Abstract
Purpose
The prevalence of Adverse Childhood Experiences (ACEs) and their link to negative behavioral and health outcomes is well documented, but very few studies have empirically examined the effect of ACEs on intervention outcomes. There is also emerging evidence of gender differences in vulnerability to developing traumatic symptoms, which relates to intervention outcomes. The current study examined the effects of ACEs and gender on trauma-informed intervention outcomes in a community-based clinical setting.
Methods
The study includes data from children who were treated with trauma-informed intervention services grounded in the Attachment, Self-Regulation, and Competency (ARC) framework from 2017 to 2019. ACE scores are measured as a total across 10 items and different types, maltreatment versus family dysfunction, at intake. Children’s trauma-related symptoms are assessed at intake and every 90 days under the ARC framework. In order to examine the changes of traumatic symptoms over time, a total of 362 children with three time points are included for the current analyses using Multilevel modeling with SAS PROC MIXED.
Results
The study found that a trauma-informed intervention based on the ARC framework was effective in reducing children’s trauma related symptoms until they experienced 6 or more ACEs. The intervention effect, however, did not hold when children’s ACEs were cumulated to 7 or more. The study also revealed gender differences in intervention outcomes.
Conclusions
The finding has significant implications for early detection and preventative intervention efforts with children’s ACEs before their ACEs further cumulate to a higher number. Gender difference should be considered in intervention planning and monitored during the intervention process.
Similar content being viewed by others
References
Adverse Childhood Experiences Coalition of West Virginia (2018). Stumbling blocks or stepping stones: Findings on adverse childhood experiences (ACEs) in West Virginia. Retrieved May 15, from https://docs.wixstatic.com/ugd/f00be8_9f2a4e0c3b35456ca4f74c04db1a87a7.pdf
Anda, R. F., Brown, D. W., Felitti, V. J., Dube, S. R., & Giles, W. H. (2008). Adverse childhood experiences and prescription drug use in a cohort study of adult HMO patients. BMC Public Health, 8, 1–9
Arvidson, J., Kinniburgh, K., Howard, K., Spinazzola, J., Strothers, H., Evans, M. … Blaustein, M. (2011). Treatment of complex trauma in young children: developmental and cultural considerations in application of the ARC intervention model. Journal of Child & Adolescent Trauma, 4, 34–51
Ascienzo, S., Sprang, G., & Royse, D. (2021). Gender differences in the PTSD symptoms of polytraumatized youth during isolated phases of trauma-focused cognitive behavioral therapy.Psychological Trauma: Theory, Research, Practice, and Policy.https://doi.org/10.1037/tra0001028
Atzl, V. M., Narayan, A. J., Rivera, L. M., & Lieberman, A. F. (2019). Adverse childhood experiences and prenatal mental health: Type of ACEs and age of maltreatment onset.Journal of Family Psychology, 33(3),304–314
Bartlett, J. D., Griffin, J. L., Spinazzola, J., Fraser, J. G., Norona, C. R., Bodian, R., & Todd, M. Montagna, C., & Barto, B. (2018). The impact of statewide trauma-informed care initiative in child welfare on the well-being of children and youth with complex trauma. Children and Youth Services Review, 84, 110–117
Bellis, M. A., Hughes, K., Leckenby, N., Hardcastle, K., Perkins, C., & Lowey, H. (2014). Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: a national survey.Journal of Public Health, 37,445–454
Blaustein, M., & Kinniburgh, K. (2010). Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self-regulation, and competency. New York:The Guilford Press
Danese, A., & Tan, M. (2014). Childhood maltreatment and obesity:systematic review and meta-analysis.Molecular Psychiatry, 19,544–554
DeLisi, M., Drury, A. J., & Elbert, M. J. (2019). Parent exposure to drugs:A “new” adverse childhood experience with devastating behavioral consequences.Journal of Drug Issues, 49,91–105
Choi, S., Hutchison, B., Lemberger, M. E., & Pope, M. (2012). A longitudinal study of the developmental trajectories of parental attachment and career maturity of South Korean adolescents.Career Development Quarterly, 60,163–177
