Research has long established a ‘dose-response’ relationship between adverse childhood experiences (ACEs) and poor developmental outcomes. ACEs are associated with a wide range of physical and mental health problems (Felitti et al., 1998) as well as an increased risk of involvement in violent and chronic juvenile offending (Fox et al., 2015). According to a study of 64,329 juvenile offenders in Florida, approximately 97% had experienced at least one ACE; moreover, higher ACE scores were associated with an increased risk of reoffending (Baglivio et al., 2014).

The alarmingly high prevalence of ACEs amongst juvenile offenders points to a cycle of violence, with research demonstrating that each additional ACE experienced perpetuates further involvement in adolescent interpersonal violence by up to 144% (Duke et al., 2010). Indeed, a previous Mental Elf blog has discussed meta-analytic evidence supporting childhood maltreatment and the female cycle of violence.

To synthesise the growing evidence linking ACEs and juvenile reoffending, this systematic review and meta-analysis by Yohros (2023) aimed to investigate the cumulative impact of ACEs on reoffending and the specific factors which might influence the ACE-reoffending relationship.

Methods

Yohros (2023) used multiple search strategies to identify eligible studies for this systematic review. This involved searching criminology and behavioural science databases (e.g., Criminal Justice Periodical Index), checking US governmental organisation websites for governmental reports on juvenile justice, and contacting experts and practitioners to identify any studies that might not have been found through the primary searches.

Studies were included if they:

1. Measured recidivism or reoffending as the outcome variable
2. Used a single cumulative ACE score as the predictor variable
3. Included delinquent youth who had been adjudicated or arrested at or before age 18
4. Utilised prospective longitudinal or experimental designs
5. Applied multivariate and methodologically rigorous statistical analyses that allowed for meta-analysis.

In addition, the inclusion of studies was not limited to published journal status, language or geographic origin.

A total of 341 studies were screened, of which 16 were eligible for inclusion in the review. Twelve studies were based in the United States, 3 in Canada, and 1 in Japan. All studies were published between 2013 and 2020. Most studies measured the original 10 ACEs from the study by Felitti et al. (1998), while reoffending was measured as a re-arrest or re-adjudication after a release, community-based placement, or charge.

For the meta-analysis, 14 studies which applied logistic regression or analyses with dichotomous outcomes were included such that the odds ratio could be treated as the harmonised effect size. Thus, this was interpreted as the change in the likelihood of reoffending associated with a one-unit change in the number of ACEs.

To account for multiple main effect sizes or studies with only subgroup effect sizes, this study employed a three-level random effects model to consider three different variance components: 1) sampling variance of the extracted effect sizes, 2) variance between effect sizes extracted from the same study, and 3) variance between studies.

Results

Overall, the meta-analysis of 26 effect sizes within the 14 studies revealed that experiencing more ACEs was associated with a 4.4% increase in the odds of reoffending. These results applied for both re-arrest and re-adjudication.

The majority of studies (14 out of 16) reported at least one significant association between ACEs and reoffending. Notably, two studies found an inverse relationship between ACEs and reoffending in subgroup analyses, although further details were not provided on this finding.

Effect sizes were highly heterogeneous across samples, with larger sample studies demonstrating larger effect sizes than smaller sample studies. Sample sizes varied greatly from 100 to over 50,000 youths.

Five of the seven studies which examined gender differences did not find significant differences in the effect of ACEs, suggesting that ACEs impact the reoffending rates for males and females similarly. However, the narrative synthesis revealed that the relationship between ACEs and juvenile reoffending might be influenced in nuanced ways by gender and racial differences, as well as other individual and environmental factors. For example:

• Among white females and minority males, experiencing domestic violence and sexual offenses was associated with particularly strong effect sizes in the increased likelihood of being re-arrested (Craig & Zettler, 2021).
• Changes in empathy moderated the impact of ACEs on reoffending, where large improvements in empathy buffered the risk of ACEs on reoffending (Narvey et al., 2021)
• Family-based programming and aggression replacement training had an impact on reoffending for males, but only completing aggression replacement training decreased the odds of reoffending for females (Kowalski, 2019)

