Adverse childhood experiences and their association with internalizing and externalizing behaviors in adolescents: A scoping review

Adverse childhood experiences (ACE) influence adolescents’ internalizing and externalizing behaviors. However, few reviews have examined these outcomes as distinct domains. This gap is important, as these two behavioral domains involve different developmental pathways and intervention needs. Therefore, this scoping review aimed to map the current empirical evidence linking ACE with internalizing and externalizing behaviors in adolescents, including ACE types, measurement tools, analytical approaches, and emerging findings. A scoping review was conducted to identify and analyze studies examining adverse childhood experiences (ACE) and adolescent behaviors. Literature searches were carried out in four databases: EBSCO, Scopus, PubMed, and ProQuest, for English-language articles published between 2020 and 2025. Search terms included combinations of keywords and Boolean operators: (“Adverse Childhood Experiences” OR “ACE”) AND (“internalizing behaviors” OR “externalizing behaviors” OR “behavioral problems”) AND (“adolescents”). Eligible studies were screened based on the inclusion criteria, and relevant data were extracted and synthesized. A total of eight studies examining ACE types were included, namely maltreatment, neglect, and household dysfunction. The ACE measurement tools used were the ACE Questionnaire, CTQ-SF, or ACE-IQ, while the behavioral measurement tools were SDQ, YSR, CBCL, or DSM-based tools. The reviewed studies used quantitative approaches, including multivariate regression, mediation and moderation analyses, and classification tree models. All studies reported significant associations between ACEs and both internalizing and externalizing behaviors. All studies highlighted emotional and behavioral problems and identified gender differences in response to ACEs: females tended to show internalizing symptoms, while males exhibited more externalizing behaviors. Overall, ACEs significantly impact adolescent behavioral health.

Keywords: Adolescent, adverse childhood experiences, externalizing behaviors, internalizing behaviors