Impact of Adverse Childhood Experiences and Mental Health on School Success in Autistic Children: Findings from the 2016-2021 National Survey of Children's Health.
Each added ACE worsens attendance, grade move-up, and engagement for autistic students beyond what anxiety or depression explain.
01Research in Context
What this study did
The team looked at the 2016-2021 National Survey of Children's Health. They asked how bad childhood events (ACEs) and mental health shape school success for kids with autism.
They checked three school marks: showing up, moving up a grade, and staying engaged. Mental health was counted if the parent said the child had anxiety or depression.
What they found
Each extra ACE pulled all three school marks down. The drop stayed even after anxiety and depression were taken out.
Mental health problems explained part of the link, but not all of it. ACEs still hurt school life on their own.
How this fits with other research
Hartwell et al. (2024) used the same survey and saw the same slide in grades. They added that high-ACE kids also get fewer special-ed minutes, showing one reason the slide happens.
Stein Elger et al. (2025) looked mild autism plus trauma and found these kids often miss early-intervention plans. Together the papers say ACEs both block service entry and later hurt daily school life.
Kuenzel et al. (2021) showed positive parenting can cut family stress for kids with ASD. Their buffer idea pairs with the new finding: lower ACEs through parenting may protect the same school marks.
Why it matters
You now have clear numbers to show teachers and families why trauma history belongs in the IEP. Ask about ACEs at intake, add counseling or attendance goals, and push for mental-health services early. Cutting one ACE—by safety planning or parent support—may save a year of lost learning.
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02At a glance
03Original abstract
PURPOSE: School is an important developmental setting for children. Adverse childhood experiences (ACEs) are linked to overall lower educational attainment and are more prevalent in children with Autism Spectrum Disorder (ASD) than in their neurotypical peers. The aim of this study is to test the association between ACEs and school outcomes among autistic children and whether mental health conditions explain this association. METHODS: We combined 2016-2021 data from the National Surveys of Children's Health for children, ages 6-17, identified by parents as having ASD (N = 4,997), to examine the relationship between ACEs and school outcomes (grade progression, school attendance, and engagement). We analyzed depression and anxiety variables to investigate the extent to which mental health can explain the relationships between ACEs and school outcomes. RESULTS: ACEs were significantly associated with school outcomes. With increased ACEs, autistic children experienced a significant decrease in the odds of school attendance, grade progression and school engagement (p < .05). Furthermore, although depression and anxiety symptoms were significantly associated with school outcomes, they cannot explain away the enduring, strong relationship between ACEs and level of grade progression, engagement, and school success index. CONCLUSION: Our findings suggest ACEs predict school success among autistic children, with mental health conditions appearing to mediate the relationship between ACEs and key factors in school success. Efforts should be made to proactively identify and address the impact of ACEs and associated mental health conditions among autistic students.
Journal of autism and developmental disorders, 2025 · doi:10.1542/peds.2019-0