Brief Report: Examining the Association of Autism and Adverse Childhood Experiences in the National Survey of Children's Health: The Important Role of Income and Co-occurring Mental Health Conditions.

The study is cross-sectional, so it cannot show whether autism, mental health conditions, or adversity caused the others. All information came from one parent or guardian report, and developmental and psychiatric symptoms were assessed with single items. Children under 6 years and those with missing data were excluded, so it does not cover younger children or some families. The survey used a modified adverse childhood experiences scale and excluded racial discrimination from the ACE total, so it may not capture all adversity relevant to families. Financial stress was counted as an adverse childhood experience and was correlated with income level, though removing it from the most adjusted model did not meaningfully alter estimates.

All authors reported receiving research funding from NIH; Dr. Berkowitz also reported SAMHSA funding. The authors report no other conflicts of interest.

Do not conclude that autism itself causes more adverse childhood experiences. This is a cross-sectional survey, and in lower-income families the association with two or more adverse childhood experiences was no longer significant after adjusting for co-occurring mental health conditions.