Early Child Adversity and Delinquent Behavior in Foster Care Youth: Do Future Expectations and Sexual Identity Moderate the Mediating Role of Posttraumatic Stress?

doi:10.21203/rs.3.rs-1991671/v1

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Early Child Adversity and Delinquent Behavior in Foster Care Youth: Do Future Expectations and Sexual Identity Moderate the Mediating Role of Posttraumatic Stress?

https://doi.org/10.21203/rs.3.rs-1991671/v1

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Purpose: Delinquent adolescent behavior is a significant public health concern for youth who experience early life adversity and complex trauma. The present study explored the longitudinal association between adverse child experiences and future engagement in delinquent behavior.

Methods: Using a sample of 1,245 foster youth who are aging out of the child welfare system, mediation, moderation, and moderated mediation analysis was used to test the mechanistic role of post-traumatic stress symptoms and the moderating role of sexual identity and positive future expectations on engagement in delinquent behavior.

Results: Results showed a positive and significant association between adverse child experiences and engagement in delinquent behavior. Post-traumatic stress symptoms partially mediated the ACEs-delinquency relationship. In addition, sexual minority youth and youth who were less optimistic about the future who experienced more ACEs had heightened levels of post-traumatic stress.

Conclusions: Interventions that promote positive future outlooks may minimize the psychological sequelae of early child adversity and delinquent behavior particularly when tailored to the needs of sexual minority youth.

Social Work

Delinquent behavior

Future expectations

Foster youth

post-traumatic stress

LGBTQ

According to the most recent data available, 631,832 youth were served by the foster care system between October 1 – September 30, 2020 (U.S. Department of Health and Human Services, 2020). High levels of family and household adversity, such as caregiver substance use, inability to cope, death of a parent and/or housing issues, in addition to being the victim of child maltreatment, are experiences that disproportionately impact youth involved with the child welfare system (Dovran et al., 2012; Keller et al., 2010). Research has consistently shown that child welfare involved youth experience relatively more adverse child experiences (ACEs) than youth without child welfare involvement (Harman et al., 2000; Kisiel et al., 2009; Pecora et al., 2009). As well, systems involved youth have high levels of engagement with delinquent behavior which places them at an increased risk for criminal justice involvement as adults (Lee et al., 2015).

Whereas public health research has documented the effect of adverse child experiences (ACEs) on a broad array of mental and behavioral health problems, surprisingly few studies have examined the mechanisms underlying the cumulative impact of ACEs on future delinquent behavior (Jones & Pierce, 2021). The few studies that do exist focus on the relationship between ACEs exposure and either risk of serious or violent offending or involvement in the juvenile justice system more generally (Baglivio et al., 2015, 2020; Wolff & Baglivio, 2017). Whereas these studies have furthered our understanding about the impact of ACEs for juvenile offenders, more research tailored to the unique experiences and characteristics of foster youth is needed to better elucidate the underlying psychological mechanisms and characteristics that may explain the ACEs-delinquency relationship in this population. Therefore, drawing upon insights from past research, the present study adds to the current body of knowledge by examining the link between cumulative traumatic exposures and delinquent behavior using a large, heterogenous sample of youth who are aging out of the foster care system. We begin by examining the role of ACEs on the development of delinquent behaviors as mediated by symptoms of post-traumatic stress for which empirical evidence shows a strong and consistent relationship. Additionally, we investigate the role of sexual minority status and positive future expectations/optimism as potential moderators of the effects of early child adversity on PTS and delinquent behavior in adolescence.

Adverse Childhood Experiences and Behavioral Health Outcomes of Foster Youth

Maltreated children in foster care are overrepresented among multiple overlapping service institutions including the child welfare, juvenile justice, and mental health systems (Blumberg et al., 1996; Halfon et al., 1992). Among foster youth with maltreatment histories, between 35-60% will develop symptoms of post-traumatic stress and between 9-30% will meet the criteria for PTSD during their lifetime (Burns et al., 2004; Kolko et al., 2010; Leslie et al., 2005). In contrast, lifetime prevalence of PTSD among youth in the general population has been shown to have lower prevalence, ranging between 0.5–9% (Kolko et al., 2010; Salazar et al., 2014). A considerable amount of research conducted during the past two decades has linked early childhood adversity to the presentation of trauma-related psychopathology including the onset and development of post-traumatic stress (Koenen et al., 2007). A longitudinal study conducted by Koenen et al., 2007 found that twice as many adults in the highest risk quartile for three developmental factors including externalizing behavior, maternal distress, and loss of a parent, developed post-traumatic stress disorder (PTSD) compared those that were not high risk, demonstrating the substantial mental health consequences of cumulative, co-occurring adversity (Koenen et al., 2007; van der Kolk et al., 2005).

