Just one adverse childhood event can nearly double health-related school absences

A new study led by researchers at UCLA Health finds that children who have experienced adverse childhood experiences (ACEs) are significantly more likely to miss school due to health-related issues. Using national survey data, researchers found that even one ACE increased the odds of chronic absenteeism due to illness, injury, or disability by nearly 2.5 times—raising concerns about how early adversity impacts both health and education. 

Why it matters 

School absenteeism has sharply increased since the COVID-19 pandemic and is a key predictor of poor educational, health, and economic outcomes later in life. This study highlights how early life trauma—such as exposure to violence, neglect, or racism—can disrupt school attendance not just through behavioral or family factors, but directly through worsened health. Recognizing and addressing the health impacts of childhood adversity could be key to improving school attendance and long-term outcomes. 

What the study did 

The research team analyzed data from the 2021–2022 National Health Interview Survey, a large, nationally representative dataset. Parents of over 10,000 children ages 6 to 17 reported on seven categories of ACEs, their child’s health status, and the number of school days missed due to illness, injury, or disability in the past year. Researchers used weighted logistic regression to estimate the relationship between ACEs and absenteeism, adjusting for sociodemographic factors. They also conducted a mediation analysis to test whether poor general health status helped explain this link. 

What they found 

Roughly 1 in 4 children had experienced at least one ACE. Those children were 1.5 times more likely to miss any school due to health reasons and 2.4 times more likely to be chronically absent for health reasons. There was a dose-response relationship: each additional ACE increased the odds of health-related chronic absenteeism by 25%. General health status accounted for part—but not all—of this relationship, suggesting that both physical and social stressors play a role in keeping children out of school. Among individual ACEs, witnessing violence and experiencing racial discrimination were most strongly tied to chronic absenteeism. 

What’s next 

The findings suggest pediatricians and educators should work together to identify students with ACE exposure and intervene early—especially when health-related absences emerge. Health systems might integrate ACE screening with school-based interventions to reduce absenteeism and improve child well-being. Researchers also call for future studies using school attendance records and more detailed health data to better understand causal mechanisms. 

From the experts 

“This study reinforces what pediatricians have long known: that kids exposed to adversity often show up in the clinic and the classroom with complex challenges,” said Dr. Rebecca Tsevat, lead author and a pediatrician and general internist at UCLA Health. “We need new models of collaboration between schools and healthcare systems to support these students before they miss too much school and experience worse health and educational outcomes as a result.” 

About the study 

The Association between ACEs and Health-Related School Absenteeism: Results from a National Survey of Youth. Published June 2025 in Academic Pediatrics. DOI: https://doi.org/10.1016/j.acap.2025.102864. Online ahead of print. 

About the Research Team 

Drs. Rebecca K. Tsevat, Margaret M. Nkansah, Nicholas J. Jackson, Shannon M. Thyne, Bahareh Gordon, and Rebecca N. Dudovitz from the David Geffen School of Medicine at UCLA; Dr. Kristen Choi from UCLA School of Nursing and Fielding School of Public Health; and Dr. Michelle Shankar from the Children’s Hospital at Montefiore, Albert Einstein College of Medicine. 

Funding and Disclosures 

This study was funded by the National Clinician Scholars Program at UCLA and the UCLA-UCSF ACEs Aware Family Resilience Network (UCAAN). The authors report no conflicts of interest.