The present study examined the association between adverse childhood experiences (ACEs) and body mass index (BMI) status among children and youth with special health care needs (CYSHCN), and the role of health characteristics and lifestyle factors in predicting BMI. Data from the 2016-2020 National Survey of Children's Health were utilized. Key variables included: ACEs, BMI status, level of functional impairment, depression, weekly level of physical activity, and daily screen time. Multivariable ordinal logistic regression analyses were used to examine associations between selected variables and BMI status. The sample consisted of 19,743 CYSHCN. Respectively, CYSHCN with exposure to 1-2 ACEs (vs. none) and 3+ ACEs (vs. none), had a 22% and 32% increase in odds of a one-level increase in BMI status, controlling for sociodemographic characteristics, level of functional impairment, and depression. When lifestyle factors (i.e., physical activity and screen time) were included in analyses, CYSHCN with exposure to 3+ ACEs (vs. none) had a 27% increase in odds of a one-level increase in BMI status. Thus, we found that ACEs were significantly associated with BMI status. However, the strength of this relation changed when considering CYSHCN health characteristics and CYSHCN lifestyle factors. A higher weekly level of physical activity, in particular, seemed to play a significant role in reducing risk of higher BMI status among CYSHCN with exposure to 3+ ACEs (vs. none). Findings support the development of physical activity promotion programs and education regarding strategic utilization of screen time (e.g., educational apps and games) for CYSHCN and their families.
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