Adverse Childhood Experiences and Preventive Intervention Efficacy

Introduction: Exposure to myriad adverse childhood experiences (ACEs), such as abuse, neglect, chronic instability, and community violence, is associated with deleterious effects on mental health and psychosocial functioning (e.g., Cicchetti & Toth, 2005; Hodges et al., 2013; Felitti et al., 1998; Widom, DuMont, & Czaja, 2007). Despite progress in the development of mental health interventions for traumatized children, a significant amount of children are not able to benefit from existing services. For various reasons, including pressure to widely disseminate evidence-based programs (Mason et al., 2013), successful preventive interventions often stop short of examining their reach. Understanding who is likely to benefit from interventions, however, has important implications for determining appropriate referrals and policy (Supplee, Kelly, MacKinnon, & Barofsky, 2013). The current study sought to examine whether the impact of an efficacious preventive intervention for maltreated children differed by participants’ level of exposure to ACEs.

Method: Baseline and 6-month post-intervention mental health data were collected from 156 9- to 11-year-old children (50.7% female) as part of a randomized controlled trial of the Fostering Healthy Futures program (FHF), a mentoring and skills group intervention for children recently placed in foster care due to maltreatment. The racial/ethnic distribution (nonexclusive categories) was 47.2% Caucasian, 45.8% Hispanic, 29.9% African American, 7.6% Native American, 1.4% Asian American, 1.4% Pacific Islander, and 0.7% Other. Multi-informant (i.e., children, caregivers, teachers, and child welfare administration) measures were utilized to assess exposure to ACEs (Raviv et al., 2010) and mental health outcomes (e.g., Trauma Symptom Checklist for Children; Briere, 1996).

Results: Significant, positive relationships were found between ACEs and baseline mental health problems (r=.18-.48). The intervention and control groups did not differ on baseline ACEs exposure or mental health variables. Significant moderation effects, however, were observed in regression models predicting post-intervention symptoms of posttraumatic stress (b = 4.62, SE = 1.33, p < .001) and dissociation (b = 3.78, SE = 1.33, p < .01). In probing these interactions, children in the FHF intervention who were exposed to relatively fewer ACEs evidenced better outcomes on posttraumatic stress and dissociation post-intervention relative to the control group. Children in the intervention group exposed to the highest number of ACEs, however, appeared no different than their high-risk counterparts in the control group.

Conclusions: Preventive interventions for traumatized children are sorely needed, but it is not prudent to assume positive effects for all participants. Findings from this study suggest that children exposed to high numbers of ACEs may not glean the same benefits as those exposed to some, but fewer, adversities. Findings from this study are relevant for audiences who work with, or make decisions for, traumatized children.