Prevalence of Adverse Childhood Experiences and Adverse Health Outcomes Among Primary School Students in Bangkok, Thailand

Abstract

Background: Adverse Childhood Experiences (ACEs) are associated with long-term health risks, including behavioural, physical and mental health issues. However, there is limited data on the prevalence and impact of ACEs among school-age children in Thailand. Objectives: To determine the prevalence of ACEs and their associations with behavioural and health outcomes in primary school Thai children. Methods: A cross-sectional study was conducted from July 2023 to June 2024, involving 399 primary school students aged 6–12 years, selected through stratified random sampling. Data were collected using the Paediatric ACEs and Related Life Events Screener (PEARLS) to measure ACEs, the Thai Youth Checklist (TYC) for behavioural assessments, and a health screening questionnaire for physical and mental health. The relationship between cumulative ACEs and health conditions was analysed. Results: Among the 399 participants (median age: 9.5 years, IQR: 8–11), 48.7% of surveyed children reported experiencing at least one ACE. The most prevalent ACE was caregiver divorce or separation (33%), followed by neglect (9.3%) and domestic violence (8.3%). Children with four or more ACEs had a significantly increased risk of behavioural problems, including internalising problems (adjusted odds ratio [AOR] = 7.57; 95% CI: 2.54–22.64), externalising problems (AOR = 5.52; 95% CI: 1.82–16.79), and total behavioural issues (AOR = 8.65; 95% CI: 2.97–25.24). No significant association was found between ACEs and health conditions. Conclusion: Nearly half of the surveyed Thai primary school children experienced ACEs, and a graded association was found between the number of ACEs and behavioural problems. These findings underscore the need for early, strength-based interventions to reduce long-term risks. Primary prevention strategies should prioritise supporting families before adversity occurs.