What do we already know?

Adverse Childhood Experiences (ACEs)

  • Refers to negative, stressful, and potentially traumatizing events that occur before age 18
  • Includes: parental death, incarceration, maternal hardship, family mental illness and substance misuse, exposure to community violence, and experiences with discrimination
  • Higher ACEs are associated with negative health and social outcomes

Traumatic brain injury (TBI) is associated with poor health outcomes, such as depression, PTSD, criminal behaviour, and victimization

ACEs increase the likelihood of risk- (e.g., driving fast, criminal behaviour) and sensation-seeking behaviours (e.g., cliff jumping, trying new activities) and related psychiatric conditions that can increase risk for TBI

There is little know about the connection between ACEs and TBIs, particularly among adolescents.


What did they want to know?

  1. Are ACEs associated with TBI among adolescents in the US?
  2. Is the association between ACEs and TBI explained by sports involvement?
  3. To what extent do ADHD and conduct problems explain associations between ACEs and TBI among youth?


What did they do?

Analyzed data from the 2016-2018 National Survey of Children’s Health in the US

  • Completed by parent/primary caregiver
  • Researchers looked at 42,204 adolescents (ages 12-17)

They measured:

  • TBI categorized as: No TBI, past only TBI, current TBI
  • ACEs categorized as: No ACEs, 1 ACEs, 2-3 ACEs, 4+ ACEs
  • Sports involvement in last 12 months
  • ADHD
  • Conduct problems


What did they find?

TBI is more common among youth experiencing each of the ACEs

  • 1 in 5 youth with a current TBI have experienced 4+ ACEs (compared to 1 in 14 youth with no TBI)

The risk of current TBI is increased by:

  • 86% for exposure to 1 ACE
  • 110% for exposure to 2-3 ACEs
  • 347% for exposure to 4+ ACEs

Exposure to ACEs causes a greater increase in risk for current moderate-severe TBIs

  • 4+ ACEs increased the risk of current moderate-severe TBI by 454%, but only 211% for current mild TBI

The relationship between ACEs and TBI is greater for youth who are not involved in sports

  • For adolescents with 4+ ACEs, risk of TBI is increased by 76% for those involved in sports and 441% for those not involved in sports (6x higher)

For adolescents with 4+ ACEs who are not involved in sports, ADHD and conduct problems contribute to the increased risk for TBI

  • Conduct problems and ADHD collectively explain about 22.70% of the association between ACE exposure and TBI


What does this mean?

As ACE exposure increases, likelihood of experiencing a TBI increases

  • This relationship is stronger for those with a moderate-severe TBI and for those not involved in sports
  • ADHD and conduct problems partially explain the elevated risk of TBI

Interventions targeted at reducing ACEs through support for families and youth will likely reduce the risk of sustaining a TBI as well

Youth with known exposure to ACEs should be screened for TBI to ensure early identification of TBI and timely access to supports

Professionals working with TBI survivors should be aware of the increased risk of ACE exposure and should adopt trauma-informed approaches to care



Jackson, D. B., Posick, C., Vaughn, M. G., & Testa, A. (2022). Adverse childhood experiences and traumatic brain injury among adolescents: findings from the 2016–2018 National Survey of Children’s Health. European Child & Adolescent Psychiatry, 1-9.


We summarize a recently published research study every week to give you current, evidence-based brain injury information.


Related posts: