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. 2025 Aug;55(8):2615-2627.
doi: 10.1007/s10803-024-06338-x. Epub 2024 May 31.

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

Hélène A Gussin  1 , Cheng-Shi Shiu  2   3 , Christianna Danguilan  4 , Iulia Mihaila  1 , Kruti Acharya  1   4 , Kristin L Berg  5   6
Affiliations

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

Hélène A Gussin et al. J Autism Dev Disord. 2025 Aug.

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.

Keywords: Adverse childhood experiences (ACEs); Autism; Mental health; National survey of children’s health; Resilience; School success.

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Conflict of interest statement

Declarations. Conflict of Interest: The authors have no relevant financial or non-financial interests to disclose. Research Involving Human Participants and/or Animals: This article does not contain any studies with human participants or animals performed by any of the authors.

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