Cicchetti, D. (2016). Socioemotional, Personality, and Biological Development:Illustrations from a multilevel developmental psychopathology perspective on child maltreatment.Annual Review of Psychology, 67,187–211
Cicchetti, D., & Cohen, D. (1995). Perspectives on developmental psychopathology. In D. Cicchetti, & Cohen, D. (Eds.). Developmental psychopathology (pp.3–20). New York, NY:John Wiley
Cicchetti, D., & Rogosch, F. (1996).Equifinality and multifinality in developmental psychopathology.Development and Psychopathology, 8,597–600
Cicchetti, D., & Toth, S. L. (1995). A developmental psychopathology perspective on child abuse and neglect.Journal of the American Academy of Child & Adolescent Psychiatry, 34,541–565
Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004). A multisite, randomized controlled trial for children with sexual abuse related PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 393–402
Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M. … Kolk, B. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398
Copeland, W. E., Keeler, G., Angold, A., & Costello, J. (2007). Traumatic events and posttraumatic stress in childhood.Archives of General Psychiatry, 64,377–384
Craig, C., & Sprang, G. (2014). Gender differences in trauma treatment. Do boys and girls respond to evidence-based treatments in the same way?Violence and Victims, 29(6),927–939. https://doi.org/10.1891/ 0886–6708.VV-D-13-00016
Crittenon Services, Inc (2018). Faces: Responding to Adverse Childhood Experiences for a Better West Virginia. Retrieved August 29, from https://static1.squarespace.com/static/5b1fc5fc50a54f520607beae/t/5b8434c688251bc772fb4a70/1535390923864/FACES.pdf
Cronholm, P. F., Forke, C. M., Wade, R., Bair-Merritt, M. H., Davis, M., & Harkins-Schwarz, M. Pachter, L. M., & Fein, J. A. (2015). Adverse childhood experiences: Expanding the concept of adversity. American Journal of Preventive Medicine, 49(3), 354–361
Crouch, E., Probst, J. C., Radcliff, E., Bennett, K. J., & McKinney, S. H. (2019). Prevalence of adverse childhood experiences (ACEs) among US children,Child Abuse & Neglect, 92,209–218
DeBellis, M. D. (2002). Developmental traumatology:A contributory mechanism for alcohol and substance use disorders. Psychoneuroendocrinology, 27, 155–170
Dube, S. R., Felitti, V. J., Dong, M., Chapman, D. P., Giles, W. H., & Anda R. F. (2003). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The adverse Childhood Experiences study.Pediatrics, 111,564–572
Dube, S. R., Williamson, D. F., Thompson, T., Felitti, V. J., & Anda, R. F. (2004). Assessing the reliability of retrospective reports of adverse childhood experiences among adult HMO members attending a primary care clinic.Child Abuse & Neglect, 28,729–737
Ducci, F., Roy, A., Shen, P. H., Yuan, Q., Yuan, N. P., & Hodgkinson, C. A., Goldman, L. R., & Goldman, D. (2009). Association of substance use disorders with childhood trauma but not African genetic heritage in an African American cohort. American Journal of Psychiatry, 166, 1031–1040
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., & Edwaeds,V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 245–258
Finkelhor, D., Ormrod, R. K., & Turner, H. A. (2007). Revictimization patterns in a national longitudinal sample of children and youth.Child Abuse & Neglect, 31,479–502
Finkelhor, D., Ormrod, R. K., & Turner, H. A. (2009). Lifetime assessment of poly-victimization in a national sample of children and youth.Child Abuse & Neglect, 33(7),403–411
Finkelhor, D., Shattuck, A., Turner, H., & Hamby, S. (2015). A revised inventory of adverse childhood experiences.Child Abuse & Neglect, 48,13–21
Flaherty, E. G., Thompson, R., Dubowitz, H., Harvey, E. M., & English, D. J., Proctor, L. J., & Runyam, D. K. (2013). Adverse childhood experiences and child health in early adolescence. JAMA Pediatrics, 167, 622–629
Fox, B. H., Perez, M., Cass, E., Baglivio, M. T., & Epps, N. (2105). Trauma changes everything: Examining the relationship between adverse childhood experiences and serious, violent and chronic juvenile offenders.Child Abuse & Neglect, 46,163–173