The finding that maltreated youth engage in delinquent and violent behavior more often than youth who are not maltreated (Paperny & Deisher, 1983; Sandberg, 1989) is robust and consistent across diverse samples (Burgess et al., 1987; Stein & Lewis, 1992; Widom, 1989.). Foster youth are more likely to experience complex trauma and early life adversity (e.g., child maltreatment, domestic violence exposure) (Pilowsky & Wu, 2006; Urquiza et al., 1994) and are at a greater risk for engaging in delinquent behavior compared to those with fewer ACEs (Gorman–Smith & Tolan, 1998). Both post-traumatic stress disorder and symptoms of post-traumatic stress (Barboza et al., 2017) are comorbid with clinically significant levels of externalizing behavior, including delinquency, in maltreated samples. For example, studies have shown that up to 40% of maltreated children meet the criteria for externalizing disorders in addition to PTSD such as conduct or disruptive behavior disorder (Ackerman et al., 1998; Copeland et al., 2007). Barboza et al. (2017) found that among foster youth with heightened PTS symptoms (T ≥ 65), 61% also had clinically significant externalizing scores on the Child Behavior Checklist (CBCL) (i.e., ≥ 63). Substantial evidence suggests developmental continuity between early childhood externalizing behavior, posttraumatic stress symptoms and long-term involvement with the criminal justice system (Van der Kolk, 2005; Koenen, Moffitt, Poulton, Martin, & Caspi, 2007). Adults with a history of placement in foster care appear to have increased criminal activity and arrests in adolescence and well into adulthood (Burgess et al., 1987; Paperny & Deisher, 1983; Stein & Lewis, 1992; Widom, 1989).

ACEs and Sexual Minority Foster Youth

Ample evidence suggests key differences in the manner that LGBTQ+ youth experience and respond to adversity in early childhood and further that adversity and trauma in childhood differentially impacts the long-term outcomes of LGBTQ + persons (Schnarrs et al., 2019). One study conducted by Craig, Austin, Levenson et al. (2020) found that rates of ACEs among LGBTQ+ participants were significantly higher than the general population (Craig et al., 2020). The average number of reported ACEs among LGBTQ+ respondents in their study was 3.14 (SD = 2.44) with emotional neglect (58%), emotional abuse (56%), and living with a mentally ill adult (51%) identified as most prevalent. Notably, 43% of participants experienced 4+ ACEs which is between 3-4 times higher than it is in non-LGBTQ+ samples. Despite the prevalence of LGBTQ+ youth in the foster system and the extreme levels of adversity they encounter in youth, there has been a lack of empirical studies regarding the experiences of sexual minority foster youth.

Positive Future Expectations, Optimism and Foster Youth

Optimism has been defined as the general tendency to expect that good things will happen and to anticipate hopeful outcomes (Soliah, 2011). Individuals who believe they will have successful outcomes believe they have control over their future and that they can make progress towards their goals. Few studies have explored how optimism and positive future expectations shape the long-term trajectories of foster youth who are preparing for independent living. One exception is a study of 277 youth residing in residential care facilities in Israel. This study found that lower levels of optimism, as it relates to future expectations, were concerning barriers to successful entry to independent living among youth aging out of the foster system. Studies using other at-risk populations, but not foster youth, have similarly found support for the role of “envisioning the future” in buffering adolescent risk-taking, including delinquent behavior and drug use, even in the face of environmental constraints (Sulimani-Aidan, 2015, 2017; Sulimani‐Aidan & Melkman, 2022). In a recent study, Barboza and Valentine (2022) found that believing one’s life will be ‘cut short’ (i.e., foreshortened future) was central for the overall development of post-traumatic stress among youth aging out of the foster care system (Barboza & Valentine, 2022). Individuals with a sense of foreshortened future lose expectations about the future which can lead to a change of priorities and adoption of different values (Baník & Gajdošová, 2014). Consistent with this assertion, the limited body of research on future expectations and optimism in foster youth points to the role that negative future evaluations play in interfering with their motivation level and/or ability to plan for an “unpredictable” future to “fulfil their hopes and accomplish their goals” (Sulimani-Aidan, p. 1114), an important orientation to have during the transition to independent living.

Study Objectives

As discussed above, two key protective factors demonstrated by previous research to promote positive outcomes for at risk youth include (hetero)sexual identity (Stein, 2005) and positive future expectations (Aronowitz, n.d.). The present study explored whether sexual identity status and future expectations are protective factors for delinquent behavior among youth experiencing co-occurring adversity in early childhood. Figure 1 presents our conceptual model portraying the hypothesized associations between ACEs, PTS, sexual identity, and future expectations. In Figure 1, cumulative ACEs exposure was posited to lead to higher levels of posttraumatic stress symptoms, which in turn is hypothesized to result in more delinquent behavior. Moreover, the strength of the mediating effect of PTS is expected to be condition by both positive future expectations and sexual identity status. Specifically, we hypothesized that heterosexuality and positive future orientation would moderate the negative effect of ACEs on both PTS and delinquency. Additionally, we hypothesized that both positive future orientation and heterosexuality would moderate the indirect effect of ACEs on delinquent behavior through symptoms of post-traumatic stress, such that heterosexuality and positive outlook will weaken the observed effect. To summarize our main hypotheses:

1. Foster youth with more ACEs will engage in more delinquent behaviors (i.e., direct effect) (Hypothesis 1).

2. ACEs is also indirectly linked to delinquent behavior. That is, PTSS will partially explain the relationship between ACEs and delinquent behavior (i.e., mediation) (Hypothesis 2).

3. The direct effects of ACEs on both PTS and delinquent behavior will vary as a function of positive future expectations and sexual identity (i.e., moderation) (Hypothesis 3).

4. The indirect effects of ACEs on delinquent behavior through PTS symptoms are smaller among youth with positive future outlooks and among heterosexual youth (i.e., moderated mediation) (Hypothesis 4).

A secondary data analysis was conducted using Waves I and II of the Multi-Site Evaluation of Foster Youth Programs (MEFYP), 2001–2010[1]. Eligible participants included youth between the ages of 14 – 17 who were under the guardianship of the Department of Human Services in one of three states in which the evaluation was conducted and at risk of aging out of care. Information was collected via a questionnaire administered to youths through computer-assisted personal interviews at three different time points, a baseline interview, conducted shortly after being referred to the program, and two follow-up interviews conducted approximately one and two years later. Youth were referred to the program by caseworkers or the court order. The MEFYP data includes measures of sociodemographic characteristics, sexual identity, early childhood experiences before involvement in foster care, future expectations, and psychological symptoms. Baseline and year one follow-up data for Wave II from all geographic areas and four study sites were aggregated for the present study (N=1,389), which was exempted by a university institutional review board. For more information about the study design and methodology see (Courtney et al., 2011).

Measures

Adverse Child Experiences. The Lifetime Experiences Questionnaire (LEQ; Rose, Abramson, & Kaupie, 2000) (Rose et al., 2000) LEQ is a 92-item self-report questionnaire used to measure exposure to early childhood adversity including a history of emotional, physical, and sexual maltreatment and neglect. Respondents answered “No” (0) or “Yes” (1) to 16 binary items asking youth about how caregivers may have mistreated them before their first entry into foster care. Examples include, “Did you ever have a serious illness or injury or physical disability, but your caregivers ignored it or failed to obtain necessary medical or remedial treatment for it?” and “Did anyone ever try to choke, strangle or smother you?’ The items were summated into a scale with a mean of 2.38 (standard deviation = 3.23; Cronbach’s α = .86). The LEQ has been shown to correlate highly with levels of emotional, physical, and sexual maltreatment reported in clinical interviews and has been shown to demonstrate good internal consistency for total levels of child maltreatment (Gibb et al., 2001).

Delinquent Behavior. During both Wave 1 and Wave 2, youth were asked to self-report their past-year engagement in 16 delinquent behaviors (0 = “No” or 1 = “Yes”) including being loud or unruly; drunk in a public place; carrying a gun; and; purposely damaging or destroying property. A summative score was created from the responses (Cronbach’s α = .79) where higher values were equated with engagement in more delinquent behaviors.

Post-Traumatic Stress Symptoms. Post-traumatic stress symptoms were measured using the PTSD portion of the Composite International Diagnostic Interview Short Form (CIDI-SF, Kessler, Andrews, Ustun & Wittchen, 1998) (Kessler et al., 1998) modified to omit questions regarding experience in a war zone or region of terror. Potentially traumatic events (PTEs) were probed using questions about the subject’s immediate reaction to the DSM qualifying event (DSM-4 & DSM5 Criterion A1) and whether the event resulted in intense fear, horror, or helplessness (DSM-4 Criterion A2). From the CIDI-SF PTSD module, each youth was then asked about sixteen questions covering the core symptoms of PTSD: reexperiencing the trauma (intrusive thoughts, distressing dreams, flashbacks, psychological distress and physiological reactivity); avoidance (avoidance of feelings, thoughts, or conversation and avoidance of places, persons, or activities that could remind of the traumatic event); problems with dysphoric arousal (concentration problems, irritability/anger, and sleep problems), anxious arousal (hypervigilance, enhanced startle reaction,) and emotional numbing (diminished interest, feeling detached, restricted affect and foreshortened future). A summative score was created from the responses that ranged from 0 – 19 (Cronbach’s α = .82). The CIDI-SF uses operationalized measures that are valid and reliable for clinical diagnoses based on DSM-4 criteria (World Health Organization, 1997).

