Adverse childhood experiences and autism spectrum disorder: a retrospective cohort study among late adolescents

Objective To examine the association between Adverse Childhood Experiences (ACEs) and Autism Spectrum Disorder (ASD) identification among Israel Defense Forces (IDF) personnel, focusing on predictors of ASD identification during military service.Methods A retrospective cohort study was conducted on 288,633 IDF conscripts evaluated between 2009 and 2021. ASD diagnoses at enlistment and during service were analysed in relation to demographic factors, cognitive scores, and self-reported ACEs. Logistic regression was used to assess predictors of in-service ASD diagnosis.Results At enlistment, 935 individuals (0.33%) had an ASD diagnosis, and 635 were identified during service. Those with ASD were more likely to be male (90.1%), Jewish (97.9%), Israeli-born (91.4%), from higher socioeconomic backgrounds, and to have ≥12 years of education and high IQ scores (31.8% vs. 19.7%, p < .001). Several ACEs, including emotional/verbal abuse, physical abuse, neglect, parental substance use, and incarceration, were significantly associated with ASD identification during service. A cumulative ACE score of ≥2 predicted ASD diagnosis with an odds ratio of 2.27.Conclusions Early-life adversity is associated with increased risk of ASD identification during military service. Integrating ACE screening into enlistment procedures may help identify recruits at risk for later ASD identification and facilitate timely clinical interventions.