Purpose

Adverse childhood experiences (ACEs) are highly prevalent in people with developmental disorders who engage in offending behaviour. Many violence-based risk assessment tools include items pertaining to ACEs, and may inflate risk scores in trauma-exposed groups. This paper aims to explore the relationships between ACEs, risk assessment scores, incidents of risk and restrictive practices, in adolescents with developmental disorders in a forensic inpatient setting.

Design/methodology/approach

Secondary analysis was conducted on clinical data for 34 adolescents detained to a developmental disorder service. Data were extracted for Structured Assessment of Violence Risk in Youth (SAVRY) risk scores and risk behaviours and restrictive practices, as measures of observed risk.

Findings

Participants exposed to more ACEs had higher SAVRY risk scores (p < 0.001, two-tailed), with elevations specifically on the historical subscale (p < 0.001, two-tailed). Neither ACEs nor risk scores were associated with the frequency of risk behaviours. Nevertheless, participants exposed to four or more ACEs were secluded more frequently (p = 0.015, two-tailed), indicating a potential association between trauma and risk severity. Those with more complex developmental disorders experienced fewer ACEs (p = 0.02, two-tailed) and engaged in self-harm behaviours less frequently (p = 0.04, two-tailed).

Research limitations/implications

The inclusion of ACEs in risk assessment tools may lead to the inadvertent stigmatization of trauma-exposed individuals. Further investigation is necessary to offer clarity on the impact of early adversity on risk assessment accuracy and levels of institutional risk, and the role of developmental disorders in this relationship.

Originality/value

To the best of the authors’ knowledge, this study is the first to explore the relative associations between ACEs, risk assessment scores and observed institutional risk and does so in a highly marginalized population.

中文翻译：

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安全的发育障碍服务中的创伤和机构风险：SAVRY 是否会增加暴露于 ACE 的青少年的风险？

目的

不良童年经历 (ACE) 在从事冒犯行为的发育障碍患者中非常普遍。许多基于暴力的风险评估工具包括与 ACE 相关的项目，并且可能会夸大创伤暴露组的风险评分。本文旨在探讨在法医住院环境中患有发育障碍的青少年的 ACE、风险评估评分、风险事件和限制性做法之间的关系。

设计/方法/方法

对被拘留在发育障碍服务机构的 34 名青少年的临床数据进行了二次分析。提取数据用于青少年暴力风险的结构化评估 (SAVRY) 风险评分和风险行为和限制性做法，作为观察到的风险的衡量标准。

发现

暴露于更多 ACE 的参与者具有更高的 SAVRY 风险评分（p < 0.001，双尾），特别是在历史分量表上的升高（p < 0.001，双尾）。ACE 和风险评分均与风险行为的频率无关。然而，暴露于四个或更多 ACE 的参与者更频繁地被隔离（p = 0.015，双尾），表明创伤和风险严重程度之间存在潜在关联。那些患有更复杂发育障碍的人经历的 ACE 较少（p = 0.02，双尾），并且较少发生自残行为（p = 0.04，双尾）。

研究限制/影响

将 ACE 纳入风险评估工具可能会导致遭受创伤的个体在无意中受到污名化。需要进一步调查以明确早期逆境对风险评估准确性和机构风险水平的影响，以及发育障碍在这种关系中的作用。

原创性/价值

据作者所知，这项研究首次探索了 ACE、风险评估分数和观察到的机构风险之间的相关关联，并且是在高度边缘化的人群中进行的。