prevalence of ACEs among this middle-class population shocked many at the time, ACEs have since been shown to have an even higher prevalence in special populations, such as children of alcoholics (Dube et al., 2001).
An individual's ACE score is expressed as the total number of reported ACEs measured in a binary, yes/no fashion. For example, a positive response to a question on sexual abuse would score 1 point, whether there were one or 100 incidents. The concept of an ACE composite score is central to our understanding of the effect of ACEs. Empirical evaluations have shown that ACEs are common, highly interrelated, and exert a powerful cumulative effect on human development (Anda, Butchart, Felitti, & Brown, 2010). This "cumulative stressor approach," based on the co-occurrence and cumulative effect of these experiences, necessitates their examination as a collective composite, as opposed to the historical approach of examining one or only a few adverse exposures, which misses the broader context in which they occur. The use of the ACE score as a measure of the cumulative effect of traumatic stress exposure during childhood is consistent with the latest understanding of the effects of traumatic stress on neurodevelopment (Anda et al., 2010; Anda et al., 2006).
The implications of high ACE scores are well documented in the medical literature (Anda et al., 2010; Anda et al., 2006). While they were first identified as risk factors for chronic disease, they 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). Furthermore, high ACE scores have been linked to a number of sexually risky 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). Higher cumulative ACE scores have been shown to increase the odds of smoking, heavy drinking, incarceration, and morbid obesity, along with increased risk for poor educational and employment outcomes and recent involvement in violence (Bellis, Lowey, Leckenby, Hughes, & Harrison, 2013). Higher ACE scores have been shown to significantly increase the 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 that for children who have experienced four or more ACEs, the odds of having one of the above-mentioned negative health outcomes in adulthood are up to 12 times greater than those of children who have not had such exposure (Felitti et al., 1998). The study of adverse childhood experiences (ACEs) and their negative repercussion on adult health outcomes is well documented. In a population of insured Californians, a dose-response relationship has been demonstrated among 10 ACEs and a host of chronic physical health, mental health, and behavioral outcomes. Less widely studied is the prevalence of these ACEs in the lives of juvenile offenders, and the effect of ACEs on children.
This study examines the prevalence of ACEs in a population of 64,329 juvenile offenders in Florida. This article reports the prevalence of each ACE and assigns an ACE composite score across genders and a risk to reoffend level classification, and compares these with ACE studies conducted on adults. Analyses indicate offenders report disturbingly high rates of ACEs and have higher composite scores than previously examined populations.
Policy implications underline the need to screen for and address ACEs as early as possible to prevent reoffending and other well-documented sequelae.
Michael T. Baglivio, Florida Department of Juvenile Justice, Bureau of Research & Planning; Nathan Epps, Florida Department of Juvenile Justice, Bureau of Research & Planning; Kimberly Swartz, University of Florida College of Medicine/Levin College of Law; Mona Sayedul Huq, University of Florida College of Health and Human Performance; Amy Sheer, University of Florida College of Medicine; Nancy S. Hardt, Department of Pathology and Ob-Gyn, and Health Equity and Service Learning Programs, University of Florida College of Medicine. Correspondence concerning this article should be addressed to Michael T. Baglivio and Nathan Epps, Florida Department of Juvenile Justice, Bureau of Research & Planning, Programming and Technical Assistance Unit, 2737 Centerview Drive, Tallahassee, FL 32399. E-mail: michael.baglivio@djj.state.fl.us
Authors' Note: The views expressed in this manuscript are those of the authors and not necessarily the Florida Department of Juvenile Justice.
KEYWORDS: juvenile offenders, prevention, victimization, maltreatment , juvenile justice, chld abuse
Language: en |