Potential mechanisms underlying the relationship between ACEs and juvenile reoffending

Across six studies, mediation analyses identified potential mechanisms underlying the relationship between ACEs and juvenile reoffending. For example:

• Negative emotionality (i.e., the individual tendency to perceive and interact with the environment in a generally negative way) mediated the relationship between ACEs and juvenile reoffending (Wolff & Baglivio, 2017)
• Drug and alcohol use partially mediated the relationship between ACEs and reoffending for White and Black youth, but not Hispanic youth (Craig et al., 2019)
• Co-occurring mental health problems partially mediated the relationship between the ACEs-reoffending relationship for Black youth, while co-occurring mental health and drug use partially mediated the ACE-reoffending relationship for White youth (Craig et al., 2019)

Conclusions

Yohros (2023) concluded that,

The analysis finds an overall small but significant effect between ACEs and youth reoffending, meaning that the greater number of ACEs increases the likelihood of recidivism.

This study also draws attention to sociodemographic factors which might provide a more nuanced understanding of the ACE-reoffending relationship. There were specific gender and ethnicity differences in the way ACEs impacted the risk of reoffending, especially when reoffending was disaggregated by offence type. These differences were further nuanced when considering other individual factors (e.g., empathy) and environmental factors (e.g., substance use). Finally, this study highlighted potential mechanisms (e.g., negative emotionality) which might mediate the relationship between ACEs and reoffending.

Strengths and limitations

Regarding this study’s methodological strengths, Yohros (2023) adhered to high standards of evidence synthesis by following the systematic review guidelines of the Campbell Collaboration. The search strategy was comprehensive as multiple sources were examined: scientific databases and government websites, along with expert consultation from practitioners in the field. “Grey” literature such as dissertations were included to avoid publication bias. Furthermore, the statistical analysis was rigorous; multi-level meta-analytic techniques were applied to account for studies with multiple main effect sizes and ensure that statistical power was not lost.

Regarding this study’s limitations, the small number of included studies (n = 14 for the meta-analysis) and largely homogeneous sample (15 of the 16 studies took place in the United States or Canada, and half of all the studies were from Florida) casts doubt on whether these findings can be generalised to populations outside of the Western context. Of course, as a systematic review is a reflection of existing literature, future research on ACEs and reoffending should sample from more diverse countries in order to achieve more generalisable results.

A more conceptual limitation embedded within the field is the predominant cumulative risk approach, which sums the total number of ACEs experienced into a risk score. Operationalising ACEs as a cumulative risk score produces numerous limitations; for instance, it:

1. Assumes all ACEs exert equal effects on poor developmental outcomes,
2. Ignores specific patterns of ACEs that tend to cluster together, and
3. Obscures the investigation of underlying mechanisms (Lacey & Minnis, 2020).

Given that this systematic review only included studies which used the cumulative ACE score, the potential mechanisms identified in the mediation analyses might not have been the true mechanism underlying each individual ACE if they had been analysed separately or grouped together as a particular ACE category. Alternative approaches such as the Dimensional Model of Adversity and Psychopathology (DMAP) have been proposed to operationalise ACEs as distinct dimensions (e.g., threat and deprivation), in order to illuminate the cognitive pathways through which different ACEs lead to poor outcomes (McLaughlin et al., 2014).

Finally, in keeping with the practice of open science, pre-registering the protocol and analysis plans on PROSPERO would have improved the transparency and reproducibility of this systematic review.

Implications for practice

This study has key implications for practice and policy. The small but significant impact of ACEs on reoffending emphasises the importance of screening for ACEs in juvenile justice settings, as well as the prevention of/protection from other adverse experiences. By implementing evidence-based ACE screening as early as possible for all youths entering the justice system, this could help to improve the life and health outcomes of at-risk youth, prevent juveniles from engaging in further risky behaviours, and ultimately reduce future costs to the criminal justice, social service, and medical systems.