Sexual orientation. Sexual identity was assessed by asking respondents which of the following categories best describes them: (1) heterosexual; (2) gay or lesbian; (3) bisexual; or (4) not sure? Sexual minority status was operationalized to include responses ‘gay or lesbian’, ‘bisexual’ and not sure (= 1).

Future Expectations/Optimism. Future expectations/optimism were measured using six questions from the Life Orientation Test-Revised (LOT-R). Examples include “I usually expect the best to happen” and “I am always optimistic about my future.” The questions were measured with a 4-point Likert response scale ranging from (1 = strongly disagree to 4 = strongly agree). The items were summed into a scale that ranged from 6 to 24 (mean = 17.16, std. dev. = 2.42) with higher values indicative of more dispositional optimism (Cronbach’s alpha = .75). Previous research has acknowledged these six questions are both sufficient and robust to conceptualize as ‘optimism’ (Liang & Dunn, 2010).

To account for confounders, all analyses controlled for youth’s age (mean = 15.98, std. dev. = 1.23), race (non-Hispanic white = 1, youth of color = 0), nativity status (born in the US = 1, 0 if not US born) and gender (male = 1, female = 0).

Statistical Analysis

Data analysis was performed using the R statistical programming environment (R Core Team, 2022). Descriptive statistics were first computed for study variables. Spearman’s rank correlations, appropriate for non-continuous data, were assessed to detect statistically significant bivariate relationships between key variables used in the analysis. Reliability scores were calculated for all scales using the alpha function of the psych library in R. The moderated mediation models were implemented using a bootstrapping procedure available in the sem function of the lavaan library in R using a step wise approach. First, a simple mediation analysis was performed to assess the direct influence of ACEs on delinquency and to test PTS as a mediator of the ACEs – delinquency relationship (Hypotheses 1 and 2). Thereafter, two proposed moderators were introduced into the model to test for moderation and moderated mediation using a binary indicator for sexual identity status and positive future expectations as a continuous variable. The mediation analysis used bootstrapped standard errors to accommodate for potential violations of normality (A. F. Hayes, 2017). The superiority of using bootstrap confidence intervals over the previously endorsed Barron and Kenny “3-step” approach is now widely agreed upon. Bootstrapping is a distribution-free (i.e., nonparametric) random resampling procedure that generates a sampling distribution to estimate population parameters. Following recommended guidelines, we used 10,000 bootstrapping resamples to produce bias-corrected 95% confidence intervals for the indirect effect (AndrewF. Hayes, 2009). Confidence intervals that did not contain zero provided evidence of a significant indirect effect (Hayes, 2009). Maximum likelihood estimation using all available information was used to address missingness. To minimize estimation bias, we follow the recommendations of (Cole & Maxwell, 2003) and included Wave 1 delinquent behaviors in models when the corresponding Wave 2 delinquent behavior measure was the outcome variable, and all variables were included in the model simultaneously with the covariates age, race, gender, and born in the US. All key variables used in the mediation/moderation analyses were mean centered prior to their introduction into the models. The johnson_neyman function of the interactions library was used to probe the significance of interactions with two continuous variables.

[1] The MEFYP is a publicly available data set that is made available to researcher’s who fill out a data license request by the National Data Archive on Child Abuse and Neglect at Cornell University (Courtney, Stagner, & Pergamit, 2013).

Table 1 provides descriptive statistics for the sample while Table 2 shows the means, standard deviations and Pearson correlations by sexual identity for key variables used in the analysis. For both sexual minority and heterosexual youth, ACEs is associated with more delinquent behavior (r = .341, p < .001; r = .237, p < .001), higher levels of PTS (r = .529, p < .001; r = .381, p < .001) and more traumatic experiences (r = .534, p < .001; r = .444, p < .001). Positive future expectations are inversely associated with both engaging in delinquent behavior (r = − .154, p = .033; r = − .142, p < .001) and experiences of trauma (r = − .148, p < .041; r = − .097, p < .001). Positive future expectations and optimism is negatively associated with both PTS and ACEs for heterosexual youth (r = − .087, p = .003; r = − .116, p < .001) but not sexual minority youth (r = − .138, p < .057; r = − .031, p < .674). Independent samples t-tests were computed for all study variables. Sexual minority youth had significantly more ACEs (mean = 3.23 v 2.23), PTS symptoms (mean = 6.61 v 4.95), delinquency (mean = 1.59 v 1.05) and trauma experiences (mean = 1.90 v 1.48), and less positive future orientations (mean = 8.70 v 9.08), compared to heterosexual youth, on average (Table 2). In addition to identifying issues of collinearity, the correlations provided preliminary evidence about the cumulative impact of co-occurring ACEs on the engagement of delinquent behavior thereby justifying further examination.

