The impact of adverse childhood events on service support and educational outcomes of children who are autistic: A theory-guided analysis using structural equation modeling.

Autistic children who have experienced adverse childhood experiences (ACEs) may have barriers to receiving special education or other developmental services-thus, impacting educational outcomes. Our objective was to model such a pathway using the 2016-2021 National Survey of Children's Health datasets. We extracted data for school outcomes, use of special education and autism-related specialty services and sociodemographic characteristics among autistic children within the data. Associations between sociodemographics and ACEs (categorized as 0, 1-3, and 4+) were tested using design-based X tests. We then used structural equation modeling to map the quasi-causal pathways. The sample for our analysis included 4717 autistic children-38.94% were aged 6-10 years, 35.73% of children aged 11-14 years, and 25.32% were between 15 and 17 years-with 88.70% living in metropolitan areas. The X showed significant relationships between ACEs and age, ethnoracial groups, and urbanicity among others. The SEM showed ACEs were directly associated with poorer school outcomes (β = -0.14 (0.04), p = 0.002) and through their inverse relationship with support services (β = -0.08 (0.04), p = 0.023)- when support services were increased, school outcomes improved (β = 0.62, p < 0.001). Findings suggested ACEs have a significant direct and indirect impact on school outcomes of autistic children, and 10.76% of children who are autistic have experienced four or more ACEs-which were more likely to occur with severe autism symptomatology and in rural areas. Results highlight the need for communities to recognize the potential long-term impact of ACEs on the academic outcomes of autistic children.