Training in trauma-informed care may be particularly vital for all practitioners and personnel who work with juveniles, including in criminal justice settings, to ensure that vulnerable youths who have experienced ACEs are met with sensitive and appropriate care. This study highlighted possible mechanisms underlying the relationship between ACEs and reoffending (e.g., negative emotionality) which could potentially be incorporated into trauma-informed training to improve mental health responses in juvenile justice settings. Critically, gender and racial differences must also be taken into account to ensure that minority youths receive support tailored to their individual needs.

In terms of implications for future research, it would be beneficial for future studies to draw from informants other than official sources. All studies in this systematic review measured reoffending from official sources, which might have been confounded by differences in police and judicial practices. Triangulating from multiple informants (e.g., self-report and parent reports) could provide a more holistic measure of reoffending. Additionally, as the current literature in this review was limited to follow-up periods of up to three years, future research should employ longitudinal designs to investigate the life course impact of ACEs on reoffending in adulthood. Applying a life course perspective would improve the understanding of the long-term effects of intervening on ACEs, which could be particularly useful for informing social policy and interventions.

Statement of interests

Athena Chow is currently funded by the Leverhulme Trust for her doctoral research on adverse childhood experiences.

Links

Primary paper

Yohros, A. (2023) Examining the Relationship Between Adverse Childhood Experiences and Juvenile Recidivism: A Systematic Review and Meta-Analysis. Trauma, Violence, & Abuse, 24(3), 1640-1655.

Other references

Baglivio, M. T., Epps, N., Swartz, K., Huq, M. S., Sheer, A., & Hardt, N. S. (2014). The prevalence of adverse childhood experiences (ACE) in the lives of juvenile offenders. Journal of Juvenile Justice, 3(2), 1-17.

Craig, J. M., Intravia, J., Wolff, K. T., & Baglivio, M. T. (2019). What can help? Examining levels of substance (non) use as a protective factor in the effect of ACEs on crime. Youth Violence and Juvenile Justice, 17(1), 42-61.

Craig, J. M., & Zettler, H. R. (2021). Are the effects of adverse childhood experiences on violent recidivism offense-specific?. Youth Violence and Juvenile Justice, 19(1), 27-44.

Critvatu, I. (2020). Can childhood maltreatment lead to a female cycle of violence? The Mental Elf.

Duke, N. N., Pettingell, S. L., McMorris, B. J., & Borowsky, I. W. (2010). Adolescent violence perpetration: Associations with multiple types of adverse childhood experiences. Pediatrics, 125(4), 778–786.

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, 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(4), 245–258.

Fox, B. H., Perez, N., Cass, E., Baglivio, M. T., & Epps, N. (2015). Trauma changes everything: Examining the relationship between adverse childhood experiences and serious, violent and chronic juvenile offenders. Child Abuse & Neglect, 46, 163-173.

Kowalski, M. A. (2019). Adverse childhood experiences and justice-involved youth: The effect of trauma and programming on different recidivistic outcomes. Youth Violence and Juvenile Justice, 17(4), 354–384.

Lacey, R. E., & Minnis, H. (2020). Practitioner review: Twenty years of research with adverse childhood experience scores – advantages, disadvantages and applications to practice. Journal of Child Psychology and Psychiatry, 61(2), 116–130.

McLaughlin, K. A., Sheridan, M. A., & Lambert, H. K. (2014). Childhood adversity and neural development: Deprivation and threat as distinct dimensions of early experience. Neuroscience and Biobehavioral Reviews, 47, 578–591.

Narvey, C., Yang, J., Wolff, K. T., Baglivio, M., & Piquero, A. R. (2021). The interrelationship between empathy and adverse childhood experiences and their impact on juvenile recidivism. Youth Violence and Juvenile Justice, 19(1), 45-67.

Wolff, K. T., & Baglivio, M. T. (2017). Adverse childhood experiences, negative emotionality, and pathways to juvenile recidivism. Crime & Delinquency, 63(12), 1495–1521.

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