Table 3 shows the regression results testing the simple mediation effect. The total effects model (c path) shows that ACEs is positively associated with delinquency (b = .074, p < .001) thereby confirming Hypothesis 1. Central to the mediation hypothesis, the effect of ACEs on PTS (a path) is significant (b = .681, t = 14.50, p < 001) as is the effect of PTS on delinquent behavior (b = .026, p = .014). In line with our second aim, the test of mediation using bootstrapping analyses revealed that, controlling for other factors, each additional ACE increased PTS by .681 (t = 14.50, p < .001). The bootstrap results with 10,000 re-samples show an unstandardized indirect effect of .018 with a 95% confidence interval around this value not containing zero [.006, .036]. This indirect effect of ACEs on delinquent behavior through PTS accounted for 19.5% of the direct effect of ACEs on delinquent behavior. These results confirm a significant indirect effect of ACEs on delinquent behavior through the mediating variable of PTS (Hypothesis 2). The direct effect of ACEs on delinquent behavior is the difference between the total and indirect effect (b = .091, Z = 5.880, p < .001) interpreted as the estimated difference in delinquent behavior between two youth experiencing the same level of PTS but who differ by one additional ACE (.074 = .091 − .018).

Next, the moderation analysis examined the conditional effects of both sexual identity and positive future expectations on the path from ACEs to delinquency and ACEs to PTS. Findings are shown in Table 4. Neither sexual identity nor future expectations moderated the effect of ACEs on delinquency (i.e., the interaction coefficients were not significant). Contrary to our prediction, Hypothesis 3a was unsupported. However, significant interactions of sexual identity with ACEs (X:W; a3: b = .232, p = .047) and future expectations with ACEs (X:Z; a4: b = − .070, p = .014) were revealed confirming the moderation effect of these variables on the ACEs ◊ PTS pathway. These results show that the effect of ACEs on PTS is greater for sexual minority youth and for youth who have less positive future expectations. To further analyze the results, the Johnson-Neyman Technique (JNT) (Bauer & Curran, 2005) was used to plot the relationship between ACEs and PTS as a function of positive future expectations (Fig. 2). The JNT probes the interaction by estimating the conditional effect, θ, of ACEs, at different values of positive future expectations and then identifies regions of significance (i.e., values of future expectations at which the regression of PTS on ACEs changes from being insignificant to significant). The results show that for values of positive future expectations that are greater than 6.56 (shaded pink in Fig. 2), the effect of ACEs on PTS is statistically significant (about 3% of the sample). Table 5 shows the bootstrap indirect and direct effects for the mediator variable PTS across sexual identity status holding values associated with positive future orientation constant at its mean. Table 5 also shows the direct effect of ACEs on delinquent behavior according to sexual attraction at mean levels of resilience is statistically significant (i.e., the 95% CI does not contain 0). As shown by Table 3, the conditional direct effect of ACEs on delinquent behavior at mean levels of positive future expectation is three times higher for sexual minority youth (estimate = .129) compared to heterosexual youth (estimate = .043). Finally, to test the proposed moderated mediation effects corresponding to our final hypothesis, Hypothesis 4, we explored whether sexual minority status (W) and positive future orientation (Z) moderated the mediation effect of PTS (moderated mediation). The index of the moderated mediation was .003 [BootLLCI = − 0.002, BootULCI = 0.10] for sexual identity and − .001 [BootLLCI = − .003, BootULCI = .001] for positive future orientation. Since both confidence intervals excluded, zero the result was insignificant. Therefore, we found no evidence that either sexual identity or positive future orientation moderate the mediating impact of PTS on the association between ACEs and delinquent behavior, disconfirming Hypothesis 4.

Delinquency is a significant public health problem for youth involved in foster care. Juvenile delinquent behavior is associated with social exclusion from a broad range of conventional pathways that are important for positive long-term outcomes well into adulthood (Lee et al., 2015). The present study investigated the longitudinal association between early child adversity and adolescent delinquency among youth aging out of the foster care system. Not surprisingly, our results showed that experiencing cumulative, co-occurring adversity in early childhood is associated with higher levels of engagement in delinquent behavior and symptoms of post-traumatic stress thereby confirming the longstanding relationship between ACEs and poor long-term mental and behavioral health outcomes. This finding is consistent with previous research showing that youth with more ACEs have a higher risk of engagement in delinquent acts as juveniles (Brown & Shillington, 2017). Consistent with other studies, our findings indicated that symptoms of post-traumatic stress are linked directly to engagement in delinquent behavior in addition to experiences of child adversity. Youth who experienced more ACEs had more post-traumatic stress symptoms, which in turn was linked to higher levels of delinquent behaviors. Our moderated mediation analysis showed that this mediating effect of PTS on the ACEs-delinquency relationship worked similarly for sexual minority and heterosexual youth and across levels of future orientation outlooks (i.e., no moderated mediation). However, two additional key insights help further contextualize our results. First, youth with sexually varying attractions who have experienced more ACEs endorse more symptoms of PTS than similarly situated heterosexual youth. Also, youth who have experienced more ACEs but who have a more positive expectations about the future have fewer PTS symptoms compared to youth with less positive expectations. As these two findings are the main contribution of the current study, they are elaborated upon further below,

