Mapping the Structures of Adverse Childhood Experiences: A Network Analysis and a Sex-Differentiated Structural Framework for Prevention and Intervention.

This study applied network analysis to examine the internal structure of Adverse Childhood Experiences (ACEs) and to develop a network-derived structural framework for prevention and intervention. Using nationally representative data (N = 4,008), we estimated the sex-stratified networks of the 13 ACE domains. Results revealed clustered structures and bridging mechanisms that linked distinct ACE domains. Emotional abuse and witnessing domestic violence consistently emerged as sex-invariant anchors with high centrality and bridging influence. In addition, we identified sex-differentiated cascade pathways, which we term "abuse-driven cascading victimization" in men and "neglect-driven cascading victimization" in women, as well as a shared "psychosocial risk environment" community that reflected common vulnerabilities across sexes. Building on these findings, we developed a structural framework of the ACE model comprising three strata: Public Awareness, Implicit Awareness, and the Social Unconscious, capturing gradients of visibility and clinical detectability. Refined through expert consultation, the model underscores how covert adversities function as gateways to broader ACE networks and clarifies leverage points for screening, targeted prevention, and multisystem coordination. By integrating network metrics with a structural framework, this approach advances beyond cumulative scores or latent class models, and offers an actionable framework for early detection, differentiated intervention, and policy innovation in child maltreatment prevention.