P2.052: A Systematic Qualitative Review on Behavioral and Mental Health Outcomes in Children with Autism with Adverse Childhood Experiences

Background: Adverse childhood experiences (ACEs) are well-established as risk factors for poor mental health and behavioral outcomes in the general population. Less is known about the effects of ACEs on children with autism spectrum disorder (ASD), a population already at heightened risk for psychiatric comorbidities. Given the unique challenges faced by individuals with autism, early adversity may contribute to distinct behavioral and mental health outcomes. This systematic qualitative review synthesizes existing literature on the intersection of ACEs, mental health, and behavioral outcomes in children with autism, addressing critical gaps in understanding trauma-related vulnerabilities within this population.

Methods: This systematic review, preregistered with PROSPERO (Id: CRD42024579120) and conducted in accordance with PRISMA guidelines, examined human studies published between 1948 and 2024 investigating the impact of ACEs on mental health and behavioral outcomes in individuals with autism aged 21 and younger. A comprehensive search was performed across PubMed, Embase, Cochrane, Web of Science, and Scopus. Two authors independently screened abstracts and full texts, with conflicts resolved by a third reviewer. Extracted data included sample size, age, patient selection criteria, study design, study duration, exposure, and outcomes. Study quality was evaluated using the ROBINS-E tool.

Results: A total of 1,839 studies were identified, with 1,227 remaining after deduplication. After abstract and full-text screening, 11 studies were included for analysis. The ROBINS-E assessment found that all the studies had a high or very high risk of bias. Results showed that children with autism may experience higher rates of ACEs compared to neurotypical peers. Throughout the studies included, children with ASD who had been exposed to trauma, abuse, or other adverse life events tended to exhibit an increased prevalence of psychiatric symptoms, such as mood disorders, anxiety, PTSD, aggression, and dissociative symptoms. These symptoms were more pronounced in children who experienced abuse and were associated with more severe outcomes, such as self-harm, suicide attempts, and comorbid conditions such as generalized anxiety disorder and major depressive disorder. Aggression, anger, irritability, distractibility, and self-harm were observed in children with ASD who had experienced trauma. Psychosocial stressors such as family disturbances and school or work difficulties were linked to the emergence of psychotic and manic symptoms in these children.

Conclusion: These studies suggest that ACEs contribute to adverse mental health and behavioral outcomes in children with ASD although the relationship is multifactorial. Future studies should aim to conduct higher-quality research to better understand this relationship and address the risk of bias. This review emphasizes the importance of addressing the mental health needs of children with ASD, as ACEs can significantly shape both behavioral and mental health outcomes.