We found evidence that positive future expectations buffered the psychological mechanisms that promote engagement in delinquent behavior in foster youth. This result is consistent with a growing body of research demonstrating the role that optimism plays on physical and mental health. For example, a recent study conducted by (Steenbakkers et al., 2019) demonstrated that youth who were future oriented experienced posttraumatic growth by turning negative experiences into positive ones. Other research has shown that optimists, compared with pessimists, more frequently used active coping tactics when confronted with aversive situations (Wrosch & Scheier, 2003). It is worth reinforcing that we found youth with more ACEs who are more optimistic have fewer post-traumatic stress symptoms compared to those who are less optimistic consistent with its usefulness for contributing to avoidant modes of coping, including engaging in negative behavior (Ngwenya et al., 2021).. This is important because, in the present study, about 1 in 3 sexual minority youth and 1 in 4 heterosexual youth who were removed from their home reported at least three ACEs prior to foster care entry. Therefore, the early family environment characterized by substantial adversity may have influenced their perception about the possibility of a healthy and productive future prior to entering into foster care. In any event, the present study adds to the empirical literature by showing that positive future expectations are important to buffer the impact of ACEs on levels of PTS that are related to engagement in delinquent behavior.

Finally, we examined differences among key variables by sexual identity and the potential moderating influence of sexual identity on the relationship between ACEs and both PTS and delinquent behavior. Consistent with past research, we found compelling evidence that sexual minority foster youth have disproportionately more mental and behavioral health issues compared to their heterosexual counterparts (Lyons et al., 2017; McCabe, n.d.; Roberts et al., 2010; Steele et al., 2009). Sexual minority foster youth had significantly more ACEs and were nearly twice as likely to have experienced four or more traumas compared to heterosexual youth. As well, compared to heterosexual foster youth, sexual minority youth had more symptoms of post-traumatic stress and engaged in more delinquent acts, on average. Our moderated mediation analysis further revealed two important findings. First, heterosexual foster youth who experienced more ACEs had fewer PTS symptoms compared to sexual minority youth. Second, sexual minority youth with more ACEs had a greater risk of engaging in delinquent behavior compared to heterosexual youth holding future orientation levels constant at their mean. Previous research has shown that LGBTQ+ youth experience significant childhood trauma that substantially interferes with their mental health (Craig et al., 2020) and further that LGBTQ youth who have higher levels of anxiety, depression and anxious attachment patterns are less able to adapt to adverse environments (Palangi, n.d.) (Palangi, 2020). The observed differences between sexual minority and heterosexual youth has been attributed to distinct experiences of identity-based discrimination, including but not limited to gender-based discrimination, and other themes of rejection and betrayal common to this population (Craig et al., 2020) that adds to cumulative ACEs burden and contributes to the development of post-traumatic stress. Studies have shown that LGBTQ+ youth, for example, who comprise around 20% of the foster care youth population, are more likely to experience homelessness, hospitalization for emotional distress, and be treated less fairly by the child welfare system overall (Bruskas & Tessin, 2013). Studies have further shown that sexual minority individuals who experience discrimination-related stressors show greater adverse mental health outcomes than those who do not face similar levels of adversity (Barboza et al., 2016; Dickinson & Adams, 2014). These results suggest two important avenues for future research. First, it would be beneficial to explore the impact of ACEs on PTS and delinquency while accounting for experiences of rejection and discrimination. Second, future research should explore the conditional indirect effect of positive future expectations on the relationship between ACEs and delinquency via PTS across levels of sexual identity (i.e., whether sexual minority status moderates the conditional indirect effect of future expectations on the ACEs-delinquency relationship, see also Hayes (2018) model 11).

