A groundbreaking study led by a multidisciplinary team at UCLA Health has shed new light on the profound effects of adverse childhood experiences (ACEs) on children’s school attendance, revealing that early trauma significantly increases the likelihood of missing school due to health-related challenges. Leveraging a comprehensive national survey dataset, the researchers uncover a compelling association between exposure to ACEs and chronic absenteeism connected directly to physical health, an insight that demands urgent attention from both healthcare providers and educational institutions.
The concept of ACEs encompasses a range of traumatic exposures during childhood, such as experiencing or witnessing violence, neglect, and racial discrimination. While previous research has linked ACEs to long-term health and psychosocial difficulties, this recent investigation focuses specifically on the acute consequences for school attendance, illustrating how early adversity can manifest immediately as increased vulnerability to illness, injury, or disability leading to significant school absences.
The study analyzed data from the 2021–2022 cycle of the National Health Interview Survey, one of the most extensive and representative datasets on child health in the United States. Parents of over 10,000 children between the ages of 6 and 17 responded to detailed questions regarding seven categories of ACEs, their child’s health status, and absences from school due to health problems over the previous 12 months. By employing sophisticated weighted logistic regression models, the research team adjusted for sociodemographic variables to isolate the impact of ACEs on health-related absenteeism.
Among the striking results, the data reveal that approximately 25% of children in the sample had experienced at least one ACE. These children demonstrated a 1.5-fold increase in the probability of missing any school days due to health reasons. More alarmingly, the odds of being chronically absent from school, defined as missing 15 or more days per year for health-related reasons, were elevated by 2.4 times in children exposed to at least one ACE. The researchers also identified a clear dose-response pattern: with every additional ACE reported, the likelihood of chronic health-related school absenteeism rose by roughly 25%, underscoring a cumulative risk effect.
An important dimension of the study involved mediation analysis to explore whether general health status could explain the relationship between ACEs and absenteeism. Findings indicate that poorer overall health accounts for part but not all of the association, implying that while worsened physical health is a significant driver of absenteeism among ACE-exposed children, other factors—likely including psychosocial stressors and social determinants of health—also contribute. This nuanced understanding elevates the discourse around trauma-informed care and integrated health-education strategies.
Two particular adversities stood out for their strong links to chronic absenteeism: witnessing violence and experiencing racial discrimination. Both exposures entail complex biopsychosocial consequences, including heightened stress responses, increased susceptibility to illness, and potential barriers to accessing timely healthcare. The profound impacts of these experiences indicate that interventions must extend beyond clinical treatment to address broader social inequities and systemic issues.
Within the broader context of escalating school absenteeism since the COVID-19 pandemic, which has disrupted educational trajectories worldwide, these findings acquire even greater urgency. Chronic absenteeism is a well-established predictor of negative academic outcomes, social marginalization, and adverse economic circumstances later in life. By illuminating a previously underexplored pathway—early life trauma leading to health-related school absences—this research calls attention to the interconnectedness of childhood adversity, health disparities, and educational inequality.
The authors highlight the critical importance of intersectoral collaboration between pediatric healthcare providers and educators. Health systems are encouraged to incorporate routine ACE screening into clinical settings, particularly pediatric primary care, and to partner with schools to identify at-risk students early in their educational careers. Such collaborative models could facilitate prompt interventions aimed not just at reducing absenteeism but also at improving overall health and well-being.
Innovative approaches might include school-based health programs that offer trauma-informed counseling, chronic disease management, and social support referrals. Integrating these services within educational settings ensures that children who face complex health and psychosocial challenges receive continuous care, potentially preventing further educational disruption. This model would require careful design, funding, and coordination among healthcare providers, school administrators, social workers, and policymakers.
Despite the robustness of the data and analytical techniques, the researchers acknowledge limitations inherent to self-reported survey data, including potential recall bias and inability to establish causal relationships definitively. The team advocates for future investigations utilizing objective school attendance records linked with detailed health data to deepen understanding of mechanistic pathways and validate findings. Longitudinal designs will be particularly valuable for discerning temporal relationships and identifying critical intervention windows.
Leading the study, Dr. Rebecca Tsevat, a pediatrician and internist at UCLA Health, emphasized the clinical and educational implications of their findings. She noted that children with ACE exposure “often show up in the clinic and the classroom with complex challenges” and called for “new models of collaboration between schools and healthcare systems” to support these vulnerable students before absenteeism escalates and deeper health and educational disparities ensue.
The research team comprises experts across medicine, nursing, and public health disciplines, from prestigious institutions including the David Geffen School of Medicine at UCLA, the UCLA School of Nursing and Fielding School of Public Health, and the Children’s Hospital at Montefiore affiliated with Albert Einstein College of Medicine. Their collective expertise strengthens the study’s multidisciplinary perspective and emphasizes the need for integrated solutions.
Funded by the National Clinician Scholars Program at UCLA alongside the UCLA-UCSF ACEs Aware Family Resilience Network, this study sets a critical precedent for aligning health equity initiatives with educational support systems. As policy-makers and practitioners wrestle with post-pandemic educational recovery, addressing health-related absenteeism through the lens of childhood adversity emerges as a promising and necessary strategy.
In sum, this research not only elucidates a vital link between early trauma and school attendance but also frames a roadmap for impactful interventions. By recognizing and mitigating the multifaceted health challenges that ACE-exposed children face, society can take tangible steps toward breaking cycles of disadvantage and building healthier, more equitable futures.
Subject of Research: The impact of adverse childhood experiences (ACEs) on health-related school absenteeism among children ages 6 to 17 based on national survey data.
Article Title: The Association between ACEs and Health-Related School Absenteeism: Results from a National Survey of Youth
News Publication Date: June 7, 2025
Web References:
References:
- Data derived from the 2021–2022 National Health Interview Survey.
- Findings presented by Drs. Tsevat et al. in Academic Pediatrics (Online ahead of print, June 2025).
Keywords:
Adverse Childhood Experiences, ACEs, School Absenteeism, Health-Related Absences, Childhood Trauma, Pediatric Health, Health Disparities, Educational Outcomes, Chronic Absenteeism, Trauma-Informed Care, Pediatric Collaboration, Public Health
