Prevalence of adverse childhood experiences among students with emotional and behavioral difficulties or disorders A multi-level meta-analysis

Adverse childhood experiences (ACEs) significantly impact students' health. Studies have shown a dose-response relationship between ACEs on the one hand, and behavioral and mental health problems, and poor school outcomes on the other. However, there is a notable gap in understanding the ACE prevalence in primary and secondary school students with emotional/behavioral difficulties or disorders (EBD). Therefore, we analyzed data of 569,731 students (aged 4 to 18 years) across 55 studies through three-level meta-analyses and a narrative synthesis. The average prevalence rate for a single ACE among students with EBD was estimated to be 29.90 %. The prevalence varied by type of ACE, with neighborhood violence being the least prevalent at 4.26 % and maltreatment the most prevalent at over 40 %. There were no differences in prevalence rates between gender, age, ACE informants, and the use of special education services for EBD. We only found five studies on cumulative ACE numbers among students with EBD, which indicates another significant gap in knowledge. Our findings indicate that ACEs are significant environmental factors that contribute to the understanding of EBD in students within a biodevelopmental framework. Further research is necessary to investigate how the number, type, and timing of ACEs impact these students. Trauma-informed approaches have the potential to substantially improve outcomes for students with EBD by promoting ACE awareness and integrating this knowledge into educational policies, procedures, and practices.