Implications for Prevention

The results of this study carry important implications for the development of preventive interventions that aim to address the negative psychological sequelae of ACEs in youth exposed to complex trauma. First, the importance of trauma-informed care for foster populations cannot be overstated given the prevalence in which foster youth, regardless of sexual identity, experience early child adversity. Studies have demonstrated that when delivered by providers who are knowledgeable regarding the impact of trauma and evidence-based practice, trauma-informed systems of care support the social and emotional well-being of youth in foster care by maximizing strength-based supports and assets (Riebschleger et al., 2015). Our results strongly support the use of trauma-informed practices to promote positive appraisals of the future using principles of positive youth development. Second, given the high number of ACEs that foster youth experience, our study reinforces the importance of widespread accessibility to mental health professionals and services both in the community and in schools and other places that serve foster youth. Rather than policing children and families, the child welfare system should begin to break down cultural barriers to treatment, particularly as regards youth of color and sexual minority youth. Third, the health and well-being of foster youth necessitates an intersectional approach that acknowledges the disproportionate burden of cumulative ACEs for minoritized groups and that incorporates sexual orientation as a risk marker for engaging in delinquent behavior. Finally, systems of care must put the results of this study, and other similar studies, into practice by acknowledging the role that ACEs play on negative youth behavior. For example, a recent publication disseminated by the Los Angeles County Bar Association titled “Making the Case for ACEs: How the Legal System Can Further Help Children and Take Meaningful Steps to Address Adverse Childhood Experiences (ACEs)” (Chroman, 2020) did not include juvenile delinquency in its long list of the negative sequelae resulting from ACEs exposure. And, while judges frequently do use their discretion to consider experiences of childhood trauma as a mitigating factor in sentencing decisions, significant discrepancies remain when it comes to recognizing, defining and categorizing childhood trauma (Kinneary, n.d.). It is worth noting as well that, as with much of the extant literature, the methodological standard of present research continues to be defined by the original ACEs study conducted almost 30 years ago despite multiple calls from researchers to include more relevant methodologies that incorporate broader measures (e.g., discriminatory treatment) and more sophisticated analyses that better captures the lived experiences of vulnerable populations.

Limitations

Despite the novelty of the present study, it is not without limitations. The data are based on self-report rather than clinical assessment and hence social desirability may be a source of bias. The data were collected to evaluate a program that these youth were part of and hence the generalizability of the results is questionable. The dataset was collected over 10 years ago and hence its relevance for the present day may be questionable. It is worth noting, however, that at present there are a number of state laws and policies that allow for discrimination against the LGBTQ youth, in healthcare, child welfare, and housing, which runs contrary to trauma informed practice (State Equality Index, 2021). Also, our measure of positive future expectation does not provide any information regarding negative future expectations and/or pessimism. Finally, as with all models, ours is not free from omitted variable bias. This only reinforces the important role of future research in identifying additional variables to further explain the ACEs-Delinquency relationship, such as social support and experiences of discrimination.

Despite the limitation, this study advances knowledge regarding the mediating role of post-traumatic stress symptoms and the moderating role of sexual identity and positive future expectations. The findings support the moderating role of both positive future expectations and heterosexuality on reducing heightened symptoms of post-traumatic stress following cumulative ACEs exposure. Early child adversity is one factor related to juvenile delinquent behavior that may lead to involvement in the criminal justice system. Our results suggest that foster care youth require intervention strategies that consider the nature of the trauma as well as individual psychological resources and personal characteristics. By considering these factors in relation to the context of foster youth’s experiences, identities and outlooks, interventions can be tailored to create systems of care designed to treat youth holistically and in a more integrated fashion.

Table 1. Descriptive Statistics for the Analysis of Adverse Childhood Experiences and Delinquent Behavior Among Youth Aging out of the Child Welfare System
	Sex Minority	Hetero	p-value
Age (Continuous)	16.13 (1.20)	15.95 (1.23)	0.060
Nativity
Foreign born	7.22	5.55	0.348
US born	92.27	94.27	0.348
Race
Non-Hispanic White	52.60	46.46	0.134
Youth of Color	47.40	53.54	0.134
Gender
Female	79.56	54.70
Male	20.44	45.30	<.001
Adverse Child Experiences	3.26 (3.82)	2.22 (3.10)	<.001
None	28.18	43.23
One	18.80	18.79
Two	10.50	7.14
Three	10.00	6.10
Four or more	32.52	24.74
Traumatic Experiences
None	32.04	33.56
One	20.44	24.72	<.001
Two	14.36	19.36
Three	13.81	10.81
Four or more	19.35	11.55
No. Traumatic Experiences (Baseline)	1.47	1.85	.008
PTS (Baseline)	6.61 (6.48)	4.89 (5.66)	<.001
Resilience (Baseline)	16.65 (2.81)	17.24 (2.35)	0.003
Delinquency (Baseline)	1.59 (2.10)	.994 (1.71)	<.001
Delinquency (Wave 2)	1.25 (1.71)	1.04 (1.85)	0.151
Note: Welch’s t-test was used to test mean differences for continuous variables; X² test of independence was used for categorical variables.

