Patterns of Adverse Childhood Experiences Associated with Externalizing Problems: A Latent Class Analysis


Clifford, Meghan E.; Nguyen, Amanda J.; & Bradshaw, Catherine P. (2022). Patterns of Adverse Childhood Experiences Associated with Externalizing Problems: A Latent Class Analysis. Violence and Gender.


Exposure to adverse childhood experiences (ACEs) is a well-established metric of cumulative risk associated with later development of behavioral and mental health difficulties. Much of the literature has relied solely on a simple summed score of exposure to different types of ACEs to operationalize the complex construct of cumulative risk, despite a lack of evidence documenting that all ACEs exert an equivalent impact on risk for a particular outcome. To address this issue and examine associations between ACEs and externalizing problems, the present study aimed to (1) measure associations between each individual ACE indicator and three adolescent and adult externalizing outcomes, (2) identify unique patterns of exposure to ACEs, and (3) examine differences in the extent to which unique ACE exposure patterns influence externalizing problems. Data came from a sample of 4185 participants in the National Longitudinal Study of Adolescent and Adult Health (Add Health). Each outcome was first regressed onto all individual ACE indicators. The authors then entered all ACE indicators into a latent class analysis (LCA), fitting models with one to four classes. After identifying the best-fitting model, externalizing outcomes were regressed onto the latent classes while adjusting for demographics. Initial regression analyses identified several individual ACE indicators that uniquely predicted increased odds of reporting externalizing problems after adjusting for other ACEs exposure. Using LCA, the authors identified three distinct ACE classes: (1) Low ACEs (77%), (2) Moderate Multiple ACEs (11%), and (3) Hostile Maltreatment (12%). Compared to the Low ACEs Class, the other two classes were associated with higher levels of externalizing problems overall, with the Moderate Multiple ACEs Class exhibiting the greatest risk of endorsing externalizing outcomes during adolescence and adulthood. Findings generally supported the hypothesis that exposure to multiple different types of ACEs captures a sizable portion of risk; however, certain ACE indicators were also identified as having particularly close links to externalizing problems in adolescence and young adulthood. The present study highlights the importance of considering the operationalization of exposure to ACEs based on both cumulative risk and unique patterns of exposure. Implications for enhanced assessment of individual risk for externalizing problems are discussed.



adverse childhood experiences,

Reference Type

Journal Article

Journal Title

Violence and Gender


Clifford, Meghan E.
Nguyen, Amanda J.
Bradshaw, Catherine P.

Year Published




Reference ID