Greeson, J. K. P., Briggs, E. C., Layne, C. M., Belcher, H. M. E., Ostrowski, S. A., & Kim, S., Pynoos, R. S., & Fairbank, J. A. (2014). Traumatic childhood experiences in the 21st century: Broadening and building on the ACE studies with data from the National Child Traumatic Stress Network. Journal of Interpersonal Violence, 29, 536–556
Hillis, S. D., Anda, R. F., Felitti, V. J., & Marchbanks, P. A. (2001). Adverse childhood experiences and sexual risk behaviors in women. A retrospective cohort study.Family Planning Perspectives, 33,206–211
Hodgdon, H. B., Kinniburgh, K., Gabowitz, D., Blaustein, M., & Spinazzola, J. (2013). Development and implementation of trauma-informed programming in youth residential treatment centers using the ARC framework. Journal of Family Violence, 28, 679–692
Holmes, C., Levy, M., Smith, A., Pinne, S., & Neese, P. (2015). A model for creating a supportive trauma-informed culture for children in preschool settings.Journal of Child and Family Studies, 24,1650–1659
Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., et al. (2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis.The Lancet Public Health, 2(8),e356–66
Kane, J. C., Murray, L. K., Cohen, J., Dorsey, S., Skavenski, & van Wyk, S., Galloway Henderson, J., Imasiku, M., Mayeya, J., & Bolton, P. (2016). Moderators of treatment response to trauma-focused cognitive behavioral therapy among youth in Zambia. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 57, 1194–1202
Kim, J., & Cicchetti, D. (2010). Longitudinal pathways linking child abuse and neglect, emotion regulation, peer rejection, and psychopathology.Journal of Child Psychology and Psychiatry, 51,706–716
Leban, L., & Gibson, C. L. (2020). The role of gender in the relationship between adverse childhood experience and delinquency and substance use in adolescence,Journal of Criminal Justice, 66,101637. https://doi.org/10.1016/j.jcrimjus.2019.101637
Lodhia, N. A., Rosas, U. S., Moore, M., Glaseroff, A., Azagury, D., Rivas, H., & Morton, J. M. (2015). Do Adverse Childhood Experiences Affect Surgical Weight Loss Outcomes?,Journal of Gastrointestinal Surgery, 19,993–998
Lyons, J., Rawal, P., Yeh, I., & Leon, S. (2002). Use of measurement audit in outcomes management. Journal of Behavioral Health Services & Research, 29, 75–80
Lyons, J., & Weiner, D. (2009). Behavioral Health Care: Assessment, Service Planning, and Total Clinical Outcomes Management. Kingston, N. J.: Civic Research Institute, Inc
McCarthy, G. (1998). Attachment representations and representations of the self in relation to others: A study of preschool children in inner-city London.British Journal of Medical Psychology, 71,57–72
Maughan, A., & Cicchetti, D. (2002). Impact of child maltreatment and interadult violence on children’s emotion regulation abilities and socioemotional adjustment.Child Development, 73,1525–1542
Mills, K. L., Teeson, M., Ross, J., Darke, S., & Shanahan, M. (2005). The costs and outcomes of treatment for opioid dependence associated with post-traumatic stress disorder.Psychiatric Services, 56,940–945
Murray, L. K., Cohen, J. A., & Mannarino, A. P. (2013). Trauma focused cognitive behavioral therapy for youth who experience continuous traumatic exposure.Peace and Conflict, 19,180–195
Narayan, A. J., Kalstabakken, A. W., Labella, M. H., Nerenberg, L. S., & Monn, A. R., & Masten, A. S. Intergenerational continuity of adverse childhood experiences in homeless families: Unpacking exposure to maltreatment versus family dysfunction.American Journal of Orthopsychiatry, 87,3–14
Negriff, S. (2020). ACEs are not equal. Examining the relative impact of household dysfunction versus childhood maltreatment on mental health in adolescence,Social Science & Medicine, 245:112696. DOI: https://doi.org/10.1016/j.socscimed.2019.112696
O’Connell, J. M., Novins, D. K., Beals, J., Whitesell, N. R., Libby, A., Orton, H., & Croy, C. D. (2007). Childhood characteristics associated with stage of substance use of American Indians: Family background, traumatic experiences, and childhood behaviors.Addictive Behaviors, 32,3142–3152
Osofsky, J. (Ed.). (2004). Young children and trauma: Intervention and treatment. New York, NY:Guilford Press