Table 2. Correlations Among Key Study Variables by Sexual Minority Status
		Trauma	PTSS	DELINQ	FE	ACEs
1. Trauma	n	--	1157	1157	1157	1157
	Pearson’s r	--	0.617	0.321	-0.097	0.444
	p-value	--	<.001	<.001	<.001	<.001
2. PTSS	n	192	--	1157	1157	1157
	Pearson’s r	0.644	--	0.209	-0.087	0.381
	p-value	<.001	--	<.001	0.003	<.001
3. Delinq	n	192	192	--	1157	1157
	Pearson’s r	0.431	0.331	--	-.142	0.237
	p-value	<.001	<.001	--	<.001	<.001
4. FE	n	192	192	192	--	1157
	Pearson’s r	-0.148	-0.138	-0.154	--	-0.116
	p-value	0.041	0.057	0.033	--	<.001
5. ACEs	n	192	192	192	192	--
	Pearson’s r	0.534	0.529	0.341	-0.031	--
	p-value	<.001	<.001	<.001	0.674	--
Sexual Minority	M	1.85	6.61	1.59	8.70	3.26
Sexual Minority	SD	1.84	6.48	2.08	1.85	3.82
Completely Heterosexual	M	1.47	4.89	1.05	9.08	2.22
Completely Heterosexual	SD	1.46	5.66	1.79	1.56	3.10

Notes: All mean differences are significant at the p = .01 level. Correlations among variables for youth with sexually varying and heterosexual attractions are located above and below the diagonal, respectively; Spearman’s Rho Correlation Coefficients are provided by Sexual Minority Status (N = 1,064 heterosexual youth and N = 181 sexual minority youth). FE = future expectations.

Table 3. Results of the simple mediation analysis investigating PTS as a mediator between ACEs and DELINQ at time 2

Coeff.

LLCI

ULCI

Effect of ACEs on PTS (a path)

0.681

0.047

14.50

<.001

0.570

0.777

Effect of PTS on DELINQ3 (b path)

0.026

0.011

2.46

0.014

0.009

0.049

Direct effect of ACEs on DELINQ3 (c path)

0.074

0.017

4.30

<.001

0.062

0.123

Bootstrap Results for the Indirect Effect

Indirect Effect of ACEs on DELINQ3 through PTS (a x b)

Effect

BootSE

Boot LLCI

Boot ULCI

0.018

0.007

0.006

0.036

Note: Analysis controls for confounders age, race, gender, US born and delinquency at Wave I.

Table 4. Moderated Mediation Regression Results
		Post-Traumatic Stress Symptoms (M_i)				Delinquent Behavior Wave 2 (Y)
	Label	Coef.	SE	t	p		Label	Coef.	SE	t	p
ACEs (X)	a1	1.272	0.259	4.916	<.001		c1	-0.041	0.081	-0.510		.610
Sex. Min. (W)	a2	-0.117	0.561	-0.209	.835		c2	-0.118	0.173	-0.685	0.494
FE (Z)	a4	-0.033	0.120	-0.274	.784		c4	-0.039	0.037	-1.063	.288
Age (C1)	f1	0.210	0.124	1.693	.091		g1	-0.043	0.038	-1.115	.264
Male (C3)	f2	-1.755	0.310	-5.668	<.001		g2	0.418	0.098	4.272	<.001
NH White v Non-White (C4)	f3	-0.169	0.303	-0.557	.578		g3	0.191	0.094	2.037	.042
Born in the US	f4	-1.377	0.641	-2.148	.032		g4	-0.012	0.199	-0.058	.954
ACEs x sexmin (X:W)	a3	0.232	0.116	1.990	.047		c3	0.045	0.036	1.258	.209
ACEs x. RESIL (X:Z)	a4	-0.070	0.028	-2.469	.014		c5	0.004	0.009	0.507	.612
PTS (Mi)							b	-0.014	0.011	-1.358	.175
DELINQ (baseline)							g5	0.464	0.028	16.426	<.001
Constant	iY	2.547	2.347	1.085	.278		iY	1.258	0.693	1.184	.070
Observations	1217					1217
R-Squared	0.221					0.248
Adj. R-Squared	0.215					0.241
Residual SE	5.151 (df = 1203)					3.350 (df = 1205)
F statistic	F(9,1203) = 37.876, p < .001					F(10, 1205) = 36.036, p < .001

Note: DELINQ = delinquent behaviors

Table 5. The conditional effect of ACEs on Delinquency as a function of sexual minority status and future expectations from an additive multiple moderation model
	Indirect Effect (a1+a3W+a5Z.mean)*(b)			Direct Effect c1+c3W+c5Z.mean
sexmin(W)	estimate	95% Bootstrap CI	estimate		95% Bootstrap CI
Sex Vary	.013	[-.006,.033]	.129		[.057,.211]
Hetero.	.010	[-.005,.025]	.043		[.005,.081]

Conflict of interest: The authors declare no conflicts of interest.

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