The Clustering of Adverse Childhood Experiences in the Avon Longitudinal Study of Parents and Children: Are Gender and Poverty Important?

Rebecca E Lacey,Mel Bartley,Laura D Howe,Michelle Kelly-Irving,Yvonne Kelly

doi:10.1177/0886260520935096

Abstract

Previous research has demonstrated a graded relationship between the number of Adverse Childhood Experiences reported (an ACE score) and child outcomes. However, ACE scores lack specificity and ignore the patterning of adversities, which are informative for interventions. The aim of the present study was to explore the clustering of ACEs and whether this clustering differs by gender or is predicted by poverty. Data on 8,572 participants of the Avon Longitudinal Study of Parents and Children (ALSPAC) were used. ALSPAC is a regionally representative prenatal cohort of children born between 1991 and 1992 in the Avon region of South-West England. ACEs included parental divorce, death of a close family member, interparental violence, parental mental health problems, parental alcohol misuse, parental drug use, parental convictions, and sexual, emotional, and physical abuse, between birth and 19 years. Latent class analysis was used to derive ACE clusters and associations between poverty, gender, and the derived classes tested using multinomial logistic regression. Five latent classes were identified: “Low ACEs” (55%), “Parental separation and mother’s mental health problems” (18%), “Parental mental health problems, convictions and separation” (15%), “Abuse and mental health problems” (6%), and “Poly adversity” (6%). Death of a close family member and sexual abuse did not cluster with other adversities. The clustering did not differ by gender. Poverty was strongly related to both individual ACEs and clusters. These findings demonstrate that ACEs cluster in specific patterns and that poverty is strongly related to this. Therefore, reducing child poverty might be one strategy for reducing ACEs.

Highlights

Previous research has demonstrated a graded relationship between the number of Adverse Childhood Experiences reported and child outcomes
We addressed three Research Questions (RQs): Research Question 1 (RQ1): How do early life adversities cluster? Research Question 2 (RQ2): Does the clustering of adversities differ for males and females? Research Question 3 (RQ3): Does the clustering of adversities depend on poverty status?
RQ1: How do early life adversities cluster? Using a large population dataset, we showed that adversities cluster and derived five classes of individuals reporting similar Adverse Childhood Experiences (ACEs)

Summary

Introduction

Previous research has demonstrated a graded relationship between the number of Adverse Childhood Experiences reported (an ACE score) and child outcomes. A recent prevalence study in England showed that around half of adults reported at least one childhood adversity, most commonly living with a parent with a mental illness, parental separation/divorce, or having been verbally abused (Bellis et al, 2014). One of the most cited studies on the long-term effects of ACEs—the Kaiser Permanente Adverse Childhood Experiences study (Felitti et al, 1998)—showed that adults who experienced household dysfunction (living with a household member with substance misuse problems, mental illness, criminality, or witnessing interparental violence) or maltreatment (psychological, physical, or sexual abuse) in childhood had increased odds of many health outcomes, including ischemic heart disease, stroke, substance misuse, depression, and having attempted suicide. Reported ACE information is known to have important limitations (Baldwin et al, 2019)

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