Adverse Childhood Experiences and ASD: The Role of Co-Occurring Psychiatric Symptoms

Background: Children with autism spectrum disorders (ASD) are at risk for adverse childhood experiences (ACEs) such as domestic violence or family socioeconomic hardship, which predict numerous negative outcomes later in life. However, the extent to which children with ASD experiences ACEs, relative to children without ASD, is not known.

Objectives: We describe differences in the prevalence of ACEs for children with and without ASD in a nationally representative sample of children in the U.S. Furthermore, we investigate whether such differences may be attributable to co-occurring psychiatric symptoms.

Methods: We examined data on 84,352 children (ages 2-17 years; 1,608 with ASD) from the 2011-2012 National Survey of Children’s Health conducted by the CDC. Cross-sectional data were obtained from parental self-report. Specific ACEs of interest included socioeconomic hardship, parental separation, household substance abuse, neighborhood violence, household mental illness, domestic violence, parental incarceration, and parental death. The presence of parent-reported co-occurring psychiatric symptoms (anxiety problems, depression, behavioral or conduct problems, and AttentionDeficit-Hyperactivity Disorder (ADHD)) was also assessed. All analyses accounted for the complex survey sampling design using sample weights.

Results: While 24.4% of children without ASD were reported as having multiple (2+) ACEs, 34.4% of children with ASD had multiple ACEs. Similarly, 42.4% of children with ASD were reported as having at least one co-occurring psychiatric symptom, as compared with only 6.0% of children without ASD. For many of the specific ACEs examined, children with ASD experienced more ACEs than children without ASD. For example, children with ASD were twice as likely to have lived with someone who was mentally ill or suicidal, compared to children without ASD (18.1% vs. 9.1%). In survey-weighted logistic regression models adjusting for age, sex, race, family structure, and poverty level, children with ASD were more likely to have multiple ACEs than children without ASD (OR: 1.66, 95% CI: 1.18-2.34). However, after further adjustment for the presence of a co-occurring psychiatric symptom, children with ASD were no more likely to have multiple ACEs than children without ASD (OR: 0.92, 95% CI: 0.66, 1.30).

Conclusions:   Children with ASD experience ACEs at a higher rate than children without ASD. However, this appears to be largely explained by the co-occurrence of psychiatric symptoms, such as anxiety, depression, behavioral or conduct problems, and ADHD.