Adverse childhood experiences and anxiety disorders in children and adolescents

Adverse childhood experiences (ACEs) are well established risk factors for anxiety disorders. This review critically examines the evidence linking ACEs and childhood anxiety, the mechanisms underpinning this association, challenges in the conceptualisation and measurement of ACEs, and current public health and clinical approaches, including the potential moderating role of positive childhood experiences (PCEs).

There is clear evidence linking ACEs to anxiety, but much of this literature relies on adult's retrospective reports of childhood adversity. Research involving children is often limited by reliance on caregiver-reports of their child's adversity. Traditional ACE frameworks may not adequately capture contemporary and culturally relevant adversities, including bullying victimisation. Emerging evidence indicates that PCEs can attenuate associations between ACEs and anxiety. For health services, more research is needed so that the screening for ACEs in children can improve outcomes. For children with anxiety, assessing for ACEs informs the support needed for the individual and their family.

Strengthening prevention and early intervention efforts requires improved conceptualisation and measurement of childhood adversity. At a population level, policies that both reduce children's experiences of adversity and promote positive, protective experiences are likely to have the greatest impact on reducing the burden of childhood anxiety.