New meta‑analysis in JAMA Pediatrics maps where risks are highest—and what can help.

A major systematic review and meta‑analysis led by developmental psychologist Sheri Madigan, PhD, reports that about six in every ten children experience at least one adverse childhood experience (ACE) before adulthood—exposures such as abuse, neglect, caregiver mental illness or substance use, and other serious family disruptions.  The authors’ bottom line is stark: ACEs are common now—not just in adults looking back—making prevention and trauma‑informed responses urgent public‑health priorities.  

The headline numbers

Pooling 65 study/sample estimates from 18 countries, the team estimated the average distribution of ACEs in child populations (ages 0–18): 42.3% had 0 ACEs, 22.0% had 1, 12.7% had 2, 8.1% had 3, and 14.8% had four or more(see Table 2, p.25).    A visual forest plot (Figure 1, p.26) shows how individual study estimates cluster around these pooled values.  

Who’s most affected

Risk wasn’t evenly shared. Compared with reference groups, the prevalence of four or more ACEs was:

• Higher in adolescents than in younger children (about 16% higher).  
• Higher in Indigenous children than in White peers (about 63% higher).  
• Higher among youth in residential care (about 26% higher) and among those with a history of juvenile offending (about 29% higher).  Household circumstances and who does the reporting also matter: samples from low‑income households were less likely to show zero ACEs (a marker of more adversity), and child‑reported questionnaires identified more adversity than parent‑reported ones.    

Why it matters

ACEs are tied to later mental illness, substance use, chronic disease, and obesity; prolonged exposure without supportive care can trigger toxic stress that disrupts brain development and social‑emotional growth.  In this review, nearly one in four adolescents reported four or more ACEs—a level often associated with the greatest health risk.  

What experts recommend now

The authors emphasize early identification and prevention, and they call for targeted, co‑designed community interventions that meet families where they are.  While routine ACE screening is increasingly used, the evidence base for universal screening remains mixed; regardless, trauma‑informed approaches to care—with or without screening—are essential and have been shown to improve provider knowledge and some client outcomes.  

How the study was done (in brief)

Researchers searched MEDLINE, Embase, CINAHL, and PsycINFO (1998–2024), followed PRISMA guidelines, and registered the protocol (PROSPERO CRD42022348429). They included population‑based samples of children (≤18) that reported the full ACE distribution (0, 1, 2, 3, ≥4) using an 8‑ or 10‑item ACE questionnaire (±2 items).  

The fine print

Coverage was broad but not global—only 18 countries were represented, with under‑representation of many world regions and some groups (e.g., LGBTQ+ youth). Prevalence estimates also vary by method (child vs parent report, file reviews), so local figures may differ.  

Bottom line for families and communities: ACEs are common—but not inevitable. Policies that reduce poverty and family stress, schools and clinics that practice trauma‑informed care, and community programs co‑built with families can lower exposure and blunt the harms when adversity occurs.  

Source: Madigan S, Thiemann R, Deneault A, et al. “Prevalence of Adverse Childhood Experiences in Child Population Samples.” JAMA Pediatrics 2025;179(1):19–33.  

Editor’s note: This article is for information only and is not a substitute for professional medical advice.