Rishel, C. W., Tabone, J. K., Hartnett, H. P., & Szafran, K. F. (2019). Trauma-Informed Elementary Schools: Evaluation of a School-Based Early Intervention for Young Children.Children & Schools, 41,239–248
Ryan, K. D., Kilmer, R. P., Cauce, A. M., Watanabe, H., & Hoyt, D. R. (2000). Psychological consequences of child maltreatment in homeless adolescents: Untangling the unique effects of maltreatment and family environment.Child Abuse & Neglect, 24,333–352
Scheeringa, M. S., & Zeanah, C. H. (2001).A Relational Perspective on PTSD in Early Childhood.Journal of Trauma Stress14,799–815
Shipman, K. L., Schneider, R., Fitzgerald, M. M., Sims, C., Swisher, L., & Edwards, A. (2007). Maternal emotion socialization in maltreating and non-maltreating families: Implications for children’s emotion regulation.Social Development, 16,268–285
Shomaker, L. B., & Furman, W. (2009). Parent–adolescent relationship qualities, internal working models, and styles as predictors of adolescents’ observed interactions with friends.Journal of Social and Personal Relationships, 26,579–603
Spinazzola, S., Habib, M., Knoverek, A., Arvidson, J., Nisenbaum, J. … Wentworth, R., …Kisiel, C. The heart of the matter: Complex trauma in CW. CW360 Traumainformed CW Practice (pp.8–9). St. Paul, MN:Center for Advanced CW Studies in CW, School of Social Work, University of Minnesota
Steinke, C. M., & Derrick, R. M. (2018). An exploration of the role of adverse childhood experiences (ACEs) on youth engagement in residential treatment,Child Abuse & Neglect, 89,355–363
Suglia, S. F., Koenen, K. C., Boynton-Jarrett, R., Chan, P. S., Clark, C. J., & Danese, A., Faith, M. S., Goldstein, B. I., Hayman, L. L., Isasi, C. R., Pratt, C. A., Slopen, N., Sumner, J. A., … Zachariah, J. P. (2018). Childhood and adolescent adversity and cardiometabolic outcomes: a scientific statement from the American Heart Association. Circulation, 137, 15–28
Tabone, J. K., Rishel, C. W., Hartnett, H. P., & Szafran, K. (2020). Examining the effectiveness of early intervention to create trauma-informed school environments.Children and Youth Services Review, 113,7pages, https://doi.org/10.1016/j.childyouth.2020.104998
Tabone, J. K., Rishel, C. W., Hartnett, H. P., & Szafran, K. (2021). Trauma-informed intervention with children: Integrating the CANS assessment with the ARC framework in a clinical setting,Journal of Child & Adolescent Trauma. https://doi.org/10.1007/s40653-021-00357-x
Taillieu, T. L., Brownridge, D. A., Sareen, J., & Afifi, T. O. (2016). Childhood emotional maltreatment and mental disorders: results from a nationally representative adult sample from the United States,Child Abuse & Neglect, 59,1–12
Tol, W. A., Komproe, I. H., Susanty, D., Jordans, M. J., Macy, R. D., & De Jong J. T. (2008). School-based mental health intervention for children affected by political violence in Indonesia: A cluster randomized trial.Journal of the American Medical Association, 300(6),655–662. https://doi.org/10.1001/jama.300.6.655
Trauelsen, A. M., Bendall, S., Jansen, J. E., Nielsen, H. L., Pedersen, M. B., & Trier,C. H., Haahr, U. H., & Simonsen, E. (2015). Childhood adversity specificity and dose-response effect in non-affective first-episode psychosis. Schizophrenia Research, 165, 52–59
Turner, H. A., Finkelhor, D., & Ormrod, R. (2006). The effect of lifetime victimization on the mental health of children and adolescents.Social Science & Medicine, 62,13–27
Wade, R., Cronholm, P. F., Fein, J. A., Forke, C. M., Davis, M. B. … Harkins-Schwarz,M., & Bair-Merritt, M. H. (2016). Household and community-level adverse childhood experiences and adult health outcomes in a diverse urban population. Child Abuse & Neglect, 52, 135–145
Wamser-Nanney, R., & Cherry, K. E. (2018).Children’s trauma-related symptoms following complex trauma exposure: Evidence of gender differences,Child Abuse & Neglect, 77,188–197
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Tabone, J.K., Rishel, C.W., Hartnett, H.P. et al. Examining the Effects of Adverse Childhood Experiences and Gender on Trauma-Informed Intervention Outcomes. Journ Child Adol Trauma 16, 9–19 (2023). https://doi.org/10.1007/s40653-022-00456-3
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40653-022-00456-3