Cumulative Adverse Childhood Experiences and Multiple Neurodevelopmental Disorders in Children and Adolescents: A Population-Based Study

Stress Health. 2026 Aug;42(4):e70202. doi: 10.1002/smi.70202.

ABSTRACT

Adverse childhood experiences (ACEs) and neurodevelopmental disorders (NDDs) are frequent yet the relationship between cumulative ACEs and multiple NDDs remains poorly understood. Using data from 120,629 children aged 3-17 years in the 2021-2023 US National Survey of Children’s Health, we examined associations between ACEs and multiple NDDs, defined as the presence of ≥ 2 NDDs. Logistic regression, adjusted for sociodemographic and health covariates, estimated associations for ACEs treated as a continuous variable and as categorical groups (0, 1, 2, and ≥ 3 ACEs). We also assessed associations for common NDD combinations and individual ACE. The prevalence of multiple NDDs increased with the number of ACEs: 4.5% (95% confidence interval [CI]: 4.2-4.8) for 0 ACE, 8.4% (95% CI: 7.7-9.1) for 1 ACE, 11.9% (95% CI: 10.7-13.2) for 2 ACEs, and 17.8% (95% CI: 16.5-19.2) for ≥ 3 ACEs. Each additional ACE was associated with 13% higher odds of multiple NDDs (adjusted odds ratio [aOR] = 1.13, 95% CI: 1.09-1.17). Compared with no ACE, the odds of multiple NDDs were higher for 1 ACE (aOR = 1.48, 95% CI: 1.30-1.68), 2 ACEs (aOR = 1.78, 95% CI: 1.52-2.09), and ≥ 3 ACEs (aOR = 1.91, 95% CI: 1.62-2.26). Associations were consistent across three NDD combinations. Individually, health- or disability-related mistreatment, household mental illness, and economic hardship showed significant associations. Cumulative ACEs are associated with a greater likelihood of multiple NDDs, suggesting future research, health policy, system and service planning require coordinated responses that account for the diverse adversities experienced by many families and children.

PMID:42410985 | DOI:10.1002/smi.70202