Defense Date


Graduation Date

Fall 12-17-2021


Immediate Access

Submission Type


Degree Name





School of Nursing

Committee Chair

Rebecca Kronk

Committee Member

James Schreiber

Committee Member

Jesse Helton

Committee Member

Karen Neil


Adverse childhood events, ACEs, Autism, Dental Issues, Asthma, Health Outcomes


Dissertation supervised by Dr. Rebecca Kronk

Purpose: Adverse childhood events (ACEs) have a profound and long-term effect on the health outcomes of many children and adults. However, few studies have focused on specific ACEs and health outcomes in children with autism spectrum disorder (ASD). The aim of the study was to investigate if ASD moderated the relationship between ACEs and specific health outcomes in children who had been the subject of a child welfare system report.

Design and Methods: Using the second National Survey of Child and Adolescent Well-Being (NSCAW II), a secondary analysis was performed on a sample of 80 children with diagnosed autism and 5,698 children without autism. ACEs score criteria included physical abuse, sexual abuse, neglect, psychological aggression, domestic violence, parental substance abuse and mental health. Health outcome variables included dental issues and asthma. Child characteristics of age, gender, race and poverty level were also included in the analysis.

Results: Chi-square analysis indicated a significantly higher percentage of children with ASD whose parents reported psychological abuse compared to children without autism ꭓ2 (28.03, df = 74, F = 11.08). Children with ASD have a noteworthy number of ACEs compared to children without autism (p = 0.00). Logistic regression found having an ACE increased the odds of having dental issues 2.80 times compared to not having an ACE (odds ratio [OR] = 2.8, standard error [SE] = 1.27, p < 0.5).

Conclusions: A diagnosis of ASD does not appear to moderate dental issues or asthma in this sample of children. Children with ASD are at risk of harmful and chronic health outcomes due to ACEs.

Practice Implications: All healthcare providers should include ACE screening when assessing children with ASD. If completed early and regularly, preventative measures may be employed that help support families and may avoid entrance into the child welfare system.