Impact of Childhood Adversity and out-of-Home Placement for Youth With Sexual Behavior Problems

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Early exposure to abuse, neglect, and household dysfunction is linked to long-term detrimental effects on mental and physical health. In the mid-1990s, Kaiser Permanente and the CDC surveyed adults in the community and found a strong and cumulative relationship between the degree of exposure to adverse childhood experiences (ACEs) and risk factors for leading causes of death in adulthood. At present, most research using ACE survey methodology examines community-based adult samples, and populations who experience the greatest number of adversities are largely ignored. An additional factor indicative of household dysfunction that has not been thoroughly explored in the context of ACE survey methodology is foster care placement. Further, little is understood regarding the impact of out-of-home placement on persons with disproportionately high ACE scores and subsequent difficulties with sexual and aggressive behavior. Studies investigating differential risk factors and outcomes could inform prevention, policy, and treatment. As such, the current study seeks to investigate the impact of childhood adversity and out-of- home placement on the onset of aggression and problem sexual behavior using ACE survey methodology in a sample of juveniles receiving residential treatment for sexual misconduct. Data for this study were collected from archival records of children and adolescents who have received sexual offender treatment at a treatment center for male youth (N=120; 88% Caucasian) for periods ranging from one month to more than four years (M=13.68 months, SD=10.96). These participants have a mean age of 14.63 years (SD=1.56; Range: 11 to 17 years) at the time of first admission into the facility. As expected, the adolescents in this study have experienced higher rates of adverse childhood experiences than the general adult population and male adolescents involved in the juvenile justice system previously reported in the literature. Only 2.5% of the current sample experienced no ACEs and 74.2% faced four or more adversities, which is considered to be high risk in the literature. Participants had a mean age at first out-of-home placement of 9 years (SD=5.21) and had an average of 3.7 out-of-home placements at time of admission to the facility. The association of childhood adversities, the number of non-psychiatric out-of-home placements, and age at first out-of-home placement with earlier onset of aggressive and sexual offending behaviors will be investigated using Cox proportional hazard analyses. Behavioral outcomes (e.g., onset of sexual and aggressive behavior problems; substance use; arrest history; and, treatment length) between individuals who were placed in family members’ homes versus those placed in non-familial foster care will also be explored. Implications for prevention and environmental responsiveness will be addressed.


Johnson City, TN

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