Adverse childhood experiences (ACEs; e.g. violence, divorce) are associated with numerous negative health outcomes. Children with autism spectrum disorder (ASD) may be at risk for ACEs due to behavioral issues and financial/social/emotional stressors associated with their care. Yet, research on ACEs in children with ASD is limited.

Assess ACEs in youth with and without ASD.

To assess rates and associated characteristics of ACEs in children with and without ASD in the general population.

Data on 84,352 children (ages 2-17 years; 1,608 with ASD) were drawn from the 2011-2012 National Survey of Children's Health, a nationally representative CDC survey of households with children. The survey included questions about child emotional, developmental, and behavioral problems, socio-demographics and nine ACEs (neighborhood violence, discrimination, financial stress, domestic violence and parent separation, mental illness, substance abuse, death, or incarceration).

A history of multiple ACEs was reported by 34.4% of children with ASD compared with 24.4% of children without ASD. In survey-weighted logistic regression models controlling for age, sex, race, family structure and poverty, youth with ASD were 1.66 times (95% CI 1.18-2.34) more likely to have multiple ACEs compared with youth without ASD. Mediation analyses suggested that the increased rate of ACEs in ASD is driven by the greater co-occurrence of behavioral and emotional problems, but not ID, in ASD.

Although children with ASD experience ACEs at a higher frequency than children without ASD, this is explained by the increased co-occurrence of emotional and behavioral problems in ASD.